Expensive. The fee you pay is only for doctor 'access' and you and your insurance still pay the normal fees for services.

Some include the physical, some include tests but not all, in the annual fee. Still not worth it?

When we were notified that our internist was moving on and opening up his own concierge practice, we were shocked at the fee to become a member.

I don't know all the particular but the $10,000 fee per person, or a discount if a couple joins, stopped me in my tracks.

The idea is that the practice is capped at 300 patients so he can give you individual care when you need it, without waiting.

I think if you have multiple medical problems that need to be managed, and if you can afford the fee, then maybe it is worthwhile. It wasn't for us.

Some practices are more like $2500 per person.

Morally obscene.

I think Lynn's husband's practice is set up that way.

A friend of mine is a patient in a concierge medical practice and loves it. There is no waiting in the waiting room, he gets an extensive physical each year and quarterly shorter visits, which are leisurely talks. He gets referred to specialists and then gets appointments with those specialists immediately. He has his doctor's private cell phone number and can call any time. The doctor either answers himself or returns the call within minutes.

Unlike other doctors who told my friend, "you are getting old and just have to live with that pain," this doctor explains the options and possibilities.

A practice I just heard about, and I haven't called to find out the membership fee, includes a physical, and other 30-minute office visits are $30 (which, coincidentally, was how much I paid for an annual gynecological visit 30 years ago, under regular insurance, not a co-pay, not on an HMO or PPO).

I was talking to my doc at Georgetown U. Hospital several years ago and told him he could never retire (we are the same age, so he will, I fear). I told him we would even pay extra if he ever decided to switch to the type of practice in the OP. He was adamant that he would bever do that. He felt it just wasn't the way medicine should be practiced. I adore him.

We did it a couple of years ago when our (young-ish) family doc went this route. We really like him for one. It is $1500 each and we do get a yearly physical which is very comprehensive, no waiting in the waiting room (time is money IMO). In fact there is a separate room for concierge patients. We have access to a nationwide network of physicians while traveling. And yes, he does spend much more time with us when we see him, for any reason. If he thinks we need a specialist, we get appointments right away. This was one reason he went this route. He wanted the ability to give more one-on-one care.

I looked into it about 6 years ago. If I recall correctly it was going to be $1800. I decided to try a regular practice recommended by a coworker first, then if I wasn't happy I'd revisit the concierge idea again. I found a great female dr in the practice and have been happy with her so it worked out.....and has saved me over $10,000 in oncierge fees thus far.

I already did the medical payer rant thread. This one is practical.

I am definitely rubbing elbows (here) OUTside my tax bracket for sure! LOL

I don't see where the inequality is (I must have missed something too). If you can afford it, who's business is it you have premium quality health insurance. What is the difference between that and being able to own a luxury vacation cabin in the mountains of Montana complete with a stable full of horses (sigh)? It's your money, you worked hard for it. I can't afford it (nor can I afford to own a luxury vacay cabin in the mountains of Montana (complete with a stable full of horses) but I would never deny anyone else to spend their money any way they want to :)

... because quality healthcare in the world's supposed best nation shouldn't be based on who can afford luxury vacations and stables of horses.

There is quality healthcare and there is healthcare above and beyond for those that have the means and choose to spend the money on it.

I think it is a great concept for those patients who need a little more hand-holding, or busy executive types who could benefit from the "off hours" that a concierge practice can provide. My Dh works billable hours and cannot abide sitting around a waiting room. He would love to attend to his medical needs early morning or in the evening. And I am grateful we live in a free market economy where someone determined there was a market for this & provided it.

I am grateful we live in a free market economy where someone determined there was a market for this & provided it.

Yes. This.

Fo those arguing that this is somehow wrong, I suppose we should also abolish organic foods because organic is more expensive than non-organic foods and if everyone can't have this healthy food option, then no one should!

Better get rid of gyms you have to pay for too, because if everyone cannot afford something related to health, no one should have it! And vitamins. Not everyone can afford those.

There is not even anything to say these concierge medicine doctors provide different types of medical care... just that the patients get more convenient or better customer service. The person getting drugs from the Medicaid doctor gets the same drug as the person getting them from the concierge doctor, he just may not get the same level of convenient customer service.

