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    Wednesday, March 15, 2006

    One-Born-Every-Minute-Medicine: The "boutique medicine," or "concierge medicine" movement is about six years old now, and still going strong:

    The Boca Raton-based health-care company started the trend in 2001 with one doctor, and has now grown to 104 physicians and 32,000 patients in 17 states. Like in Palm Beach County, where MDVIP has 25 affiliated doctors, the company's physicians tend to cluster in wealthier cities, including Beverly Hills, Calif., Southampton, N.Y., and Scottsdale, Ariz. About one-third of all concierge doctors nationwide are MDVIP affiliates.

    As much as I hate to side with insurance companies, the Blue Cross/Blue Shield executive in the article - it's not about the patient, it's about doctors making more money - lots more money:

    Of the $1,500 annual fee that patients pay to join an MDVIP doctor, $1,000 goes to the doctor and $500 goes to the company, which handles all the administrative functions of the concierge practice such as marketing, putting patient records in electronic form and sending patients a newsletter specific to their health needs.

    The access fee does not include the cost of medical care.

    A doctor who has 600 patients, then, gets $600,000 - without ever seeing anyone - and they get the money from the visits, too. Not bad. But what does the patient get?

    On a recent Friday morning, his waiting room was nearly empty. But that's typical for an MDVIP doctor, who sees only eight to 10 patients a day, compared with 25 a day for a typical primary care doctor.

    "I thought there was a better way to provide preventive care," said Watren, adding that he had little time with patients in his traditional practice. Before he opened a concierge practice, he said patients usually sat an hour or more in the waiting area.

    Now, he promises same-day or next-day appointments, and patients can reach the doctor by phone whenever they need him.

    AcceptExcept for access to my home phone number, my patients get the same thing, even though I see 25 patients a day and don't charge them an "access fee." I've found that seeing fewer patients does not necessarily translate into longer or better visits, either. Treating an ear infection or a sore throat only takes a certain amount of time. Ditto with a physical or other health maintenance exam. Boutique doctors have just found a way to make good money with less work. But what they're selling is mostly illusion.

    P.S. Is it not just too rich that Tommy Thompson is now working for a boutique medicine corporation?

    posted by Sydney on 3/15/2006 07:56:00 PM 10 comments


    I use a concierge doctor--and I think your post illustrates an interesting type of arrogance and stupidity typical to doctors--that somehow the practice of medicine is not simply a service industry.

    I pay my extra $3000 per annum not because I will necessarily get better outcomes with my doctor, but that I will get better service. If my kid has a bad fever at 3 am and is vomitting badly, I don't have to call an answering service and then be told to go to the emergency room. I call--and I meet my doctor at his office. That's what I expect from all people in my employ: my maid, my garderner, my accountants and lawyers and financial advisors.

    Plus, it's that sort of demanding consumers that LEAD to BETTER QUALITY.

    By Anonymous Anonymous, at 3:05 PM  

    I think you mean "Except .... "

    By Anonymous Anonymous, at 6:28 PM  

    Yes, I did mean "except". Thanks.

    By Blogger sydney, at 6:42 PM  

    If you can afford to shop at Neiman Marcus and go to a concierge doctor, more power to you. Most people in this country shop at Wal-Mart. A few enterprising primary care physicians seem to have learned from plastic surgeons and dentists how to cater to the upper class and command premium fees. A few will succeed in selected markets. Most of us will continue to practice Wal-Mart medicine. There's nothing wrong with it. At Wal-Mart, you get a decent product for a good price. Let's just be realistic about the whole thing. Don't expect doctors to deliver Lexus medicine for Kia fees.

    By Anonymous Anonymous, at 7:32 PM  

    I don't have much of a problem with doctors earning more by switching practice styles. Truth to tell, I'm probably more envious than anything. I have a problem with them being coy about why they're doing it. None of the doctors quoted in articles about boutique medicine say that they're changing for the money; nearly all of them mention, in passing, that yeah, the money's better, too - but, they hasten to add, that's not the reason. Its *possible* that the money really is secondary. Its also possible that lobbyist donations don't affect political decisions. I wouldn't bank on either.

    Some of this would happen anyway,because there will always be people willing to pay more to get what they perceive as better service. Most of it is likely due to the way we deliver the medical product, and the dichotomy between medicine as a service and medicine as a product. The first is noble; the second makes money. Speaking for my own experience, I'd pay more for a doctor I could rely on, even though I'd still flinch when I saw her Ferrari.

    By Blogger bill, at 1:08 PM  

    I agree with you that MDVIP is a scam. The “access” fee that they are charging while billing medicare is truly having your cake and eating it too. There is an ethical way to be a concierge doctor, however. My husband is already not a provider in any HMO or PPO and will not enroll patients older than 65 until he is no longer a medicare provider. That way, medicare will not pay him a dime and the annual fee will cover all of the patient’s medical care. If you are concerned about access and the number of med school graduates who choose primary care, nothing will draw more students to primary care than demonstrating that they can make a decent living not having to see 25 patients a day. Criticizing the most successful in your group is no way to attract more people.

    By Anonymous Janet Fuchs, at 10:52 PM  

    Patients who go to concierg practices are not uniformly wealthy. They and their families do what we all do: we buy our goods from the source we feel best addresses our needs. We may buy the kids' clothes at WalMart, a specialty kitchen item at Williams -Sonoma, and a present for our best friend's 50th birthday at an upscale boutique. The point is we all make choices about how we spend our money, what we want to have and what we expect get in return. If patients are signing up for concierge practices, it is because either they can't find what they need or want in the fee-less health care system.

    I think the much bigger issue is how we physicians have let our practices be completely dictated by reimbursement. If it weren't for declinig insurance payments there would be no need to have the average doctor see 25-30 patients. The reality is that overhead (including those expensive coders) puts the doctor behind the 8 ball almost immediately.Instead of denigrating doctors for choosing to free themselves from assembly-line medicine, we should be trying to figure out how expand the idea so that everyone gets to have the time they need to have with their doctor. We'd see fewer disgruntled patients and possibly have fewer lawsuits. And the future of primary care would not look so bleak to those of us practicing now and to those who might consider following us in the future.

    By Anonymous Anonymous, at 11:54 PM  

    This is probably one of the most brilliant ideas out there. Although people will end up paying more, they of course get better service. Yes, most of the patients are somewhat wealthy, but it depends on your priorities. I go to an MDVIP doctor and I do not make a whole lot of money. I just want better service. I do not believe that MDVIP is a scam or else I would not be paying $1,500 per year. Janet, I believe you are just angry that your husband does not have the opportunity to become an MDVIP doctor. Do not go off criticizing other people because they want to be able to give better service and make some more money.

    By Anonymous Anonymous, at 11:05 AM  

    I’m sorry, I wasn’t criticizing MDVIP doctors as much as the idea that they both charge an extra fee and then bill medicare and PPOs. So far, that isn’t against medicare regulations, but I think it soon will be. I’m not, however, suffering from a case of “sour grapes;” any doctor can join MDVIP if they want to, certainly anyone as busy as my husband was. He just decided to do it himself and keep everything totally free from medicare intervention (not to mention that he doesn’t have to pay 1/3 of his retainer fees to a franchise).


    By Anonymous Anonymous, at 7:39 PM  

    I'm curious if any of you would see a Nurse Practitioner, particularly one with a clinical doctorate as a concierge medicine provider.

    By Anonymous Anonymous, at 4:13 PM  

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