Concierge or boutique medicine is growing as busy people of means look for a way to bypass the red tape, waiting times, and inconveniences that may accompany a visit to the doctor.  On the physicians' side, doctors, including primary care physicians have joined concierge groups to avoid the long hours, incessant forms and high overhead of an overworked, understaffed practice.

Basically, concierge medicine is generally a small practice of physicians who limit the number of patients they see for an additional fee or "membership" that the client pays. In return for this fee (usually $1000-2000 per year over actual treatment fees), the patient gets return phone calls and same day appointments, in most cases. The doctors get to see fewer patients but are able to provide more customized care and be able to navigate their patients more efficiently to any needed hospital care or specialists.

So what about the good, the bad and the ugly?

The good (on the patient side)  includes more personalized care and as a result, more timely preventive care, when most diseases are caught early and interventions can prevent more serious problems.    Most people work hard because it enables them to lead a better life.   People work to send their kids to better schools, take more vacations, and have a better house.   Why shouldn't an executive be able to see a doctor at his or her convenience!   This is the American dream, right?   We all want the best for our loved ones.

The good (on the doctor's side) includes a less stressful workplace, more time to really spend with a patient, and more time to have a personal life.   They may see this as a better way to get to know their patients and provide better care, without the time limits of an overbooked waiting room.  Because there are less patients, the paper work including insurance forms get processed quickly---no insurance delays here!

For the individual patient and doctor, it looks like a pretty good deal.   But what impact will this have on the middle and lower economic classes that can't afford these 'boutiques' let alone health insurance.  This is where the bad and the ugly come in.

As more primary care providers join concierge practices, less physicians are available to provide general medicine to the masses.  This causes a larger workload for the physicians who are left in the mainstream.    This could lead to lower quality care because visits will be shortened and patients will be referred to see more physician extenders like physician assistants, nurse practitioners, etc.   Not that there is anything wrong with these compassionate and dedicated caregivers who can handle the majority of stomach aches and ear infections (and sometimes are preferred to a busy doctor).  But what about the prediabetic, the child with funny looking blood cells.  Sure, the PA or NP can refer any unusual symptoms to the doctor on duty (if they can catch them between appointments!).  But this only adds to the time needed to get a problem diagnosed and treated. The result could be less healthy patients who often miss the advantage of preventive care.

At the end of the day, this really becomes a social justice and ethical issue.    We have a broken health care system that is forcing some to run away---if they have the money and opportunity.   The others who don't have the resources simply deal with it.   We need some kind of fair and equitable way to ensure that all people have access to basic health care that includes less costly preventive care.   If we keep filtering off resources (e.g. primary physicians) to help those with money, there is little left to ensure the others have basic care.  In the end, we all pay when we miss the opportunity to practice preventative medicine and a patient ends up in an expensive emergency room because their acid reflux wasn't treated and they now have a bleeding ulcer!

 

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Comments

Thanks for your view on this topic. I have not heard of boutique clinics in my state of Mississippi but then again I was not aware they existed. I can definitely see the advantages and disadvantages. It is frustrating to get to your appointment on time then have to wait for hours just to see your primary care physician. On the other hand I don't know if I could afford the added expense of a boutique price tag!

This is a very interesting trend; I think it's a smart way for physicians to provide benefits for themselves (less patients,more comfortable environment, possibly more money)and patients (low wait time,comfortable environment, doctor focus).

While I agree with most of what this article has to say, it poses a hypothesis that doctors who go into Concierge Medicine will no longer be available to mainstream patients. This assumes that the only choice of primary care physicians is to accept the status quo or move into Concierge Medicine. The fact is that many more disgruntled physicians have chosen to leave the profession than adopt this new health care delivery model. If alternative delivery models can provide incentives for physicians to stay, then even if they take care of fewer patients, we are still ahead in terms of overall supply. One other item of note: even the most optimistic models put physician participation in Concierge Medicine at .05%. Movement to Concierge Medicine has a trivial impact on physician supply when compared with other factors constraining supply. Neither of these observations negate the fact that our system of delivery is badly broken and is in need of radical process change. Perhaps, we can learn lessons, both in process and ethics from Concierge Medicine that will bring about those improvements. For myself, I believe that until we can apply technology to health care delivery much as we have with shopping, banking, travel, and home entertainment, we will not achieve real radical change. For an example, take a look at www.guardian247.com

I agree with the a lot of what the article has to say, but like Jonathan Harding, I think it will no longer be available to mainstream patients.

I believe if more people are exposed to the cost value of concierge medical care, it will make big difference in what they spend. I recently read a story in The New York Times that supports this belief. The paper reports that the state of Indiana has a high-deductible plan and another that's a traditional HMO. People in the high-deductible plan spend thousands less than those in the HMO. "The average expense in 2009 for patients on one of these [high-deductible] plans was $6,393," the paper writes, "compared with $8,570 for patients enrolled in a more traditional health maintenance organization plan." It’s also a little known fact that nearly 60% of concierge medical programs across the U.S. cost an individual less than $135 per month. (Source: ConciergeMedicineToday.com, December 2010). Some programs cost as little as $10 per month for children. A practice in Wichita, KS offers flat monthly fees ranging from $10 per month for kids and $50 ,$75 or even $100 per month for adults based upon age. Members of that concierge medical practice receive unlimited access to the doctor at their home, work or the doctor’s office along with unlimited "technology visits" like cell phone, web cam, email and texting. Furthermore, many concierge physicians offer access to wholesale pricing on prescriptions, lab tests, imaging services and medical supplies for pennies on the dollar. I recently submitted data stating that: ‘Utilizing a blended rate based upon national averages for current fees charged for concierge medical care, an estimated 9,285,714,286 people could be provided concierge medical care with the 13 trillion dollar debt. Carrying this out 928,571,429 people could be provided this care for 10 years. These figures are based upon information obtained through average pricing surveys conducted from 2009-2010 by The Concierge Medicine Research Collective.’ Here's the upshot: When you combine high-deductible health plan policies with a concierge medical program, you empower people and families to make better decisions about their health care, they in turn receive more comprehensive medical care and then the savings happen and stronger relationships occur between the physician and their patients. One California concierge physician recently made the statement that truly encompasses this fact when she says her patients can say ‘I no longer have a doctor who needs to look at my chart to know my name.’ For more news and information about concierge medicine, I would suggest you go to: www.ConciergeMedicineToday.com, www.AskTheCollective.org - which is the research organization asking some important questions about the concierge medicine marketplace. For those physicians wondering if this model is right for their practice, there is a great resource called Concierge Medicine 101 - it even has a self-test you can take online for FREE. Go to: www.ConciergeMedicine101.com.

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I share your views on how Concierge Medicine will affect those who will not be able to afford it. While it's true that nurses and other physician extenders are there to help, nothing beats the expert advice of an expert. I hope that there will still be a lot of doctor who will be left behind in the mainstream or better yet, doctors who are into "boutique medicine" practice would set aside even a day each week to render service to the general public. After all, isn't it part of the Hippocratic Oath that they serve the humanity without prejudice to station in life and race?

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