Looking back on my years caring for patients, one thing I always wished for was time—more time to spend with each individual during an office visit, without the pressure to move on to the next person in line. I think I could have delivered higher-quality care, and I imagine my patients would have felt more satisfied.
Unfortunately, this is the nature of our healthcare system. Who among us hasn’t had to wait weeks for a medical appointment, only to feel rushed through the visit when it finally happens? Much of this has to do with how healthcare is reimbursed. A standard office visit generates a similar revenue regardless of whether it’s 10 minutes or an hour long. That ramps up the pressure on providers to keep appointments short and see more patients—particularly in today’s environment of corporate-owned medical practices, which tend to see healthcare as a commodity rather than a service.
The result, too often, is that neither patients nor doctors are happy with the care provided.
Enter “concierge medicine.” The concept has different variants and names, including retainer-based medicine and direct primary care, but the basics are the same: Patients pay a monthly or annual membership fee to a primary care provider (most concierge practices are primary care)—on top of their regular insurance premiums or Medicare payments. In exchange, they get perks such as same-day appointments, longer visits, round-the-clock phone and email access to the doctor, and even old-fashioned house calls in some cases.
Frankly, this is the type of medicine I wish I’d been able to practice. Most doctors, I would venture, want to devote their time to patients—not to the endless headaches of insurance paperwork or fulfilling a corporate bottom line.
Looking deeper, though, it’s easy to see the downsides of concierge care, too. On the societal level, it raises some troubling questions. Is this essentially elitist healthcare, where people who can afford a retainer fee get different care than everyone else? I do worry about us going in a direction that worsens existing healthcare inequities. Plus, we already have a shortage of primary care providers in this country: If more doctors go into concierge care and see fewer patients, that will only add to the problem.
There are also caveats for individuals who are enrolled, or would enroll, in a concierge practice. While it seems like a no-brainer that their quality of care (and, therefore, health) should improve, there’s actually little research to show whether that’s true.
A UC Berkeley study published last year should give us pause. It used data from Medicare and a large concierge medicine company (yes, corporations have their hands in Medicare, too) and reached the following conclusions: Older adults who enroll in concierge care typically do so because they have the money, not because they have more health issues than anyone else. Their healthcare spending goes up, not down. They don’t live any longer than their peers in standard primary care.
So, is it for you? At this point, surveys suggest that about 7 percent of U.S. adults are enrolled in concierge care. The practices are not yet widespread and tend to be concentrated in large urban areas. But if this type of care is available and appealing to you—and if you can afford it—do some research before taking the plunge. Understand exactly what’s included in a provider’s membership plan: Costs vary widely (monthly fees are often in the $100 to $200 range, but prices could soar as high as $10,000 a year), as do the specific services included. And just as you would in choosing any doctor, check into the provider’s credentials and reviews—any information that might give you an idea of the quality of care. Also, keep in mind that you’ll still need health insurance to cover medical care not included in a concierge plan.
For some people, it may be worthwhile to pay an extra fee for primary care that feels more accessible and personalized—even if we lack evidence on the ultimate health benefits. Just do your homework and go in with your eyes wide open.