Even in countries with single payer or socialized medicine, those who can afford it can and do pay for better medical care. It's a fact of life in every single aspect of life that people who can pay for better are going to get it. There is no getting around that.

And, sometimes, when rich people pay for costly experimental treatments not covered by insurance, that's a good thing because otherwise these treatments might not be done enough to eventually make them mainstream and thus more widely available even to the non-rich.

I guess in the other direction, if you think of health care as a human right, if the rich and powerful can opt out of the regular health care experience they have no motivation to fund (most importantly) or improve the system for the non rich. Similar to education and private vs public schools. I think it's a bit chicken and egg...in Canada public schools are good and the rich by and large choose to send their children to public schools thereby ensuring the public school system still has political clout and there is some pressure for funding and accountability ensuring the schools stay pretty good. One factor influences the other. If our schools were terrible the rich would find a way to flee them.

in Canada the specter of "two tier" health care (easy access and no waits for the rich, crappy service and years-long waits for the poor) is all of: political hot potato, ostensibly taboo, already happening, already diverting resources from the public system, increasing wait times in the public system.

Not sure why a concierge medical practice would be considered morally offensive. As beagles mentioned even in countries with a form of socialized medicine there are still private physicians and private hospitals. I don't believe that the relatively small number of concierge medical practices effects the overall quality of medical care.

But robo, HOW are you ever going to stop the rich and powerful from opting out? You cannot.

Even if you ban private insurance AND private pay (which I don't think ANY country has done?) then rich people could just fly to another country to get the care they want.

The statement that everyone has a basic right to healthcare is an argument that sounds really good, but it isn't that simple. There has to be some rationing in every single system, whether the government is the one doing the rationing by deciding what they will or won't pay for and for whom, or whether the rationing is based on who has more money.

What about pills that cost thousands and extend life for a few days, or a few weeks, for example? A rich person could afford to pay exorbitant sums for this medication which will let him live a month longer... but should the government guarantee that a person who cannot afford this care on his own MUST get it, even if it strains the system and makes it impossible to provide basic services for others? Or should we say the rich person CANNOT buy it unless everyone can have it?

I'd rather pay for concierge hair care....

I disagree robo, because those of us who CAN pay are not necessarily opting out of other health care plans (we still have the same plans) just opting IN to the concierge care by our family physician. I HAD to go on Medicare when I reached a certain age and I pay a hefty premium for it because of my income versus what one had to pay for it at a lower income. That's fair. I also have secondary insurance because of my previous Government service (and even tertiary, thanks to Uncle Sam and my husband's military service).

No, not everyone is in my shoes, but I've paid more than my share to keep a lot of other people insured along the way. Fair? no, maybe not from my perspective that I have had to pay for something 'I' didn't receive. I'm healthy. That's what matters to me. But I learned in 1st grade that life isn't always fair.

I don't think the OP intended for this post to get into health care in general. So let's get back to concierge care and is it worth it. To me it's worth it for now. It's not for everyone and it should certainly not affect quality of health care. To lump 'concierge care' in the same category with 'quality of health care' is just wrong. Same doc, same care. I am just guaranteed a directly line to him should I need him.

In Canada the general policy position has been to forbid and/or discourage queue jumping if a parallel service exists in the public system. So if you realllly want to do something and don't need to wait you may have to fly elsewhere. On the other hand I do private healthcare for fertility treatments because they simply aren't available in the public health care system and there are private MRI providers etc. So we have kind of a mixed system. I think we may even have a few concierge family physicians although they tend to get shut down. There was also a scandal in AB because concierge doctors were getting their private (rich) patients pushed to the front of the public colonoscopy queue.

http://www.ctvnews.ca/concierge-medicine-a-controversial-trend-in-canada-1.678239

http://healthydebate.ca/opinions/alberta-physician-regulatory-college-makes-the-right-move-to-address-private-medical-imaging

Rationing definitely exists in our system in terms of diagnostic imaging on demand. In fact the availability of private imaging providers is predictive of longer wait times in Canadian provinces (the provinces with more private image providers also have longer wait times in the public system, unsurprisingly).

