What is Concierge Medicine

One medical trend that’s been gaining momentum over the past five years is the concept of concierge medicine.

It’s a practice that goes by various names—boutique medicine, retainer-fee practice, direct care, and membership medicine. Basically, it’s a system where patients pay an added fee in exchange for more personalized care and better access to their doctors. Doctors carry less of a patient load in return.

The concept of concierge medicine began in 1996, when a Seattle doctor decided to ask his patients to pay a flat fee—or retainer—in exchange for what he called “highly attentive medicine.” This allowed him to not have to rely on fees-for-service that were regulated by insurance companies.

The momentum grew and today such practices exist around the country. Do a quick Internet search and a handful of doctors who practice concierge medicine show up in Hampton Roads.

With a traditional office practice, a doctor tries to manage some 2,000 patients on an average of about one patient every 10-15 minutes. Insurance reimbursements are such that doctors have to see a high number of patients in order to make ends meet. Personalized attention can sometimes seem like it’s lacking when a doctor is rushed.

A concierge practice, in comparison, will keep its patient rolls to fewer than 500 patients. Doctors say they can spend more time with patients and focus more on preventative health care. In addition, a concierge practice will offer specialized services like guaranteed same-day visits, 24-hour access to the doctor, low waiting room times, and sometimes even house calls.

Getting this direct care comes with a cost, though. Retainer fees, which are charged over and above what’s covered by health insurance, can run from a few hundred dollars a year to tens of thousands a year.

From a doctor’s standpoint, concierge medicine seems like a good business model: See fewer patients and be able to offer them excellent care for the same amount of money. From a patient’s standpoint, however, if your doctor switches to a concierge practice and you can’t afford the retainer fee, then you’re faced with having to find a new doctor.

But some critics also argue that concierge medicine creates a two-tiered health system, for the haves and the can’t-afford-its. Meanwhile, there’s a nationwide primary care physician shortage.

Today, only 30 percent of all physicians in the United States practice primary care. Fifty years ago, that number was 70 percent (although there’s always been a shortage in rural- and urban-poor areas). Newly minted physicians are increasingly coming out of medical school and going into specialty care. And older primary care doctors are retiring.

It’s not an easy fix. Partly, you can’t make it easier to become a doctor. It’s already hard enough and expensive going through medical school. Graduates are looking for more exciting jobs that bring better money and less stress. But the worry exists that the concierge medicine theory will actually exacerbate the primary care physician shortfall.

If there are fewer primary care doctors, and increasingly more who require retainers, how does that affect families already under economic pressure? Will it make health care too exclusionary? Concierge doctors might be more selective with the insurance carriers they choose work with. And they probably don’t accept Medicaid.

Insurance companies don’t pay for concierge services at this time—the retainer fee is paid out-of-pocket. But it’s not hard to imagine why insurance companies would like the idea—concierge physicians report less payout, fewer hospital admissions, and improved care to prevent chronic conditions, like hypertension, high cholesterol and diabetes, which are costly to treat. Insurance would be used for outside lab tests, X-rays, visits to specialists and hospitalizations.

So what’s right for you? Those who use concierge doctors say they’re happy with their choice, so it comes down to whether you’re willing to spend more on health care for that extra attention.