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  1. #1
    jendoe's Avatar
    jendoe is offline Senior Member
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    Concierge doctors?

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    I'm looking for a primary-care type doctor (haven't had a checkup in ~3 years). And, I keep finding docs who sound wonderful... but have transformed their practice into "concierge" practices.

    For those that aren't familiar with the term, you pay an annual "retainer" (looks like it's around $1500 around here, on average). From what I can tell... the retainer covers your first visit/exam. After that, you still pay for each office visit, procedure, test, etc. The retainer is really just so that you can get access to the doc.

    I'm reading some articles about it... and people are saying things like... it's worth it, because you can call your doctor, and schedule same day/next day appointments.

    I guess I'm curious as to what others think. I'm generally all for people structuring their businesses in ways that make sense to them, but this is frustrating.

    At first, I thought I was frustrated at the extra costs. The $1500 doesn't really cover anything other than the first exam (not sure if it includes tests run at that exam even). So you're paying about $125/month for your doc (even if you don't go), plus your insurance costs, plus the costs of any office visits/tests. And, if you have a high-dedectible policy, you're paying 100% of these costs until you hit that deductible. (And even more if the concierge doc doesn't take insurance at all - so is out of network for you.) Yikes.

    But, there's something else that bothers me...

    To me, it seems that things like:
    - returning calls
    - meeting patients promptly at their scheduled appointment time (rather than having excessive waits), and
    - maintaining time in your schedule so that you can see people with emergencies quickly

    ... should be part of any PROFESSIONAL's business. Not reserved for those paying extra!

    If you're running a business, of course you should return phone calls from your customers! And meet with them on time... don't most business owners/professionals have to schedule appointments, and keep them? And, ideally keep some "emergency" spots open so that... if people truly need to see you fast, they can.

    I don't have to pay my piano teacher, or therapist, or massage therapist *extra* to make sure they are actually ready for me when we set up a lesson or appointment. Even contractors that come to the house - the professional ones - are on time, or let you know if there's going to be a problem. If they don't show up when they say they will - they don't get called again, and get bad reviews online.

    Am I missing something?

    And... any advice on finding a decent primary care doc ?

    thanks...

  2. #2
    IvyBlue's Avatar
    IvyBlue is offline Senior Member
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    I don't think you realize what Dr's are up against w/ managed care. The HMO's or whatever are judging them based on increasingly unrealistic parameters, especially time spent w/ patient. They are not being reimbursed at a rate that allows them to cover costs and make a reasonable profit given the level of schooling they have.

    The concierge practice fee is an attempt by some Dr's to get around this problem. The increasing cost of medical care (and decreasing net salaries for GP's) is something the average consumer has been insulated from for many years but that doesn't make it any less real. It is only going to get worse and this is what's driving so many physicians out of primary care and into specialties where fees are higher.

    I have been searching for a decent Dr for years now and any recommended Dr has long since stopped accepting new patients at all, let alone w/ additional fees. If I had some serious issues to be addressed I would probably seek one of these concierge practices out but absent that would give it a pass. If the fees were paid via FSA's it would be at a 40%+ discount for most tax brackets which would take the sting out of it.
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  3. #3
    emmie's Avatar
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    I agree with the OP and also with the insurance problem for doctors--the insurance companies ARE the problem in American health care.

    However, one reason I don't plan to move at any time is because at my age (69) doctors are important, and I have a sound primary doctor and assorted specialists who are terrific and monitor my health. NONE of them are 'concierge' doctors.

    I pay a lot for my health insurance, and I think it's a crime what these doctors get in terms of payment for services.

    I don't know where the OP lives, but a friend of mine had to get a 'concierge' primary because she could not find a decent one in her area. It's becoming a problem for many people.

  4. #4
    Alex Good's Avatar
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    O Canada, we stand on guard for thee!
    And that is why I pay my doc 0$. I'm going and getting a blood test for the hell of it in a week or so.
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  5. #5
    jendoe's Avatar
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    Thanks guys for responding.

    You're probably right, in that I don't have an intimate knowledge of how insurance billing and doctor's office finances work... and I'm trying not to judge, as most of the doctors I've met personally seem to be genuinely caring people who want to help.

    But it's a little hard to read articles about how general practioners "only" make $200k (compared to $300-$400k for specialists) - when $200k is so far out of reach for most people I know.

    Anyway, I suspect I'm not the right market for this, and if I needed more frequent doc visits or someone to help coordinate care among many doctors, it might make alot more sense.

    And, IvyBlue, it's a little scary to hear that you've been looking for a good doc for *years* though!

    Thanks...

  6. #6
    mixie's Avatar
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    I have no knowledge of or experience with "concierge doctors", but I sure do love my primary care physician. She follows "Ideal Medical Practice" principles, which means a tiny, single-room office with no waiting room or wait time, and a personal, one-on-one relationship with her patients.
    My preference is for a FNP or DO over an MD if possible, and first and foremost, a practitioner that follows Ideal Medical Practice principles.

    The Ideal Medical Practice Model: Improving Efficiency, Quality, and the Doctor-Patient Relationship - Sep 2007 - Family Practice Management
    YourGMap - Ideal Medical Practices

    These folks usually make very good money, if not millionaires, and seem to care very deeply for their patients as individual human beings. It's a far cry from the cattle call of a standard large practice.
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  7. #7
    canio6's Avatar
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    Quote Originally Posted by jendoe View Post
    But it's a little hard to read articles about how general practioners "only" make $200k (compared to $300-$400k for specialists) - when $200k is so far out of reach for most people I know.

    It's the same for me, however, most people I know did not go to college for 7 years, maintain impeccable grades, do a long residency, accrue hundreds of thousand of dollars in student loans, pay thousands in malpractice insurance, or employee an office full of other professionals. I'd want $200K for that as well.

    OP I am not trying to knock down your argument. I agree that medical care can be prohibitively expensive. I just do not begrudge doctors their money as they work their collective asses off. As others have said, it is the insurance industry that needs to be reformed/abolished.

  8. #8
    Apex Predator's Avatar
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    Quote Originally Posted by canio6 View Post
    It's the same for me, however, most people I know did not go to college for 7 years, maintain impeccable grades, do a long residency, accrue hundreds of thousand of dollars in student loans, pay thousands in malpractice insurance, or employee an office full of other professionals. I'd want $200K for that as well.

    OP I am not trying to knock down your argument. I agree that medical care can be prohibitively expensive. I just do not begrudge doctors their money as they work their collective asses off. As others have said, it is the insurance industry that needs to be reformed/abolished.
    I personally know of doctors with 500k+ in debt just from school.

    Yes, the problem is "insurance" or rather, government and union interference with it.

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