On the other hand we have a lot healthier population with better outcomes for way less money overall than the US so...guess something is working.

How I understand it is: These are docs who were fed up with pushing patients through as fast as possible, seeing them for a couple minutes only and then doing hours of paperwork for billing each night. The docs I know in concierge medicine wanted to be doctors again..... spend quality time with their patients, really get to know them and try to solve their problems. They wanted to be available to them to help without having to worry about needing to spend their time crunching through patients/paperwork. So, the docs get paid a certain amount as a monthly fee for being available to these patients. That's their income. Depending on a patient's personal health situation and needs, I think there can be situations where concierge medicine financially is a sensible option and/or not necessarily more expensive. FYI -- each clinic is completely different. Some charge $60/month and then something like $10/visit. Obviously, there are some with much higher retainers..... I read one article that said most patients pay under $135/month, though.

Very interesting. I don't know of any concierge groups/doctors in my area. I am going to have to investigate that. I don't think it's something we would be interested in at this point in time as we have an internist we are extremely happy with and would not want to change. However, if he were to go into this type practice - we would definitely be considering it!

Interesting, lolauren. There was a big push for concierge practice around here a while ago, but mostly from GPs who had trouble retaining patients otherwise. Understandably, they didn't make it as concierge practices, either.

Most of them now run sober homes/do drug "treatment" instead.

I suppose if you use a lot of health care services it could be a plus. Around here it's more than $1800 to join. A lot more.

I think that separate waiting room idea needs work.

I say bring on the robots. Most of the health care I've used over the past 20 years could have been provided by robots which would free up doctors for more serious work and lower prices for routine care.

This year getting my numbers done (cholesterol etc) and 10 minutes chatting with the PA cost $600. That's worse than the vet.

I think that separate waiting room idea needs work.

Not a good visual.

I did find an article from earlier this summer that this is coming to our area. However, only one doctor is mentioned but it doesn't sound like a bad thing. When I google for concierge doctors in the big city near me, I don't get any hits, however.

http://www.wbir.com/news/local/concierge-medicine-making-its-way-to-knoxville-1/244129867

I haven't used concierge services, but I have used practices that didn't take insurance for my wack-a-doodle thyroid.

After being told by at least four physicians of various specialties that they could tell something was wrong, but were unable to diagnose it I went to a practice in Los Angeles specializing in fatigue and autoimmune. The practice has a lot of press and support from prominent thyroid activists.

They were able to diagnose the problem and start me on treatment. I went there for two years, had three different doctors because they kept leaving the practice. And because it is LA, turns out they had a lot of "anti aging" folks and really pushed a lot of product.

Appointments and meds were twice what I pay now, even with compounded meds that are not covered by insurance. I was fortunate to find an endocrinologist who, while he didn't think some of the prior blood work was necessary, he follows the same med protocol at a more conservative rate.

So how do I feel about the experience? I was grateful to get a diagnosis and treatment. Having down time out of work is not an option for me. it was expensive, but I had the means to pay for the services.

BUT, I ended up with a lot of concerns about the doctors themselves after asking some questions that they should have known the answers and did not. I felt like it was a money grab for them and the quality did not justify the expense.

That being said, had I not found a traditional practice to take over my treatment, I might still be with them out of necessity.

(Sigh!) Part of me wants to avoid this thread like the plague, because I don't want to get embroiled in any heated discussion where unkind things might be said by people here I care very much for. But, having been in the medical field now for well over 30 years, and seeing it from every angle: patient, employee of hospitals, doctors' offices and clinics, and being married to family practice physician for 33 1/2 years now, I know what I'm talking about. 31 1/2 of those years, my DH was in a happy partnership with another great doc. This guy retired 4 years ago.

I'm a good doctor's wife. I'm in the business myself, so I understand the long hours, patient and hospital demands. As co-owner in our clinic, I also very intimately understand and deal the high cost of owning and running a busy, private medical clinic. Just the day to day expenses are mind-bogglingly.

