Oct 30, 2005

Doctors Delighted to Serve

As if the rich don't have enough privilege in this country, I just read about a new trend in healthcare: Concierge doctors.

For a yearly retainer, these doctors provide same-day or next-day appointments, 24-hour phone access, and lots and lots of personal time and attention with their patients. Waiting rooms are filled with bowls of fruit salad and platters of bagels and sponge cake to tide you over while you wait to see your doctor.

These doctors charge fees as high as $10,000 a year, depending on the services promised. The majority charge $1,500 to $2,000. Basic services consist of same-day or next-day appointments and 24-hour telephone access to the doctor. The most expensive may also promise the doctor will make home visits, deliver medications and accompany patients on visits to other doctors.

It sounds like a great concept, and if you have the money, I guess it's great if you or a family member is getting old and need to have this level of service. But something about this whole setup leaves a bad taste in my mouth. Maybe this is one reason. In the NY Times article, it highlights one Dr. Kaminetsky, whose patient load went from 2500 patients to 600 once he became a conceirge doctor.
Despite the drastic decrease in patient load after he changed the way he ran his practice, Dr. Kaminetsky's personal compensation and the salaries of his office staff members increased by about 60 percent.The arithmetic behind this seeming contradiction results from the low per-visit reimbursement rates set by Medicare for primary care office practices. Medicare now pays an internist like Dr. Kaminetsky slightly over $50 for an average office visit. Thus, a regular internist might earn about $200 a year from Medicare for caring for the average older patient with high blood pressure or elevated cholesterol but no other major health problems.

Aside from how much money they're making, these doctors also appear to be straying from this notion I have that healthcare should be equally accessible by all citizens. This emerging boutique system of healthcare further divides services for the rich and the poor, and I can only see this as turning into a huge crisis later on. I'm seeing 10-20 years down the line a shortage of doctors who will want to work at city/county hospitals because they know they'd make so much more money as concierge doctors.

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