The doctor is in
Trend is for 'boutique' doctors to offer more time to patients
You're out of time. You dashed out of a busy workday to sit in an uncomfortable waiting room chair but your time is up. You've waited for almost an hour and the attendant at the front desk can only apologize and tell you that the doctor should be free momentarily.
Frustrated, angry and needing to get back to work, you tell her you'll call to reschedule.
If this scenario sounds all too familiar, you're not alone. Unfortunately long wait times and limited face time with doctors isn't a trend that's fading anytime soon. In fact, it seems to be here to stay.
And you're not the only one who's dissatisfied.
"I was always in a hurried state when seeing patients and felt I wasn't doing an adequate job, particularly for those who had a lot of medical problems," Dr. Donald Parsons, a primary care physician, explained in his office in Danville.
Fed up with not being able to provide more attention per patient, Parsons started a practice that focuses on personalized healthcare and longer appointment times with each person.
"My practice is about giving the most time to patients," Parsons said. "I'm scheduling patients for about 30 minutes so I'm able to spend the time and look into all of their health problems at once."
Parsons has been practicing since 1979, focusing on internal medicine and infectious disease. He's been in practice in the East Bay for the last 10 years. Since he started his "concierge" practice last March allotting more time, he has received great feedback from his patients.
"Now I'm seeing eight to 10 patients a day and can take more time. Before I was seeing an average of 20 and not spending enough time with each," Parsons said.
No waiting time for patients
"Concierge" or "boutique" medicine is a shift in primary care in which doctors charge their patients for more individualized and personalized service beyond today's typical doctor's office visit.
Considered the pioneer of concierge medicine or, as he refers to it, "highly attentive medicine," Dr. Howard Marion launched MD2 in 1996 in Seattle, Wash. Marion, former physician to the Seattle Supersonics, opened his office with fellow colleague Dr. Scott Hall. Marion enjoyed the personalized service he gave to the players and wondered why everyday people could not also have a personal physician.
Doctors who practice concierge medicine generally care for fewer total patients (100 to 800 per doctor) vs. the few thousand that traditional practitioners see every year. Annual fees can range from $100 to $15,000 a year per patient and can include additional services such as guaranteed same day or next day appointments, house calls, scheduling and referrals to other physicians and after hours access to doctors via phone.
Payments and insurance coverage varies by doctor. Some concierge doctors charge lower retainer fees and in cases where patients need more complex tests and examinations (X-rays, CT scans), individuals are expected to be responsible for insurance reimbursement.
MDVIP, a Boca Raton, Fla.-based company, helps doctors across the country convert their traditional practices to the concierge model. It also helps find the right doctor for patients interested in and willing to pay for internal medicine and preventative care that cannot be given in a traditional medical setting. MDVIP currently has 29 doctors throughout California.
Critics of concierge
Critics are wary that concierge medicine will polarize healthcare in the United States.
"Concierge care is like a new country club for the rich," said U.S. Rep. Pete Stark (D., 13th District), at a joint economic committee hearing in Congress, according to a New York Times article in 2005. "The danger is that if a large number of doctors choose to open up these types of practices, the health care system will become even more inequitable than it is today."
"Doctor Is In - For a Price," an article on sfgate.com, quoted Dr. Gordon Shiff, a founder of Physicians for a National Health Program, as saying: "Many of the things that doctors are saying they'll do under concierge medicine should already be expected by patients. It shouldn't be an extra privilege that you have to pay for."
"If medicine is a public service and we're here to take care of everyone, you don't limit yourself to people who have money," he added. "Most people expect to be treated based on need, not how much money they have."
In a world where customer service has shifted from man to machine and people spend more and more time navigating the maze of de-personalization, concierge medicine seems like the perfect answer to rushed appointments and long wait times.
"The most frequent complaint I hear from patients is how long it took to get their first pre-natal appointment," said Danville resident Joanne Vecce, a labor and delivery nurse with Kaiser Permanente Hospital in Walnut Creek. "You have to navigate an automated system every time you call in. It can be frustrating."
"Doctors will hardly spend time with you anymore," said Vicki Hughes, another Danville resident. "It feels rushed and impersonal."
When asked if she would consider concierge as an alternative, Hughes said, "I'd love to, but with a husband and two kids, I don't really think it's affordable."
Questions are being raised about concierge medicine, but are doctors really to blame in wanting to provide better service to the patient in a world where models of practice in traditional medicine won't be improving anytime soon? And with a transition to this new model are doctors targeting a level of clientele who can afford their services or are they simply wanting to improve their job satisfaction?
In a world where people can fly coach, business, first class or by private plane; and can choose to sit in the VIP box or enjoy the game in the bleachers; concierge medicine is more often being offered as an alternative as well.