Concierge medicine raises many questions

Implications: It is important to look closely at the new niche called Concierge Medicine. It is obviously created out of  a special need and will prove lucrative for physicians who choose to go that route. But there are larger questions of access and ethics of exclusivity/ One has to consider whether this provides better care, better service, or simply convenience.  All who provide and use healthcare ought to be interested in this trend and be prepared to weigh in as more physicians  pursue this model

Analysis: Concierge medicine is known by a variety of names, all indicating its exclusivity- boutique medicine, executive health medicine and even retainer-based medicine.

There is the hassle-factor. Physicians are fed up with the hassles of practicing medicine under the current model. Reimbursement has decreased from public and private payors, paperwork has increased, it's a hassle to file claims, the overall cost of doing business constantly increases. Coupled with these hassles are the fact that as  docs see more patients their social and family life suffer, and they often feel they are not giving good care because of the volume of patients they are forced to see in a typical day. Concierge medicine is tempting because it addresses, in their mind, almost all of these downsides of the current traditional practice. By limiting their patient population and charging a set fee of between $1000 and $20, 000 per year, they can have a nice income with fewer hassles!

Patients like the idea of ready access on short notice to a doctor who spends more time per visit and also helps them to navigate the healthcare system. There are often nice "extras" like physicals, spa-like decors in offices, house calls, networking and the like. For those who can afford it, what's there not to like?

However, there are questions about the ethics of access, equal quality of care and the like. Concierge physicians argue there is nothing wrong with paying extra for better "service". I wonder. Our society is rife with examples of 2 levels of service whether it's a celebrity hiring a high profile attorney while Joe-Blow gets a public defender, or choosing a  an exclusive private school for your child over an urban public school. This raises wider questions of healthcare as a right and the role of "the market" in addressing social and ethical  dilemmas.

Then there are contractual issues. Some like legislators in Washington state suggest concierge physicians should be subject to insurance regulation since they offer a service for a set premium just like insurance companies do. Contractually, patients must be very clear what's covered and what's not. What are the physician's obligations? What if a physician goes out of practice or fails to be available when needed? What if the patient becomes dissatisfied with the physician at some point? What if the patient requires a service outside the physician's scope?

If I were a physician I might well be tempted to go this route, but I would be concerned with maintaining my clinical competency and also my social obligation. But that's a personal construct.

Like everyone else, I watch this trend with interest.