Concierge Medicine: A Moral Issue?
Concierge doctors restrict the number of patients they see, accepting 80-90% fewer patients than their primary care counterparts. Their patients pay an extra $1500 – $2000 annually, over and above their regular health insurance, to become one of their exclusive patients. The number of primary care physicians turning to a concierge practice has become cause for concern. We already face a shortage of primary care physicians; and the Affordable Care Act (ACA) will add 30 million more people into our health care system. It seems wrong, even unethical to some, that doctors would limit their practice to only those who can afford to pay extra for their health care when others must struggle to find adequate primary care. Is this a fair charge?
To begin with, what exactly is a concierge medical practice? In return for an extra fee, concierge doctors commonly offer 24-7 doctor accessibility, same or next day appointments, extensive annual physical exams, personalized wellness and preventive care measures, unhurried office visits, coordination with specialists and more. In sum, by having fewer patients, a concierge doctor can spend more time with the patients they have.
Why are so many doctors adopting this type of practice? Concierge doctors are usually primary care physicians which includes general practitioners and internists. Although they’re the doctors we see the most, they’re the least paid compared to medical specialists and surgeons. A primary care office visit might involve several complicated medical issues and require much of the doctor’s time; but they’re reimbursed by Medicare and many insurance companies on a much lower reimbursement scale.
In order to make ends meet, a primary care physician, paid on the basis of office visits, must see as many patients as possible. In fact, according to a recent Kaiser Family Foundation survey, patients’ face-to-face consultations with doctors last an average of just 10 minutes. More patients mean more paperwork, red-tape, frustration and stress for doctors and staff. It means less time spent helping people. The average primary care doctor sees 25-45 patients a day, with a total patient load of 2500-3000. Compare this with a typical concierge practice of 500. It is no wonder that increasing numbers of doctors see concierge medical care as a way to recover the sense of purpose that led them to be a doctor in the first place.
A concierge practice is not only a haven for over-worked doctors, it is a God-send to patients who need a physician’s focused attention. Patients with chronic conditions such as heart disease and diabetes have other health issues which complicate their treatment, making them ideal candidates for concierge care. Others include people with a family history of life-threatening disease who need to be especially vigilant. People with a complicated medical history need a medical provider willing to sort out their singular health issues. Given circumstances like these, it should be no surprise that concierge patients these days are not necessarily wealthy. They see their access to a dedicated physician as a priority in their lives. That annual fee, for them, takes the place of a large HD TV or frequent dining out, or weekend vacations.
Concierge medical practice is still in its early stages but there are already indications that promises are being fulfilled. Studies show that, despite serving a generally sicker patient population, concierge care results in fewer emergency room visits and acute care hospitalizations compared to standard forms of medical care in the same areas. Concierge practitioners also claim a high early detection rate of serious problems and an aggressive approach to getting to the right treatments/specialists on time.
So, is it fair that people willing and/or able to spend extra money get better medical attention than the rest of us? Is it right for some doctors to limit the number of patients they see when access to primary care givers is becoming more and more difficult?
Asked about this, Med-PAC, a congressional commission tasked with advising lawmakers on health care issues, sees the movement of doctors toward concierge care as a symptom of a much deeper problem. As more people get access to health insurance, the pressure on primary care doctors will become even greater. Over 30 million people will be added to the health care system via the ACA. While the health care reform act provides funding to educate 500 primary care doctors by 2015, it’s 63,000 more physicians that will be needed! It’s no wonder that one commissioner called the movement to concierge medical practice the “canary in the health care coal mine.”
It means you can’t keep adding people to the health care population and expect doctors to somehow handle it. They have other options and leaving medicine altogether is one of them. A recent Mayo Clinic study finds substantial rates of burn-out being experienced by primary care doctors right now. Compared to all other working adults, physicians are more likely to have symptoms of burnout and more likely to be unhappy with work/life balance. What will happen when even more people will be in line for primary care?
It looks like, unless changed, the Affordable Care Act will exacerbate, not fix, our health care problems. We need more doctors seeing less patients.