The doctor will see

Concierge medicine eliminates long wait times

Created date

August 25th, 2009

Health care is one of the most difficult issues facing the nation today. While most of the focus is on universal access to health insurance, many already insured Americans are having issues with access as well. A new study indicates that depending on where you live, it could take months to see a doctor.

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The survey tracked how long it takes to get a nonemergency appointment in five different medical specialties: cardiology, dermatology, obstetrics/gynecology, orthopedic surgery, and family practice. Results ran the gamut from as little as one day to as long as one year.

"Finding an available physician can be challenging today, even in large urban areas where most doctors practice," says Mark Smith, president of Merritt Hawkins & Associates, the national physician search and consulting firm that conducted the survey.

For example, despite the high concentration of doctors in the Boston area, wait times there were the longest. Bostonians waited an average of 70 days to see an OB/GYN, 63 days to see a family physician, 54 days to see a dermatologist, 40 days to see an orthopedic surgeon, and 21 days to see a cardiologist. In Philadelphia and Los Angeles, the average patient wait times exceeded 45 days in some specialties.

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The study points out that higher wait times in Boston may be attributed to the fact that in 2006, Massachusetts implemented a health care reform plan mandating coverage for all residents. With hundreds of thousands of newly insured patients, demand for doctors greatly increased. Although Massachusetts has one of the highest concentrations of physicians in the nation, patients are having difficulty scheduling appointments. Should access to health care be expanded through a national reform plan, Smith believes accessing physicians would be even more problematic for many patients nationwide.

Concierge medicine

Some patients are dealing with long wait times by joining what s known as a concierge medical practice. Patients pay a retainer fee ranging from $1,000 to $20,000 per year to join a concierge practice. While people who can afford to pay the retainer fee don t necessarily receive better care, they do receive something that many believe has fallen by the wayside in recent years time with the doctor.

Concierge physicians limit the size of their practice so they can devote more time and attention to their patients. Most guarantee same-day or next-day appointments, give patients their personal cell phone number for off-hours medical issues, and even make house calls when the need arises.

Just like Marcus Welby

Steven D. Knope, M.D., a board-certified internist in Tucson, Ariz., and author of the book Concierge Medicine: A New System to Get the Best Healthcare, calls it "the Marcus Welby" model of care. "Concierge medicine is nothing more than private practice medicine. It s very similar to what people got in the days of Marcus Welby, M.D. The only difference is that people will pay a monthly retainer or an annual retainer for those services. But the real issue is that instead of having third-party payers and treating medicine as an entitlement, people pay doctors directly for their care. Which is what people did up until the time of Medicare in the mid-1960s."

While some concierge practices accept insurance and/or Medicare, Knope does not. His patients pay him directly and use Medicare or insurance for drugs, lab tests, x-rays, or hospitalizations. But Knope believes that costs are secondary to his patients concerns.

Frustrated with the system

"What patients hate the most is that they have no time with their doctor," says Knope. "The reason is that their doctor is only reimbursed a small amount for every visit and the only way to keep up with their overhead is to see more and more patients. It s against the law for a doctor to raise his fees above the Medicare rate so he can t charge an extra $10 or $20 to cover his expenses and the only way he can stay afloat is to see more patients, spend less time with each and deliver more superficial care."

Knope points out that patients are not the only ones who are frustrated with the current system. "Doctors are upset too," he says. "The message that this is a terrible profession is out there loud and clear. As an example, in 2007 only 2% of the medical school class went into primary care internal medicine because they refuse to do this job anymore."

When Knope first switched his traditional practice to a concierge practice, he says the local Arizona newspaper ran a headline that screamed, "This is boutique medicine at its mercenary worst." Nine years later, the critics have quieted and others are cheering. David S. Alberts, M.D., director of the Arizona Cancer Center at the University of Arizona, is one of Knope s patients and says, "I call him The Answer the answer to our dysfunctional, impersonal health care system."

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