Two and half years ago my sweet, smart, wonderful physician husband was exhausted and swamped with work. His patients loved him and with good reason, he truly cared about each and every one of them. This is not BS, but the honest truth. But, it was tearing him apart. He was putting in 12 hour days at the clinic and then coming home and spending 45 minutes eating dinner with me before heading into his study to return patient calls, dictate charts, call in RXs, call and talk to specialists about referrals for his patients until 11PM or longer. Monday through Thursdays, always, and then most every weekend afternoon, as well, he worked in his study, as well. But, he was frustrated. Frustrated with what the medical field had evolved into. Seeing patients every 10-15 minutes, and not being able to really sit down and talk to them. Most docs these days can't afford to own their own practices. It's too expensive, and time consuming. So, they instead go to work for clinics and urgent cares that are owned by FOR PROFIT hospitals and corporations. They need to make and show profits for their investors. They bring in nurse practitioners and PAs, too. Most "caregivers", the new word to lump them all together, don't see the same patients every time. There is no continuity of care. To make more profit, caregivers are forced to see one patient every 10-15 minutes. They are not allowed to order certain tests or RXs. On the other hand, urgent care caregivers, are often forced to order many tests the patient doesn't really need. Why? Because they don't know you. They get a bit of history from you, but nothing very detailed. They don't have much time for a long, detailed visit, and need to cover their butts against lawsuits.

DH could have retired. He was old enough. But, he isn't in it for the money or the prestige. He truly loves being a doctor because he loves helping people, and he's very, very good at it! So, he looked at what he could do that would not exhaust him and still practice good, satisfying medicine. A hospital owned clinic or urgent care was out for obvious reasons. And then he started looking into alternative medical practices. And it clicked. A somewhat concierge-type practice. You cut your patient population drastically, to a few hundred. Every office visit is 30 minutes long. This way, for example, if you're seeing someone for a sore throat, you can do that in 10 minutes. And then, you listen to their heart, lungs. And sit down and talk with them for the remaining 20 minutes. "How are things going? Any health concerns or new problems? How are things going at work? How's Martha and the kids? I see that you've gained a few pounds. Let's review your last cholesterol test . . . and talk a bit about what your diet is like these days." DH and other docs like this are discovering medical problems in their very early stages because they now have this extra time with each patient. And there is Total Continuity of Care with this type of practice. This is a very, very big thing for a patient. There are no multiple docs, no PAs, no NPs. You see your own physician every time. You have a question or a possible medical problem and it's after hours, you call your doc on his cell phone. No answering service. No other doc or nurse on call talks to you. Your doc answers his phone. On weekends, holidays, at three in the morning. This saves you, the patient, a whole lot of time, stress and money, especially if you were thinking of heading to an urgent care. Most of the time, your doc can tell you how to handle it at home, call in a RX if needed. And, see you if needed, that next morning first thing at the office. Oh, and that's another major plus. Patients are seen the day they call or the next day 98% of the time. We know personally a wonderful 81 y/o gentleman who had influenza and called his (other ) doctor. They couldn't get him in for 2 weeks! He called the local urgent care (in Rio Rancho, NM- big town, not small, with lots of people, 1 or 2 large hospitals and many urgent cares) and the urgent care actually told him he would have to make an appointment to be seen . . . but not that day, maybe the next or the day after that! I swear this is the entire, total truth!

Our patients are never, ever turned away. Yes, there is a cost. It's about $1,500 a year, but this includes the most comprehensive annual physical imaginable. DH has a longtime patient that is one of the heads of a major, major international investment corporation. They offer their executives a yearly physical like this, but it is no better and in some ways less than ours is. Ours, BTW, is through the renowned Cleveland Heart Lab. He opts for ours. In most annual physicals, they do 3-4 tests for cholesterol. Ours does around 30. This is just one example. With such minutely detailed tests, my DH can detect very, very early signs of heart problems, diabetes, some cancers and so much more. So, how much would just a physical like that, with many, many labs tests, EKG, chest x-ray, eye exam, strength tests and measurements, vein and artery testing, and measurements, pulmonary function test for your lungs, etc., etc. cost you every year? Just that one thing? This is covered in our practice. And, finally, what is a practice like this worth to someone in their forties, fifties and up, when the reality of not-so-great test results start coming back and we finally face the facts that some things are on the downside physically? It's value is in Prevention! Being able to take that time with each patient and you find, prevent and treat things so much better. Oh, and patient's kids are seen free up until age 25.

