Primary Care Doctors. Concierge Medicine. US Health Insurance

The BBQ Pit
1

Something like 10 grand a year in medical expenses here (that includes insurance, and our out of pocket with a high-deductible plan). The employer probably pays an additional 10 grand a year.

And now, the the second time in three years, we’re being offered the opportunity to shell out something like 1,800 dollars apiece in addition. For a family of 3 adults, it’s over 5,000 dollars a year.

This 5,000 gets us a sum total of NOTHING except that it means we get the privilege of being seen by the doctor, for which we must pay just as if we hadn’t already shelled out another five grand.

OK, in theory we have better ACCESS to the doctor. The doctor now has only a thousand patients on his caseload and you can call him on his cell phone and even sometimes have house calls (supposedly).

So our medical expenses would go up 50% just to improve the doctor’s life (and income).

I have zero problem with a doctor making a decent living. Our system here is so screwed up that the primary care doctor, who should be the most cost-efficient way of delivering routine medical care, is getting squeezed out of the marketplace unless s/he gouges the patients like this.

But who in hell has a spare 1,800 dollars per person, per year???

Fuck that. Time to find another primary care doctor.

Can’t even use flex spending to pay for it. Well we could (for some at least) but then that leaves nothing to pay for, yanno, the doctor’s copays, medicines, etc.

2

Oh yeah. Concierge medicine. I’ll be interested to see if that is sustainable for the long term for the docs who’ve decided to try this. (Although, when I’ve had bronchitis and just don’t even want to put on outside clothing, the idea of house calls is really tempting.)

I believe that these docs can’t bill certain insurance plans directly, so there’s that as well. People could be paying whatever the doctor says and only getting partial reimbursement from their insurance. Bah, humbug!

I rarely see my PCP anyway – mine seems to exist solely to refer anything more complicated than a transient case of the sniffles to a specialist. Fuck that; if that’s the deal, I can go right to my allergist for the sinus infection.

Sorry you have to find a new one. That’s a pain in the arse.

3

So, if you want to actually see your doctor under current circumstances, without paying the five grand, how long do you have to wait for an appointment? And if you get to see him, is he any good? It sometimes seems, in the United States, that a PCP is more of a concept than an actually existing person.

4

It’d almost be cheaper for you to go to medical school Mama. Hope this all works out for you.

5

I had one doctor, a pulmonologist, go concierge on me. Fuck that, health care is already too expensive.

6

I’m starting to think that going concierge is the MD equivalent of becoming a Tea Party member. “I don’t need the gubbmint! I can do it all myself!”

7

When I first saw him, I got an appointment for less than a week away. By contrast, the other doctor I met with about then (this was when the prior doc was going concierge and I was shopping), I couldn’t get in to see for a month or more.

The one time I had an emergency (asthma flareup), they fit me in the same day. I would have been fine with seeing someone else in the same practice (two brothers practice together and they also have a nurse practitioner) - in fact that’s a key for whatever practice we go to: emergencies aren’t common but when they DO happen, being able to fit a patient in can prevent something escalating into an ER visit.

They seem OK - they were recommended by both my former doc and my gynecologist.

Sigh. I was hoping these guys wouldn’t make the leap. They’re younger than I am so I wouldn’t have had to worry about changing doctors for quite a while. They seem OK with the fact that I’m proactive about learning about my own health (some doctors get VERY snotty about it). Their office is convenient to us (10 minutes away).

8

And that’s exactly what some of the current healthcare cost reduction strategies are emphasizing. So I don’t know why it’s not more common in physicians offices!

Good luck on finding another pulmonologist nearby.

9

The only concierge medicine MD practitioner I know sure ain’t Tea Party! He came back from a year in New Zealand and set up this sort of practice. I hear they do make house calls. He’s a smart man- there must be something to it.

Our group practice clinic site will have anywhere from 5 (really low) to 30+ available appointments at the beginning of each day- the joys of so many providers ;).

The argument against concierge medicine is that it is self selecting, at least here- wealthier, for one, and I pit elitism.

10

Actually the pulmonologist isn’t the problem :slight_smile: I do have one, went through a full workup there about 18 months ago due to what appeared to be worsening asthma symptoms.

As far as I know, specialists around here do NOT do concierge medicine. They tend to be less overbooked (though for one of mine, you do need to book a couple months in advance). It’s the primary care doctors - the ones who are supposed to have a better view of the whole patient - that are taking this route.

11

I’d just found a GP I liked when they decided to go concierge on me. Basically, I got a letter telling me I’d have to pony up $1000, up front, each year if I wanted to continue getting service at that partnership. No new services or rewards for that money, merely the right to stay a patient there. It wasn’t even ‘real’ doctors, it was a team of physician assistants doing the work there.

I liked them. They were nicer and spent more time with me. I’d be glad to pay them more than other doctors if they did something noticably different. But a thousands dollars a year for a vague promise to be better than other practices is a lot of cash for nothing.

12

I have friends that have gone concierge. Frequently it is older doctors who have older wealthier patients. These doctors have all the money they are ever going to need and do not like modern day primary care practice where you see a patient every 15 minutes and go home with less money than you used to. For the ones I know the alternative to concierge is retirement.

13

There are a bunch of strange contradictions here.

They have all the money they need, so they now charge their wealthier patients even more, and screw the ones who won’t pay the concierge fees? If they have all the money they ever need, they could, if they wanted, avoid the “modern day primary care practice” and simply schedule fewer patients based on the need of the patients. And if they’re truly interested in bucking the trend in “modern day primary care practice,” a good place to start might be practicing medicine based on the need of the patients rather than who has the most money.

They don’t have to do any of this, of course. They are free to do business as they see fit. Your explanation, though, seems like a rather cheap rationalization for “Give me more money.”