I read with interest the family medicine chat a couple weeks ago about the ethics of concierge medicine. Some argue that concierge medicine is unethical and a failure to uphold the medical profession. I missed the chat so I would like to throw in my “2-cents”.

After 10 years practicing medicine within the confines of the insurance-driven health care system, I jumped ship, so to speak, and started a concierge/direct-care practice. This wasn’t a decision that I took lightly. It took several years of contemplation and introspection and was a difficult decision. I had to work through the guilt of abandoning my colleagues who are struggling through a dysfunctional system. I had to work through the argument that I was making accessibility worse by caring for fewer patients. Most importantly though, I had to make sure it was the right decision.

Ultimately I decided that the health care system would likely not be fixed within my lifetime and that I could make a more significant contribution by caring for a few hundred patients exceptionally well than caring for thousands of patients poorly. I decided that I would be of little use to anyone,  my patients and my family, if I continued in a state of poor health and burn-out. I decided that I could help patients change their health by bringing back the integrity of the doctor-patient relationship. To me, that was the right thing to do. It was a personal decision, one that I made in the best interest of my family, myself, and my patients. Another reason that I decided to jump off the hamster wheel is that it would give me more time to give back, volunteering time that I didn’t have before and focusing my efforts on educating patients on how to stay healthy.

I would like to address the most common misconception about concierge medicine: that it is only for the wealthy. My patients are a mixture of patients without insurance, patients with catastrophic or high deductible insurance, patients with low deductible employee insurance plans, and those with Medicare. What they all have in common is that they are frustrated and disillusioned with our health care system. Their needs are not being met.

Concierge Medicine is not about selecting wealthy patients. It is about getting the insurance company out of primary care. Primary care is not in itself expensive. It is expensive when there is a 3rd party between doctor and patient. It is expensive when you call it insurance when it is really a health plan. Insurance is meant for catastrophe and spreads out the risk of an unlikely event among a large group of people. But when the coverage is for something that is not unlikely and will be required (primary care), it is expensive. Who pays the 3rd party? The patients, in high premiums, and the doctors, by taking discounted payments and paying someone to collect from the insurance company. The players in the system who are hurt are the patients and the doctors. For patients, they pay more and get less of what they need, access and personalized care. For doctors, they have to care for more patients than they can handle which often leads to poor health and burn-out.

Is concierge/direct-care the answer to the problem with our health care system? Maybe… maybe not… but concierge/direct-care models would not exist if there wasn’t’ a demand. Again, it is a symptom of our broken health care system.

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