Concierge Care

I've been seeing a concierge practice doctor for several years now since he and his partner decided after the departure of two of their colleagues to form their own high-priced retainer service to opt for a middle-class one. I pay several hundred dollars a year for unlimited care from my doctor. This has been invaluable to me, although more useful when I was coordinating my cancer care in 1998 than in recent years. Until Ben's first cold several months ago, I had avoided any cold or flu that was more than a passing runny nose for two years. Now I've had several colds via Ben, and I don't blame him a bit.

Concierge medicine involves a doctor assuming only the risk to provide their service to a patient and the services of their office. This has caused Washington State's insurance commissioner to investigate the practice as he believes it might fall under the provision of an insurance company. I don't believe risk is really involved because the doctor is pledging his or her own services. My doctor's practice puts fees in escrow until after each month in which service is provided, thus limiting a patient's actual dollar exposure to $0.00 for any given month.

The New York Times is picking up on this trend quite late. The Wall Street Journal wrote about my and other doctors back in 1998, and I was quoted in the article. I have the same reaction as many of the folks on both sides of the concierge debate in this Times article: I love the access I have and I know my doctor enjoys his practice more. And I know that he is able to better keep up on developments in treatment and have his own life. Nobody said that being a good doctor should involve 80-hour or 100-hour weeks for your entire career.

The "lavish care" in the headline doesn't apply to most retainer-based doctors. Lavish means getting the doctor on the phone when you call, getting in the same or next day for an appointment, and spending 15 to 30 minutes with a doctor when you're there. Lavish. Right.

On the other side is the fact that the more doctors that retreat into retainer-based services, the fewer doctors available for general medicine. Retainer-based doctors have fewer patients in their practices. Because I can afford his fees, it means I get better health care than others who have to see whomever.

Of course, my reaction is that Medicare and other social support systems for healthcare should organize to build networks of retainer-based clinics that would allow patients to avoid expensive emergency room visits and save everyone in the system money. For fairly small fees, people with little or no money could be subsidized into better health care. Right now, hospitals eat huge bills (or pursue people with no money like they're the Erinyes) or people face financial ruin.

There is a lot of evidence that the lower you are on the income totem pole in the US, the worse you sleep and the worse your health. Because you make less money, the less you are able to improve your health through routine care and medication that might cost a fraction of emergency-room visits or late-in-the-process care. There's that telling scene in As Good As It Gets when Helen Hunt's son who has some kind of asthma-like disease is finally seen by a regular private-practice doctor paid for by Jack Nicholson: the doctor says, this is pretty easily treated as long as we're on top of it. This is not Hollywood magic.