Saturday, January 19, 2013

Concierge Medicine as Last Refuge from Complexity
Simple pleasures are the last refuge of the complex.
Oscar Wilde (1854-1900), Aphorisms
Refuge, noun. 1) shelter or protection from danger or trouble; 2) a place of shelter, protection, or safety. 3) anything to which one has recourse for aid, relieve, escape
Definition of Refuge

January 19, 2013 -  Some physicians are opting out of traditional practices to enter concierge medicine as the last refuge from health reform's complexities.

A recent survey of more than 13,500 physicians found that 6.8% of them would "embrace" direct pay or concierge medicine within the next three years. That includes 9.6% of practice owners, 7.7% of primary care physicians, and 6.4% of specialists, according to the survey conducted by physician recruiters Merritt Hawkins for The Physicians Foundation.
Physicians Interested in Concierge Medicine
Those physicians who said they would make the switch include:
·        Females, 6.4%

·        Males, 7.1%

·        Primary care, 7.7%

·        Practice owners, 9.6%

·        All physicians, 6.8%

·        Specialists, 6.4%

·        Employed physicians, 4.5%

Concierge Medicine  as a Last Refuge
Physicians are interested  in entering concierge medicine as a last refuge against 3rd party trends that make their practices complex by:

·        Controlling  their fees at less than the cost of doing business

·        Requiring  them to spend more than 20 hours a week on paperwork

·        Making  them  more vulnerable to malpractice suits 
  • Turning them into data entry serfs for government and other insurers

·        Forcing  them to restructure their practices and modes of doing business

·        Questioning  their integrity and clinical judgment  and  label them as “greedy” or "inefficient," or not interested in "best practices"

·        Distracting  them from their training and primary mission of spending time with patients and taking care of them

Traditional Practice Versus Concierge Medicine
Traditional practices serve 2500 to 3000 patients, generate $400,000 to $500,000 in revenue,  have overheads of 50% to 60%, require physicians to see patients at the rate of 10 minutes for each  patient or 20 to 25 each day,  require 20-25 hours spent on paperwork, and carry heavy business responsibilities of billing, collecting, coding, and carrying bad debts.
In the concierge model,  patients pay $1500 to $1800 a year (or $120 to $150 a month) for unlimited access to doctors with no payment at the point of care. At the $1500 rate, a practice with 500 patients will have $750,000 of revenues.  Billing and collection are eliminated, and overhead drops to 10% to 15%.  The number of employees required for the practice declines  from 4-5 to 1-2, Business and staff employee responsibilities go down  by 75% to 90%, and doctors  only have to see 6 to 8 patients a day. Surveys indicate patient satisfaction rates of 90% to 95%,  with a similar percentage of patients renewing their concierge contracts.
Pleasures of Concierge Practices
The pleasures of concierge practices are obvious.
·        More time with patients

·        More income

·        Less hassle

·        Less paperwork

·        Less overhead

·        Greater satisfaction for doctor and patient alike

·        Greater independence to what one is trained to do

Downsides Not So Obvious
The downsides of switching to concierge practice are:

·        The process to telling patients they must now pay directly for access to your services

·        The business risk -not all concierge practices succeed

·        Telling loyal employees you no longer need them

·        Accusations of greed

·        Creation of a two tier medical system

·        Aggravation of the doctor shortage

·        Exclusion of many Medicare and Medicare patients

·        Displeasure of progressive policy makers

·        Threat that legislatures may make caring for patient in government program a requirement for practicing medicine.

     Some physicians, still small in numbers (6.8%), are deserting traditional practices to establish concierge practices.  They say concierge medicine offers  a simpler one-on-one relationship with patients removed from the complexities of health reform. What the future holds for most physicians - a public-private mx, team care, single provider, or single payer - remains undetermined.

     Whether concierge medicine is finally ready for takeoff is not known at this point, but 77% of physicians are disenchanted with traditional practice and 58% would not recommend it as a career for their children. 

Tweet:  Almost 7% of physicians are interested in switching from traditional practices to concierge practices.  This switch has its pros and cons.


1.  The Physicians Foundation: A Survey of America's Practice Patterns and Perspectives, September 24, 2012

2.  Kurt Mosley, Vice President, Strategic Alliances  Merritt Hawkins/AMN Healthcare,  A Presentation:  Our Fragmented, Fragile Physicians: A Discussion on Cultivating Hospital-Physician Cooperation

3.  John Commins,  "Is Concierge Medicine Finally Ready for Take-Off?"  HealthLeaders Media, January 18, 2013 

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