The interview, such as it was, happened on the walk in from the doctor’s parking lot. As early morning approachability of doctors varies widely, one is especially cautious about starting conversations at this time of day.
He had recently changed his very busy Internal Medicine practice to a concierge style practice. Maybe because of this, he looked happy and rested enough to ask the question.
“How is your new practice?”
“It’s really good,” came the reply. Now the pause came, the brief ‘y’ in the road in which a mutual decision is made to talk more–have real conversation–or just move on to the morning duties.
He offered.
“It’s amazing how good it (his new practice) is…we (his other partner) went from over 3000 patients to about 700. We no longer worry about making enough money….I see about ten patients a day, and if someone needs to be seen it’s never a problem working them in that day. You have to be on call at all times, but this weekend, I only had a few calls.”
Here came the zinger. He thought for a moment and gave it to me…
“You know, the medicine is way better, like it should be.”
As we parted ways, I couldn’t help but to think of how much fun I had practicing medicine on this winter’s only real snow day. That is, snow in a southern state halves the number of patients to be seen. Concierge medicine seems to have succeeded in creating a snow day every day. Fewer patients equals better doctoring.
Fortunately, our family has little need for the services of an internist. But if we did, couldn’t I justify the cost of a daily designer coffee for the availability of a well-rested and happy doctor?
The purpose of publishing this impromptu interview with a recent convert to concierge medicine, is not to say retainer fees to doctors are the end all answer for our health-care delivery woes, but rather, to further illustrate this obvious conclusion: society cannot expect more care, better quality care and less expensive care. These are incongruent triangles, never to be justified.
I wonder what the future of health-care holds. Fewer young people will choose medicine as a career. Training doctors takes longer as the complexity of medicine expands exponentially. More middle-aged doctors will retire early. Doctors are increasingly moving to shift work, as the incentive to work themselves into an inflammatory haze are removed. All this while more patients enter the health care arena. And for some unclear reason, many seemingly intelligent people expect to pay less for more care.
I am not sure how Ivy league colleges teach economics, but at Hobart, we learned that if demand (of health-care) is on the rise, and supply is diminishing, the price does not go down.
Like parents in Harlem who enter a lottery in hopes that their children will be selected for admission to the best charter school, will there be lotteries and wait-lists to see the few-in-number best qualified doctors. Sure, like there are other schools in Harlem, there will be other health-care available.
But what kind of care will it be?
We will see.
JMM
Steve Parker, M.D. says
If I ever leave hospitalist medicine, sounds like "concierge" is the way to go. I got off the office-based primary care treadmill in 1991. Much happier ever since.
-Steve
Anonymous says
What's an ER doc to do? We can't fall back on the concierge model unfortunately.
Russ
Anonymous says
Dr. J — Your observation below is at once both cogent and banal, but seems lost on Mr. Obama and Madame Pelosi….
"Doctors are increasingly moving to shift work, as the incentive to work themselves into an inflammatory haze are removed. All this while more patients enter the health care arena. And for some unclear reason, many seemingly intelligent people expect to pay less for more care."
It seems you have highlighted the fundamental intellectual dishonesty of ObamaCare, the failure of which is as predictable as it will be tragic for what has heretofore been the most dynamic and innovative healthcare system ever invented.
vbm