“The doctor can see you immediately.” When’s the last time you heard that? The shortage of physicians in the US means that you’ll probably have to wait about 18 days for an appointment.
By the time you do get in, you can expect a quick visit (13 to 16 minutes, if you’re lucky) from a physician who will probably interrupt you within the first 18 seconds that you speak. It’s true that some doctors do buck these averages, but the overwhelming majority of patients don’t get a lot of hand-holding—let alone a cell-phone number for emergencies.
Recent development: Even though the rich and famous have always had personal physicians who go the extra mile, “regular” people are now able to get some of the same attention—at a fraction of the cost that’s traditionally been charged by so-called concierge physicians.
What you need to know about the world of concierge medicine today…
Starting in the 1990s, some physicians (mostly primary care doctors) began offering concierge services—also known as “boutique medicine”—to affluent patients. In exchange for an annual fee, they provided same-day appointments…lengthy office visits (about 40 minutes)…e-mail availability…24/7 phone/text access—and even home visits.
But the personal touch didn’t come cheap. Some red-carpet practices charged patients $25,000 a year…on top of the usual fees for lab tests, procedures and hospitalization. Patients who ponied up still had to pay for insurance for emergencies and care from specialists.
In the last few years, doctors have begun offering similar services for far less money. Some offer concierge care for as little as a few hundred dollars a year—the national annual average is roughly $1,000 to $2,000. The cost for such services has been reduced due to increasing demand and by changing the scope of services—for example, VIP perks such as limo rides to the office are not offered.
Doctors in these practices accept fewer patients, so they can spend more time with them, and mainly offer basic care, such as physicals and checkups. These services may be covered by insurance, but patients must file their own claims. Other services (such as wellness counseling, which involves discussing issues including nutrition, exercise and stress reduction) may not be covered by standard insurance plans and usually require an extra fee.
Five years ago, there were about 1,000 concierge practices nationwide. There are more than 5,000 now, but they still represent a tiny percentage of medical practices in the US.
Some such practices are run by altruistic primary care physicians who offer lower rates to low-income patients. But most concierge medicine targets patients who have the means to pay for convenience and extra attention.
What do you get for your money? A Tufts University study found that patients in these practices got better service overall (such as faster appointments, less wait time in the office and more personal attention). But there’s no evidence yet that these patients are any healthier than those who get their care from traditional practices…or that they have better health outcomes from medical treatments, surgical procedures, etc.
A provision in the Affordable Care Act (ACA) allows a form of concierge services known as “direct primary care” (doctors who largely avoid the insurance system and charge patients a flat monthly or yearly fee, with some charging additional fees for services such as preventive checkups or care for chronic conditions) to meet the required guidelines for ACA-compliant insurance. Patients are still required to have an insurance policy for emergencies and specialists.
There are obvious advantages for doctors. Because they can avoid (or at least limit) their involvement with insurance companies, they can spend less time on record-keeping and filing claims and more time with patients. Many limit the number of patients that they treat to about 800, down from the 2,500 that are common in primary care practices.
Even with the reduced number of patients, the cumulative fees can be lucrative—particularly when they’re paid by healthy patients who might not see the doctor more than once or twice a year.
How it can help patients: A concierge practice can make economic sense for some patients, too. Suppose that you have a high-deductible ($1,300 or more per year) insurance plan. If your health care mainly consists of routine checkups and dealing with the occasional (and minor) health problem, you’re unlikely to meet the deductible and will be paying for everything out of pocket. You might do better with an annual concierge fee that covers all the services that you’re likely to need.*
But you’ll still need insurance. The monthly/annual concierge dues are for primary care only—you (or your insurance) will pay extra for visits with specialists, procedures (such as colonoscopy) and many lab tests. These will come on top of the concierge fees. Some direct-care practices have special rates for Medicare patients.
Concierge practices give people more face time with their doctors. That’s why a concierge practice can make a difference for those with complex medical problems or conditions (such as mental-health issues) that are difficult to address in a rushed medical practice.
On the other hand, a traditional medical practice—and the insurance coverage that’s mandated by the ACA—will cover the essentials. Patients still get the necessary exams and tests, including colonoscopies, immunizations, etc. The quality of care is usually at least as good as what can be found anywhere else.
Bottom line: Unless you want to be treated like a VIP and/or have a high deductible, it’s probably smarter to find a good doctor in a traditional practice than spend extra money on a concierge practice.
*If you are interested in finding a concierge doctor, consult the American Academy of Private Physicians, AAPP.org, which allows you to search doctors by location.
