This photo from a previous post represents to traditional ideal of medicine. But is Concierge Medicine the way to restore that ideal.
By Paul V. DeMarco
Guest Columnist
Almost all people of a certain age who are concerned about their health wants a primary care provider. I have been privileged to be that person for a small but well-loved group of people for the past 30-plus years. Over the past two decades, a new way of providing primary care has emerged which is often called concierge medicine (CM).
A common concierge medicine arrangement is for a patient to pay a monthly subscription fee. Rates vary, but in the Pee Dee you would expect to pay about $2000/year. In addition, the patient (or his insurance) may have to pay for individual visits above what the subscription allows. The per-member, per-month revenue allows physicians to see fewer patients while generating the same (or higher) revenue. Proponents of CM point to this as a primary motivating factor, which I fully understand. Physicians who practice primary care invest years and hundreds of thousands of dollars training with the goal of developing long-term relationships with patients. But when they begin practice, they often work for hospitals or companies that overload them with patients, not to mention all the documentation and communication a busy practice entails. CM allows physicians to do more of what they trained to do and love to do, spend time with patients in an unhurried way.
Concierge medicine provides a setting in which relationships have time to develop and deepen. Many non-CM physicians, including myself, who work in a typical office practice have their patients’ appointments scheduled 15 minutes apart. That is often not enough time, and part of the reason patients’ waits are so long in practices like mine.
Another positive aspect of CM is the return of the house call. Many CM physicians will visit with patients at home and also still make hospital rounds. I think the renaissance of the house call is a marvelous development. Visiting a patient at home is an intimate enterprise and feels completely different from meeting with a patient surrounded by the generic four windowless walls of an exam room. Patients are often more relaxed, family is more often involved, and occasionally food is offered. Many patients see the house call as a gift and feel a special gratitude. Doctors who visit homes always come away with a deeper understanding of the person for whom they are caring.
As you can tell, I appreciate the CM model. It’s the way primary care should be practiced. I understand the reasons why CM physicians are drawn to it. I personally know some truly excellent concierge physicians.
However, CM is ethically untenable. From Hippocrates onward, the obligation of physicians to provide care to any patient in need, regardless of their ability to pay, has been central. It’s an easy obligation to forget, given the gigantic profits hospital, pharmaceutical, and insurance companies make in our system. But when one becomes a physician, he or she is bound by a moral duty.
Put another way, I have never heard a physician of any kind publicly remark, “I just want to see affluent patients.” Nor have I ever read a medical school application essay with that statement. Our commitment to all patients, not just a select few, is part of physicians’ social contract.
I am not suggesting physicians are required to treat everyone for free. Physicians’ offices have high overhead. It usually takes many support staff-receptionists, medical assistants, nurses, administrators, business managers, etc., to run a successful practice. What I do say is that physicians abrogate a core responsibility of medicine if their business model excludes people below a certain income. Despite what is right and attractive about CM, I think in final analysis it represents a destructive trend in primary care, and ultimately an abandonment of the patients who need us the most.
Therein lies the paradox. In order to practice in a fulfilling way, one that rewards physicians emotionally and financially and satisfies patients, our current medical system incentivizes many physicians to abandon a fundamental tenet of patient care.
There are better solutions. I will mention one in passing and then expand on it and some others in my next column. There is an organization that already exists to provide excellent primary care to all patients – the Community Health Center (CHC). There are approximately 1,400 CHCs in the US that serve more than 30 million patients, almost 9 percent of the population. Full disclosure, I work for one. My CHC, HopeHealth, has more than a dozen offices spread across Florence, Clarendon and Williamsburg counties. If you think CHCs are just safety net clinics for those who have no other option, stay tuned.
A version of this column appeared in the December 17th edition of the Post and Courier-Pee Dee. Dr. DeMarco’s opinions are his own and do not necessarily represent those of HopeHealth.
Related Posts
