My PCP did this so I changed doctors. I like the new one better and he is closer to home. Maybe I could see this if you went to your PCP often but insurance doesn't pay for the fee to join. You or your insurance are still billed for your visits.

My brother has a MDVIP contract, but at about half the annual cost you mention. And, his income allows him personal luxuries most of us can't budget for...He's a very busy man, has little time or patience to be sick, and the money to make his health care totally convenient for him. No waiting for an appointment, no waiting for a call back, he has 24/7 email/text/phone contact with his doctor and can be seen evenings or weekends if necessary.

My own primary care/encocrinolgist became so fed up with having to practice medicine under insurance guidelines, she joined Qliance Seattle for a while. I saw her there twice and paid out of pocket for the appointment - but because she has been of more help to me than any other medical professional in my lifetime. I also consider her a friend. I knew it couldn't go on indefinitely, not within my budget since I was paying for a policy for any other care outside endocrine at the same time...we have a small business and were buying insurance, not covered under an employers plan.

As it turns out, she moved to a very limited specialty when a hospital offered her a prestigious position, and loves it there. I did have to find other care as had been in my plans anyway - those couple of appointments had been 'a splurge'. I miss her ;)

Lindylu, my insurance wouldn't pay typical fees for office appointments, services at Qliance (Lifewise at that time, part of the Blue Cross network then) as per any other provider....I had a $3000 deductible to be met before they would address any fees there, and then would pay 50%. I had an 80/20 policy, $500 deductible at any health care that accepted Lifewise, Premera, Blue Cross that didn't apply to that type medical facility.

I look at the whole healthcare field somewhat differently.

I can even remember back to the days when insurance companies were substantially service organizations, and while not exactly non-profit, they felt a strong commitment to service for their clients' needs.

ole joyful

Many trends in medicine in recent years,

-VIP or concierge service. Primary care physicians tire of every day being a slog because of low insurance reimbursement rates for non-procedure office services. But they like what they do. The annual fee is a way to make more money and cut down the bulk. My wife's internist (a fabulous doc) joined an upmarket concierge practice - 50 families, $25K per year. He filled up in a week.

-Closing of small practices, docs joining larger group practices. Again, too hard to slog it out these days with insurance companies, running a business, etc .

- On a more limited basis, in some very upscale neighborhoods, some docs won't take Medicare patients. Some won't bill insurance companies. They say " Our fees exceed what insurance reimburses and we won't agree to a discount. You pay us, we'll give you paperwork to file a claim yourself. What they do or don't pay you is between you and them.

PS

joyfulguy, you're in Canada, no? It's not the same system, I think the scene for medical services in the US is very different, and in many ways.

Well I was thinking that a neighbor of mine who is originally from Canada, married a guy here, once told me that paying an annual fee for health care was pretty much the norm up there. I thought she said, she paid an annual fee and "we don't have to pay for anything". By that meaning visits, physicals, etc. I assume. I'll see her tonight at a dinner gathering and ask.

My doctor right now has 1800 patients! No wonder she can't spend much time with individuals. Altho scheduling appts. and getting in when needed really hasn't been a problem for me all these years. I understand the concept of the type of practice she wants to establish - based on wellness and prevention, esp. for people who go to the doctor alot or have chronic conditions. But I already pay a monthly premium for health insurance of $200+, I just don't see how I can afford the $1650. Even tho it was mentioned I could also pay per month - $137.

The worst part is having to find a new doctor. If mine is reducing her load by 1400, area doctors will soon be flooded with requests! And then there are the med prescriptions to transfer before one runs out of the med. Luckily (or not) I just began home delivery with 90-day refills. It was such a hassle to get it all in place, now to do it all over again with a new doctor. ugh.

In 1972 my DH and I started seeing an internist who practiced as Snidely describes. He was highly rated; never lacked for patients; collected his fee directly and gave the patient the paperwork to file for insurance coverage. We were still 'young' during the decade when he was our MD, but I doubt he ever accepted Medicare-adjusted fees. He was a highly regarded doctor. He was also a very wealthy man, heading the board of our local hospital as it expanded. (Now one of the two largest hospital groups in a prosperous demographic area.)

I don't know anyone who has an MD 'on retainer'. Although DH and I had some difficulty finding a good doctor in 2000, when most were in private practices, we had a wide choice of experienced, newly-hospital-affiliated MD's when we changed last year. (There are few private-practice doctors now, which is doubtless why schoolhouse and others are seeing doctors resort to the retainer plan.)

The US is increasingly getting 'managed care' -- managed to the bottom line of the bean counters in the health care and insurance industries. Other first world nations get 'managed care' as a government service. We spend more and are less healthy as a nation. I'm cannot understand why American voters (literally) *elect* to continue this way.

I had a wonderful primary care physician who moved to a concierge practice. Not only did he charge $1,500 per year, he required that you have a complete annual physical that was not covered under his annual fee. I had to find a different PCP as a result.

I live in an area where there is no shortage of doctors and hospitals; however, at the medical group I use, I need to schedule an appointment for a physical six months in advance. I hate that.

A friend of mine is enrolled in MDVIP and loves it. His doctor is amazing, and he gets a very intensive physical each year. He sees the doctor every few months, there is no waiting in a waiting room, and the visits are un-hurried. Referrals are made to very highly qualified specialists, and he gets to see them quicker than people not in this program. His doctor is always available by phone.

Yes, we had the same experience after our the family care practice we were going to elected to go the "VIP" route. Our doctor left their practice very quietly and went to a local Patient First (urgent care, no appt facility) We decided to follow him and have been very pleased. You can elect to see the same dr each time, it's the same copay, and tests (ie xrays, bloodwork, EKGs) can be done right on site. We decide when we want to go in based on our dr's schedule (posted online) and do not haggle with a front desk nurse to schedule an appt. Wait time is typically about 30-40 min and e have noticed no difference in the level of care.

Teabooks, I go to a similar urgent care, no appointment place. I love it. We've never waited more than 5 minutes before seeing the doctor, no matter which day or time we go.

Our 'new' MD had just moved to a hospital-based practice when we first saw her a year ago. Glowing reviews from former patients we know -- importantly including some people with serious or chronic ailments. No wait for an appointment; ten minutes in the waiting room. (This ay change as patients follow her.)

I've never really had a problem getting an appt. but the waiting time to actually be seen by the doctor has become ridiculous the past several years. I guess if you can afford it, $1650 is worth it not to wait.