Concierge Medicine is Medicine's Magic Bullet

Editor’s Note: For 16 years, I've published weekly essays here on Blogspot, which will continue. I’ve now begun publishing my work on a new blogging platform, Substack, and I hope you’ll join me there. Please enter your email address at this link to receive my posts directly to your inbox.

A good friend of mine has contracted with a concierge medical practice. Concierge medicine is also referred to as 'boutique practices' for reasons I will explain below. This is certainly not a new practice model for medical care.  Concierge providers came onto the scene decades ago.  These patients pay a cash fee to the concierge practices, which can be several thousand dollars annually.  This is in addition to the patients’ existing costs for their conventional medical insurance.  In return, these patients get supreme VIP medical care.   For instance, they may enjoy same-day or next-day access for appointments.  The office visits are lengthy and relaxed. And with more time available, physicians can address wellness, nutrition, and preventive medicine more fully. Patients may be given the physician’s personal cell phone number.  The concierge doctor may also accompany the patient on appointments with other medical specialists.  House calls are also possible.   It sounds like medical care for the rich and famous, but some concierge practices will have lower price points that are within reach of more Americans.

Concierge physicians enjoy this experience where they can practice medicine in an idealized manner. They no longer have to pack their schedules which has led to unhappy and frustrated patients and physician burnout.  Physicians can earn the same living seeing a fraction of the patient load they formerly carried..

In a perfect world, all of us would be receiving concierge care.  Note to readers - the world is imperfect.

I think the biggest driver of this model is the lack of access that patients have with their own doctors or selecting a new one.  Indeed, I have opined on many occasions that I feel this is patients’ #1 gripe with the profession - they can’t get in to see their doctors.  In my institution, patients may be told that the next office visit with their primary care physicians may be 6 months or more away.  Of course, this is insane and the concierge market has emerged to remedy this failing.   (I’m not blaming doctors for this issue. The reasons explaining lack of access are complex and systemic.  But it’s still an unacceptable reality.)  How would folks react if repairmen,  attorneys, landscapers, airlines, politicians, plumbers or law enforcement - to name a few - responded to our calls with a message that they will get back to us in 6 months or so? (Hint:  Not well!)

No timers or clocks present in a concierge practice appointment!

I don’t think that concierge care is unethical.  It’s better medical care for those willing and able to pay for it.  Ideally, I wish all of us had access to this, but this is neither possible nor how our society operates.  We offer several tiers of quality to all manner of goods and services in the marketplace.  Do you think, perhaps, a wealthy person drives a better car or has access to better legal advice?

Those who rely on conventional medical insurance, as I do, can only dream of receiving concierge level care. I had to wait months for an appointment with my own PCP.   

Why hasn’t the medical profession solved the access problem? Is it truly insoluble?  I don’t think so.  Patients, similar to beleaguered airline industry customers, simply have no recourse.  Where else can they turn?  Concierge medicine, for those who can afford it, is an escape route from the chaos.