Is it right and good for primary care doctors to change their regular practices into "concierge" or "boutique" practices? Most of the doctors associated with BIDMC have the traditional kind of arrangements with their patients, but a few have adopted this other model. Here is a portion of an essay written by my friend and colleague Dr. Harold Solomon on this topic. Please let us know how you feel about his approach and his point of view:
"Four years ago, in frustration, and after a 38-year career in internal medicine and nephrology, I closed my Beth Israel Deaconess Hospital-affiliated practice, reopened as a "concierge" physician. As an alternative to quitting medicine altogether, I joined MDVIP, a national association of physicians. I wanted to make a loud statement about the error of undervaluing primary care.
"MDVIP charges a $1500 annual fee, covering a prevention-oriented physical and wellness plan, other services- newsletter, personal health information CD, website, and internet services. I limit my practice to 600 patients. I participate in all insurance, HMO, and Medicare. Fewer patients means quick access, same day visits for acute problems, a personal touch. I rarely sign out to coverage. Unless I am in a plane, or abroad, I am the first contact for my patients’ after hours needs.
"I was moved to preserve the quality of my work, and was willing, for the first time in my career, to be a bit controversial. . . . 475 patients signed up, and to my surprise, I had overestimated signups by the rich by a third, underestimated the middle class patients by a third. The demographics of my practice did not change. This was not an "elite" patient group. Why did more rich patients leave that I expected? I did not understand then, but I do now. The upper class patients already know how to get special care. They become hospital donors, are connected socially. Many hospitals have development offices which promise better access in exchange for donations. At Boston's most famous hospital, there is a "concierge" floor. Donors of $1000 get a unique color hospital ID card which alerts employees of your importance. You get a free flu shot, ahead of the line!
"Most doctors defer to patients with stature -- politicians, celebrities, physicians, the wealthy. A former cabinet secretary left me angrily, and was seen within three days by a colleague whose practice is "closed", and who is a public figure in the movement for universal access in Massachusetts! I wondered who pried his closed door open!
"The argument against "boutique" medicine is that it creates a two-tiered system. I would argue that the US has had a multi-tiered system for many years, as does Great Britain, Germany, New Zealand, Denmark -- countries I have visited recently. Whenever the government, or insurors, limit care, a segment of society looks finds more. Instead of forcing mediocre primary care from the bottom up, why not force quality care from the top down?"