Yes, I wish everyone was able to have this kind of care. Everyone deserves it, but this is the real world reality in this country and in this day and age. And, BTW, we have many teachers and average income folks in it. In fact, most of them are average income earners. Some people thought that my DH was going into this kind of practice to make a lot more money. (LOL) Nothing could be further from the truth! Our income has gone down significantly!

He still comes home tired many nights, but he loves this kind of practice. He loves the extra time he has with each patient. He loves that it's helping him catch things early . . . or prevent them in the first place, and by teaching healthful eating and exercise. That's where I come in. You know how he describes it? He always tells me, "This is the way medicine was meant to be practiced. I'm just so glad that I now have this opportunity, and can pass it along to my patients!"

I am, too. If you're not, this is your choice, but I will not hear any criticism of my wonderful husband and the choices, and huge sacrifices, he's made.

I have an elderly relative who is fortuneate to live in an area where concierge service is available. His Dr. visits him in his home and a nurse comes to him for lab tests or minor issues. It is a fantastic service. He doesn't get exposed to other sick people and he gets care that he would not get if it were up to him to leave his home for it. I think he pays $250 a month which is a bargain for the service he receives. He will likely be able to live in his home longer because of it and it prevents emergency room visits.

I wish there had been something like this when my children were little and sick.

I would totally do that Lynn.

Standard medical care in Southern California took ten years to diagnose my thyroid. Ten Years. Having to battle doctors and argue with them is not a positive environment for patient or physician.

When I'm pursuing a problem beyond the standard stuff, I start every new doctor off with the question "are you prepared to be my advocate through this"? Some are taken aback while others start speaking to me differently. And I have excellent coverage and access to many good doctors.

Don't shy away from the value your DH brings.

Lynn, thank you for taking the time to comment. Years ago when my DH was considering (and ultimately made) a career change, he threw out the idea of medical school. I said he'd have to find a new wife because having worked for several physicians I'd seen up close and personal the long hours they put in, the stress involved for both the physician and the spouse, how much time medicine takes from families, etc., and that wasn't what I'd signed up for. Everything you said is exactly what I witnessed when working in the medical field.

I say thank you also Lynn for sharing your perspective. Kudos to your husband! His patients are very lucky to have him.

LisaD82, my analogy wasn't basing quality healthcare with those that can afford non essential luxury lifestyle amenities, altho, I would tend to place concierge medical care in that category. I'm not saying that healthcare is "non essential" but that LEVEL of care most likely is. But for those that can afford it, feel it's worth it and have the means to pay for it, that's great! I don't expect every American to be privy to it tho! Concierge medical care isn't the only "quality" medical care available. It's just a level of care made available to those that choose to pay for it.

My husband had open heart surgery last year. The clinic we use and the hospital they are affiliated with are not for profit. The clinic is for WORKING people that do not have insurance and you pay office visits, tests and even surgeries based on your income. This is a faith based organization. That's right, we don't have medical ins. We used to but the cost of ins when you're self employed got to be too much and with all my health issues, we were going to be dropped anyway.

DH's Dr decided he needed a stress test. An appt was made at the affiliated heart hospital (a new state of the art facility). Stress test was nixed as soon as his bp was taken. He was whisked upstairs for a cardiac cath and scheduled for double bypass the next morning :o And the biggest blessing of all was the Dr that performed his surgery. The #1 heart dr in the heart hospital. He treated David (all of us) like royalty. He had the heart of a servant. The entire hospital did. He does a procedure where he does not remove the heart (or put it on a heart machine) It's better on the heart and recovery time for the patient. If it wasn't for this church that offers medical treatment for patients that WORK full time but with no ins, he may not be alive today. Before finding them, we paid out of pocket but it was more than what we pay now for office visits and tests. Most (if not all) clinics/Drs will accept a reduced rate for private pay patients. DH had quality care medical treatment above and beyond what was expected from housekeeping to admissions to his wonderful surgeon. A++

Lynn, thank you for writing so eloquently about your DH's and your practice. It pretty much sums up what our family physician, who is much younger, also faced when he went this route. He invited all his patients to a meeting about it where he spoke about the type of medical care he wanted to provide and then went on to describe the concierge services. We signed up that night. Some didn't, but he (and his 2 partners) retained some non-concierge patients. I forget the percentage, but it is small.

