Health & Science

I'll Stick With the Long Waits

Why I’m not taking my doctor up on her offer of concierge care.

This fall I received a surprising, sort of alarming letter in the mail. It was from my primary-care physician, a low-key doctor with a bare-bones but clean office in downtown Washington, D.C., whose uniform seems to be comfortable pants and an old turtleneck. It announced her decision to convert her practice to a “new innovative model.” There would be fewer patients and more comprehensive care for each one, including 90-minute annual physicals, 24/7 availability via her personal cell-phone number, house calls when needed, and the time to practice “whole-person preventive medicine.”

The letter concludes with, “I look forward to embarking with you on this exciting journey to build a healthier you.”

An exciting journey! What’s not to like? Who doesn’t want the things she promises: same-day appointments, rapid referrals to top specialists, in-depth holistic attention to my body and mind, and elimination of the long waits spent reading three-year-old magazines (not to mention a “healthier you”)? Nothing, except for the $2,400 it’d cost me a year. The letter didn’t call the new plan “concierge medicine,” a frequent term for this kind of health care that might sound uncomfortably highfalutin’ to us commoners on a budget. (Many proponents prefer blander phrases like “personalized medicine” or “direct care.”) Still, it was clear that this “journey” would be more easily taken by folks used to riding first-class.

There are plenty of reasons for doctors to like the idea. General-practice physicians are a bit beleaguered, facing, as the New England Journal of Medicine has put it, “a confluence of factors that could spell disaster.” Those include declining reimbursements from insurance companies, a rise in chronic conditions that are time-consuming to treat, and an unmanageable number of patients on the roster clamoring for attention. (Insurance ultimately pays for quantity, not quality.) That all means grumpy patients who can’t get timely appointments, plus exhausted, frustrated doctors. Some doctors stopped taking Medicare, unsatisfied by its payment levels for primary-care services. On top of that, their salaries are far lower than those of their peers in specialized medicine, according to a survey by the Medical Group Management Association: The median compensation for primary-care physicians last year was only $186,044, compared with $339,738 for specialist physicians. The health care bill now being wrestled over in the Senate may address the problem—some lawmakers have suggested, for instance, a slight increase in the Medicare payment rate for primary care docs at the expense of surgeons (who, needless to say, don’t approve, and wield sharp knives). But what that reform will resemble by the time this battle is over is anyone’s guess.

It’s no wonder that concierge care is an increasingly popular remedy. According to the Society for Innovative Medical Practice Design, in 2005 there were about 500 doctors participating in concierge medicine, while today, there are more than 5,000 primary doctors operating some form of direct-payment practice—supplementing or replacing the insurance reimbursement system—in the United States. That’s an “educated guess,” says the society’s chair and a family-care doc practicing concierge care in Southern California; it’s hard to track, he explains, since “a lot of them are doing it under the radar.”

My doctor, Darcy Hansen, says she’d reached a crisis point: working until 10 at night and on many Saturdays while seeing an average of 25-30 patients a day. Tacking on that extra fee will keep her financially solvent enough to lower her patient load from 4,000 to, at most, 600 patients, allowing her to give them the time they deserve and to practice medicine “the old-fashioned way.” And unlike many general practitioners these days, she’ll be able to keep accepting insurance and Medicare patients, thanks to the extra cash.

Tags: health care

Christina Ianzito is a Washington-based freelance journalist.

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