Will Concierge Medicine Solve Our Primary Care Crisis? – Dr. Steven Knope
The reason for the primary care shortage is obvious. Young doctors coming out of medical school will simply not tolerate the abuse from third-party payers and Medicare bureaucrats that their predecessors endured. It’s just not worth it. In reality, most medical students could not even afford to enter primary care, even if they wanted to. Reimbursement for primary care doctors is simply too low to repay the average medical school debt. As one family practice physician said to me this week at the American Association of Family Practice meeting in San Diego, “The only people who are going into primary care medicine now are those with a ‘religious, do-gooder’ mentality, or those at the bottom of the medical school class. You’d have to be an idiot to go into primary care under the current third-party payer system.’” Chew on that one for a while.Concierge medicine and free market forces may right the system over time. As the need for good internists becomes more apparent to the public, the market will force change, as more and more patients become willing to pay primary care physicians for their valuable services. With an increase in demand, more medical students will enter primary care to fill the market need as they realize that they can make a living in primary care medicine. This retooling, however, will take decades to accomplish. In the mean time, patients will suffer. Many will be forced to see nurse practitioners, or physician assistants instead of fully-trained diagnosticians. Even if half of all medical students opted for primary care over the next couple of years, there would be a lead time of 10-15 years before we will have trained enough doctors to take care of our aging population.

Here’s a good post from an author of a book on concierge (or retainer based) medicine, hypothesizing that concierge medicine just might encourage more doctors to try primary care.  He’s not making any predictions, mind you, but this may be one way that young students can see paying off medical school loans while still not flooding the specialist markets.  I think it’s a good theory, and I really like the options this model gives us.  One great feature is a true return to the doctor-patient relationship unencumbered by third party politics.   And something like this combined with an HSA or a HDHP or, even better, a health care sharing ministry could be a way to keep consumers directing their own health care.

“Concierge Medicine is Unethical!” (Concierge Medicine Blog)
Let’s look at the ethics of standard care medicine as well as concierge medicine. Are we to accept that the modern doc-in-the-box who accepts all insurance plans – the guy who sees 30-40 patients per day, spending 7 to 8 minutes with each – represents the ethical gold standard against which concierge physicians are judged. What is so ethical about this practice? Is it good to see so many patients and offer them so little of your time, just to pay your overhead? What about the fact that such doctors sign contracts with insurance companies, agreeing to ration care to their patients, so that Wall Street investors and CEOs can make obscene profits? I wonder if our cocktail party internist has ever asked himself these questions.

Dr. Knope has written a cogent defense of the accusations against concierge medicine.  I think that this model restores doctor-patient relationships by eliminating third parties, and allows doctors an incentive to keep people well, rather than profiting from their sickness.  Doctors are worthy of their pay, and a retainer based model allows consistent access to a doctor in a way where sickness is not extra costly.  A great article, and I’ll be ordering his book.

HT:  StateHouseCall