You are right. The physical we receive is the most comprehensive ever.

Thank you. What I neglected to say earlier is that so many doctors feel the same way as my DH does.

Lynn, to your point, we have physician friends who strongly discourage their children from going in to medicine particularly over the past few years.

Of course we'd all pay for a doctor like Lynn's husband if we could afford it. But many of the people in this country who most need to spend 30 minutes with a doctor and all the other luxuries that go along with it cannot afford this. Namely those who lack daily resources to maintain their health and have access to only baseline services when they need them.

We all pay, though, for their lack of access. In one way or the other.

Lynn, that was very interesting. Thank you.

Lynn, thank you for presenting the other side. I know that if my dr decided on a concierge practice I would most likely follow her. I have to say that the practice she is with is large, maybe 10 physicians, but I think it is very well run and that makes a big difference. They do schedule patients every 15 min but I never feel she is giving me the bum's rush. Likewise, I've never waited more than 15 minutes to get in. If I call with a sudden ailment, like a UTI for example, I can usually get in that afternoon or the next day to see a PA, which is fine with me.

Concierge practices have always existed for the wealthy....i.e...celebrities aren't showing up at the dr's office, presenting their insurance card, and taking a seat in the waiting room. Like most things that start off for the wealthy only, this idea is now trickling down to the masses. I think it's good for the dr and patient and harkens back to the old days when physicians came to your home, which I remember! Unfortunately, many people just cannot afford this type of service.

Very interesting - I have no experience with concierge medicine other than a brief conversation with DH's cousin who is an internist and spent some time in a concierge role within his clinic. He wasn't in favor of this role and eventually left that organization - could have been an entirely different situation than what Lynn describes.

I guess I should feel very fortunate that my annual physical with my internist next week is scheduled for 40 minutes. I'm very happy with the non-concierge care I receive but concerned about what happens when my doctor retires. I tried to find a different doc when I moved but all the ones I preferred weren't taking new patients. I do think we're heading for trouble with fewer docs going into primary care. Many in the health care system I use are now from other countries and I have no problem with that except when I can't understand their spoken English which has been the case in the past. Fortunately at that time there were other choices and I could switch to someone whose English I could understand.

Thanks to all for insight, opinions, and observations. I didn't mean for this to be philosophical debate on the ethics of paying extra for customer service, but rather am looking for people's personal experiences and whether it is a good value for them. Given my age and family history, I think that it is something I personally might strongly consider. My BIL has a concierge practice for all the same reasons as LynnNM's DH, though in a country with national health care. The pricing is something I'd need to research.

Unfortunately, many people just cannot afford this type of service.

And therein lies the crux. Great for those who can; too bad for those who can't.

My nephew, a top cardiologist, just did exactly what Lynn spoke of and is extremely happy with the outcome. He is a father of young children and has more time with his family. Yes,he and his wife, who is also a surgeon,make less money but are soooo happy.

Lynn, thank you for your very thoughtful, thorough comments. We belong to a type of concierge practice, and I very much like my physician, but I am less than thrilled with how my annual exam goes. I used to work in a very good internal medicine office & was privy to how they did their patient's annual exams which were so much more thorough than mine is. I would call mine cursory, and that is disappointing. She doesn't, for example, check for bruits in the carotids, no type of neuro eval, just heart, lungs, abdomen, & the rest is lab work. Haven't decided what to do about this yet, but don't fuss about it too much because being a retired RN, I can pretty much apprise her of any specific concerns, but I wish the exam were more thorough. I also wish she had office nurses instead of physicians' assistants. My former rheumatologist had an office RN & she was fabulous. I so miss them, but the Dr. retired, mainly because of how she was being forced to practice medicine...a great loss to her patients.