One of the hottest trends in medicine is towards the provision of so-called concierge medicine services. For an annual fee ranging between $2500-$5000, a patient gets the right to have a physician on call for himself/herself 24 hours a day, 365 days a year. To facilitate this, the physician will also provide the “client” with their cell phone number. Additionally, there are guaranteed appointment times, luxurious waiting rooms, full day physical examinations once per year, central collection of medical records, and the personal shepherding of the patient through the medical system by the concierge physician. Need a consult? No problem! The concierge physician will arrange it, then will personally follow-up with the physician (low-cost plans) or actually attend the consultation with the patient (platinum level).
This kind of access is not cheap. The internists who have been providing these services bemoaned the overload of HMO patients, crowded waiting rooms, decreased patient interaction, and crushing paperwork obligations. The solution was to cherry-pick the richest patients in their practice, offer them this “deal”, and then abandon the rest of their practice.
Palo Alto is filled with these concierge services. We are drowning in altruistic intentions of giving the patient the attention they deserve. Instead of seeing 40 patients a day, they now get to devote an entire day to each patient, or on a busy day, two patients are scheduled. Typically, 300 patients per concierge physician here in the Bay Area at a $2500 a pop. For those of you who can’t count that high, that is a cool $750,000 right off the bat. It gets better. The annual fee is just a retainer a lot of the time. These concierge physicians then bill regular insurance for the actual services performed.
Fortunately, I am not in it for the money. Otherwise, I would think that my mom had raised two idiots (my brother also being a retina surgeon). Here I am seeing 40 patients a day. Each patient gets a guaranteed appointment time, and they get to spend all day in my clinic (usually along with the remaining 39 patients). Luxury accommodations, no. We do have free parking, and the waiting area was recently re-painted and new furniture supplied. On top of that, I give every one of my patients my cell phone numbers. All for an annual fee of FREE! Let’s see 5500 patient visits vs. 250 patients? Which would you rather see? At the end of the day, I choose the 5500. I actually enjoy seeing patients!
Regarding the cell phone thing. I have three cell phones—a Treo, a Blackberry, and an iPhone—and I distribute the numbers to all of my patients. My boss refers to this as operating “a hotline.” The reality is quite different. I know my patients better than my partners, and I can usually answer any question quickly, or refer them in. Most months I receive fewer than 10 phone calls from my patients, eight of which can be handled over the phone. The usual pattern with the anxious patient, the one you fear giving your number to, is that they call you within 24 hours. They are shocked that you either answer or call them back. They repeat, and never call you back unless they have positive findings. My general advice to all patients is to call early and often and to let me worry about whatever is bothering them. I tell them that if I don’t answer, leave a message, and try one of the other numbers. If no reply within an hour, then call the office. The overwhelming majority respect that I have a home life and that I work during the day. I recommend you try it as a patient satisfaction builder for your practice. Concierge retina? Probably not, but it has saved me a lot of trouble over the years.
Have a question or comment on this article? Use the “Comment” link above to leave your thoughts, and the author will respond.