These days, it’s not easy to find a primary care doctor. Many practices have waiting lists, especially in rural areas. When you do find one, insurance makes the rules: you’re not likely to spend more than 15 minutes with your physician. And you may have waited a month to get that appointment.
Patients and doctors alike are sick of this model. Enter concierge medicine. Concierge medicine is a healthcare model where patients pay a membership fee for enhanced access to their physician. This special access may include longer appointments, 24/7 communication, same-day visits, and even accompaniment by the doctor to specialist appointments. Annual membership fees can range from $200 for very limited services, to $10,000, $20,000 or more for extensive access to the doctor.
That fee covers many of the same primary care services that insurance would, but a concierge medicine subscription should not replace insurance. Emergency care, surgery, and specialist care will not be covered by the annual concierge fee, so be cautious of companies that try to pitch their subscription as a low-cost alternative to insurance. Insurance will always be the more affordable option–but concierge care offers benefits that many are willing to pay for in today’s healthcare landscape. And more affordable concierge options are growing, making personalized care accessible not just to the wealthiest.
Doctors and Patients Want to Get to Know Each Other
Concierge medicine is trending, but it isn’t new. “Retainer,” “boutique,” or “luxury” practices first appeared in the U.S. in the mid-90s. And even in 2013,
surveys reported that as many as 1 in 10 doctors were leaving traditional practices for the relative freedom of concierge medicine.
Why the exodus? The biggest reason is that concierge physicians serve fewer patients than they would in traditional practices. The average primary care physician in the U.S. has a patient panel between 1,800 to 2,000. Concierge doctors serve fewer than half that number on average, around 600 patients. So, it makes sense they can spend twice as much time with each individual. "My real joy is spending time with patients and trying to help them improve their health,” shares “Dr. F” from North Carolina on the
Concierge Medicine Today site. The retainer model gives doctors that time back. “I spend about 30 minutes with a patient during our average visit. This is the main reason that most patients give for returning to our practice. People are willing to spend money on something they value, and they value time with the doctor."
Besides offering that personal time that both doctors and patients crave, the concierge medicine model also offers doctors a stable income from membership fees and independence from insurance constraints. In short, doctors are turning to concierge medicine to avoid the burnout that has become a hallmark of the profession in modern times.
The Downsides of the Retainer Medicine Trend
If only the U.S. had an overabundance of qualified primary care physicians. Unfortunately, the country is looking at a shortfall of
up to 86,000 physicians by 2036, factoring in the aging population’s growing need for care. "Concierge medicine potentially leads to disproportionately richer people being able to pay for the scarce resource of physician time and crowding out people who have lower incomes and are sicker," researcher Adam Leive told
CBS News.
When a doctor transitions to concierge medicine, their previous patients experience a gap in care. With a current national deficit of more than 20,000 physicians, finding a new, non-concierge primary care doctor is already a challenge. Many people in this position end up abandoning the idea of a PCP and start to rely on urgent care centers or emergency rooms for primary care.
To help fill the gap, some practices are starting to distinguish between concierge medicine, a boutique service accessible only to the wealthy, and “direct primary care” or DPC. This newer model has been called the “
blue-collar concierge practice.” One difference is that concierge practices always charge an annual fee–often tens of thousands of dollars. DPC practices, like
Direct Primary Care in Boca Raton, charge monthly fees and don’t require a long-term contract. At Direct Primary Care of Boca Raton, for $85/month, you don’t wait to see your provider, and there’s more weekend availability. The practitioner doesn’t bill insurance, except for medication, and when patients need specialist care, the DPC provider will do a soft handoff to specialists who take their insurance.
Some DPC providers will even accompany their patients to rehab centers or specialist appointments, but that’s not the norm. If that high level of personalized care is important to you, be sure to look for it in the contract, and expect higher monthly or annual rates.
The concierge trend offers consumers more options for care and relieves doctors of the unrealistic patient load that today’s insurance system places on them. As this industry grows, patients and their advocates will want to stay aware of what’s available, while also promoting equitable insurance-based models of care.