Preferred Patient

[cabinetman]

LOML has used the same GP doctor for many years. She received a letter informing her that the doctor is reducing his patient base from 2000, to 600. To become one of the 600, she has to pay out of pocket $1500 per year to be a "preferred patient". This payment is in addition to any office visit or treatment.

So, what does it provide?

There will be low to no waiting time for a visit.
At any time-day or night, the doctor can be contacted for an emergency.
General tests will still be performed-blood tests, blood pressure, etc.

That's about it. Doesn't sound like anything that shouldn't be provided anyway. Well, fortunately we don't think he is that valuable. Actually we were taken back by this "entrepreneurship".
.

[jackellis]

I'm young enough and in good enough health that I probably would not take the doctor up on his offer, however in a few years I would consider it. After seeing how doctors coordinated care for my brother (cancer) and my mother-in-law, I'd be prepared to pay a relatively modest sum so that my primary care doctor had the time to make sure no one did anything to me that they shouldn't and that they were doing the things they should, especially if neither my wife nor I could make the decisions.

It's a sad fact of life that doctors are very pressed for time. It's an even sadder fact that doctors often do not do a good job of coordinating each patient's care among themselves. If part of the service you paid for included the equivalent of acting as general contractor for car that requires multiple specialists, and if you could afford it, I would take it.

[cgallery]

Wow, that's 900k a year for the doctor before they even pickup a chart.

I think I'd take a pass on that. In fact, I'd be very surprised if it would fly in Florida. Manhattan, or LA, maybe even Chicago, sure. Not so sure about elsewhere.

If it does fly, then you're living among hypochondriacs. Maybe the elderly population in Florida would make it work?

[Whaler]

When we moved to Sequim last fall we investigated all medical options available here. We went with a medical center that charges $60.00 a month just to be a patient and the treatment so far has been well worth it. There is a doctor on call 24/7 which we felt was important with no hospital or er in town. The day I sliced my hand open LOML called the office and my doctor was sewing me up 30 minutes later.

[meanroy]

LOML has used the same GP doctor for many years. She received a letter informing her that the doctor is reducing his patient base from 2000, to 600. To become one of the 600, she has to pay out of pocket $1500 per year to be a "preferred patient". This payment is in addition to any office visit or treatment.

...

My Wife and I have been going to the same Medical Group and had the same Doctor for somewhere around 30 years.
Two years ago he did the same thing, "It will cost an extra $XXXX/yr. to remain my patient. blah blah blah".

There is a name for this practice which I can't seem to bring to mind, but apparently it is becoming common.

We declined, and I can't say I regret it at all. Old Doctor was an "Old Doctor".
New Doctor is a very bright and knowledgeable, attractive young Woman.

Gives a whole new perspective on some of those more invasive checkups!

Roy.

[germdoc]

That's called a "concierge" or "boutique" practice, and this model hasn't caught on in the Midwest much to my knowledge. It reflects a basic problem that general practice docs get paid a lot less than specialists, and even less from Medicare and Medicaid.

The current system isn't equitable or sustainable, however I think that this "solution" is not reasonable. I wish I could make $900,000 a year before I did a lick of work!

[herb fellows]

Actually, I'm surprised that this isn't considered unethical by the authorities that 'supervise' doctors. You can charge whatever you want to I suppose, but this strikes me as morally bankrupt. He is essentially telling a lot of patients that his main concern is money, not their health. Even if I could afford it and liked the doctor, I would get away from that situation asap!

[Tom Slick]

Sounds similar to having a lawyer on retainer.

[shoottx]

I just love American ingenuity!

We have a situation where a person after spending a lot of money and time to become a doctor, is in a field constrained by insurance rates, malpractice costs, increasing costs of help, office, etc. And they have more cash flow through their hands keeping less and less.

I have a good friend who is an Ob/Gyn; he explained when they started their practice there were 4 doctors, 7 nurses and 7 staff people, and they collected 90% of what they billed. Now 20 years later, 4 doctors, 7 nurses and 27 staff people and they collect roughly 50% of what they bill.

So the choice is to increase the number of patients or define a premium pay for service practice. With the premium service package if it is figured correctly the doctor can cover his annual overhead and then bank the insurance reimbursement as salary or profit. What is not to like about it.

Oh yeah, we have to spend a little extra to get premium service, I forgot that is against the rules. It always comes down to choice, if the premium service is a value for you, pay for it, if not find the Harbor Freight of medical service and take your chances.

[radhak]

There are two sides to this coin.

One - would I pay $1500 to be on a doctor's "good list"? No. And that's because I don't have the money !
But - what if it was $150? Maaaybee. How about $15 per year? Absolutely, in a snap! I can see it making sense for anybody who can afford it.

