It just figures. Today is my 45th birthday. Ideally, every person who has a birthday (depending on age) wants the day to be all about them. In the past, such things as the evacuation of Saigon in 1975 and the LA riots in 1992 have occurred to take the spotlight off of me. So what happens on my birthday this year? A royal wedding in England. Of course, being that it happened at Greenwich Mean Time, we were all asleep, so that’s that. All things being equal, I have better hair than Prince William anyway.
While I’m on the subject of royalty, I have to admit to the reader that one of my favorite TV shows (currently on hiatus) is Royal Pains on the USA Network. The plot line of the show involves an ER physician in New York City who, half by happenstance and half by extraordinary demonstration of skill (it’s a TV show), ends up as a doctor-on-demand (commonly referred to as concierge medicine) for rich people in the Hamptons on Long Island. Thanks to the umbrella of suspension of disbelief that comes with television, the protagonist has treated people for such things as leprosy, lyme disease, hemophilia and parrot fever.
Out in the real world, it turns out that concierge medicine is beginning to take hold across the country. A recent article in the Boston Globe indicates that due to long hours, enormous caseloads, insurance headaches and a desire to deliver more personalized care, physicians are slowly beginning to warm up to the concierge model.
Medicine on demand works like this. For a yearly retainer, usually in the $1,000-$2,000 range, you have access to a doctor at any time for any health issue. Concierge practices have varying policies with regard to insurance acceptance on top of the retainer. There also exist what are called “hybrid practices” in which doctors have an equal number of retainer-based patients and those with insurance coverage.
On the surface, provided you have money for both the initial outlay and insurance premiums, this sounds like a good deal. There are some catches though, the foremost of which being that there appear to be less than 800 physicians nationally with such a practice, according to an October 2010 government-commissioned study.
The article in the Globe tells the story of two high ranking internal medicine physicians who were affiliated with Newton-Wellesley Hospital in Newton, Massachusetts who joined a company based in Florida that assists physicians in running concierge practices. Soon, their practices that treat 3,000 patients apiece will shrink to 600, an 80% reduction in workload. This will feel like a great deal to the physicians and the 1,200 patients with care on demand, but for the patients of their former practice, it represents an unexpected barrier to primary care at a time when most medical school graduates are focusing on specialty medicine.
The basic idea behind the Patient Protection and Affordable Care Act was that every patient has access to insurance coverage. Medicare initiatives over the past year have focused almost solely on reducing costs. Access to quality health care is another matter altogether that has been largely ignored, save for provisions aimed to increase the number of medical school graduates that enter the world of primary care. The results of this particular initiative are more than likely a decade away from making a real difference in the current state of unbalance between primary and specialist care.
As it stands right now, concierge medicine does not represent a threat to the medical delivery system for those without the dollars to explore the option. Yet with the insurance industry in a downward spiral of offering fewer tangible benefits for ever-increasing premiums, the trend of concierge medicine is one that deserves close observation as we get closer to full implementation of PPACA.