On the other side, is the doctor, as a service provider. I don't see anything wrong in him/her demanding a retainer. He's effectively saying that he doesn't have time to look at 2000 patients; he can only see 600; he could see the first 600, and shut the door on the rest (ie, not accept any new patients beyond 600). But in capitalism, I pay to be served. And here, if I pay, I am served well. What's wrong with that? (Remember, socialism is an ugly word )

He's asking me to pay to get into that exclusive club of 600. Obviously if I think that's too expensive, I am free to go elsewhere. How come a retainer is acceptable for lawyers but not for doctors? Simply because it was never like that ! Well, years down the line, it might be the norm...

In a way, I am happy somebody thought this up; maybe the concept should get around. Because I am seeing a drastic shortage of doctors everywhere I see. ERs wait times are in hours; new appointments are months later. Maybe this would entice more youngsters who are on the fence to consider the profession, and negate the immense burden of liability / insurance.

And unlike a plumber (or maybe even a lawyer, I dunno), a doctor earns his stripes after a looong time, half-a-lifetime of study/internship; so maybe they have earned it.

[germdoc]

Can't resist commenting. There are some ethical issues involved here. Medicine is a service profession, like hotel or restaurant business, except that human health and lives are involved and doctors take an oath to uphold these above all else.

Would it be ethical for a doc to take a bribe to treat a patient? Of course not. So there are limits. There must be a balance between money and service, otherwise doctor is making decisions based on greed, not medical necessity.

If a doctor cannot support his current style of practice and changes it to be more efficient, that's fine. If he or she changes it to make a ton of money, well there is a line there somewhere that has been crossed.

This is a hot topic of discussion among medical professionals:

medicaleconomics.modernmedicine.com/memag/article/articleDetail.jsp?id=112475

There's no doubt that while this style of medicine may benefit certain doctors, it does nothing to benefit the health care system as a whole, as we all will find as we get older and look around and can't find a primary care doc.

[master53yoda]

Food for thought

building lease 125000 probably a little low.
insurance 65000 rough guess
8 staff 560000
utilities 10000
equipment 20000 I'm sure this is low
misc etc 20000
800,000 before he turns a dime



I would not think the 1500 is out of line for restricting his or her patient load to 600, if they are willing to take medicare patients and deal with the paper work etc.

My Previous doc that I no longer have access to chose to not take anyone under medicare or anyone needing pain medications because of the costs of dealing with those to types of claims. When my MS got to where I needed both he dropped me because of it.

We have started thinking that we have the right to socialized medicine, I for one want no part of socialized medicine. Ask anyone in the countries that have had it or anyone that has been deeply involved with an HMO if they like the service that is a available based on their time of need. How quick can you get in etc. Most people are over what they have before they can get an appointment.........or dead.

I would work with a doctor that would offer what this doctor appears to be offering without a question. He is charging upfront and taking reduced service payments from medicare etc. Pain meds require a call once a month that he has to deal with even though it is a long term medication figure out how many hours that is if ev en half of his six hundred are on pain meds..... At least he is serving as best he can.

[scmhogg]

I have a terrific internist. He was the clinical chief at Cedars Sinai, board certified, etc.

He is very thorough and doesn't rush you through a visit. He always calls personally, the next day, when blood tests are taken.

I don't know how he makes a decent living, with what my insurance company pays, and the overhead, staff etc. Surgeries and such are referred out.

I know how much LOML and I had to earn to support our two person law practice. And, we didn't need all that shiny equipment either.

Steve

[Richard in Smithville]

Makes me glad of the health care system we have in Canada. It may not be perfect but I don't have to face this kind of decision. When my doctor left, loml's doctor was happy to pick me up and gives me the same care as she does anyone else.

[germdoc]

Well, Art, here's the deal: most reasonably efficient docs will keep 40% that they bill, that is the cost of practice is about 60% (http://www.medicalmanagement.com/aac/aac0306019-2.htm). Of course, not everything they bill gets paid...

Therefore, the average internist who makes $176,000 (http://www.studentdoc.com/internal-medicine-salary.html) will generate billings of $440,000. Out of this they pay staff salaries, rent, malpractice insurance, etc., A one-doc practice might just have one nurse and rent a small space in a strip mall, but most docs pool resources for staff and equipment and rent.

I agree there are a lot of costs and challenges involved. The hassles of dealing with this is one reason I got out of small group practice BTW.

My bias, and admittedly it's a gut reaction, is that the concierge-type of practice is wrong and that most docs who do it are motivated out of laziness (less work) or greed (more money). I know that sounds extreme, but I have not seen anything to dissuade me from this notion.