is this is Canada? I have never heard of it.

Yer MD ... becomes a V I P ... did (this furriner) hear ya say?

ole joyful

One of my previous physicians went to this concierge type service, I did not join it. She restricted her patients to only those who joined. It was no substitute for insurance, and specialists would be seen according to the insurance one had. It was more a way for her to spend additional time with her patients and less time filling out paperwork for insurance companies. If one joined the annual fee was a sliding scale based on age because of the expectation that older patients would have more issues and need more time.

It entitled one to email responses from the doctor as well as extended visits and telephone access.

My mom is in Florida and received a similar letter from her long time provider. I think they called it "Concierge Treatment". She's looking for a new provider.

I have heard of if and thought that it is a great way for a doctor's office to gain revenue without really doing anything. When you call for an appointment in most offices if there is an opening you are asked if that is the time and day that you want. Which means that opening is the first available. Unless a doctor blocks out certain times and dates for this service for the purchasers there is little difference between the current service and this type of plan. There are some doctors offices that will only accept patients that pay this premium.

The question to ask yourself before spending your money is would you benefit more than just calling for an appointment and accepting the first available. Paying a doctor for an appointment just seems wrong to me.

My internist became an MDVIP concierge doctor about 5 years ago, and I stayed with him because he's such a good physician. As concierge prices go, $1,800 is not bad: many doctors charge $2,500+ around here.

Because he sees far fewer patients I can be seen the same day or at the worst, the next day. And you can call him on his cell any time. He spends 45 minutes with me at my annual physical, and has referred me to top specialists when necessary. And without going into details, his attentiveness saved my life. So I'm happy to pay the fee!

My brother has that type of concierge type physician. I don't know what he pays.

My endocrinologist who was acting as my primary care joined that type of practice. It was the year she lost her father, and I know she was frustrated with how many patients per day she needed to see, how much time she could allow each per insurance, wanted a change.

I could still make an appointment with her for $150 out of pocket and did that a couple of times without joining. I don't remember now what the annual amount was (was about 10 years ago). Having our own small business, I was already paying private monthly premiums and that wouldn't have changed. I just looked back at my accounting program and in 2009 I was paying $1404.00/mo for the two of us and another premium for full coverage for our employee. I couldn't rationalize paying more.

Shortly after, one of the major hospitals offered her job as head of neuro-endocrin and she took it. The concierge group she had joined has closed and no longer exists.

" it keeps their collection accounts down to a minimum because their clients have already proven they can afford to pay."

Few physicians in group practices, and probably almost none in the remaining private practices, see patients with no insurance. The clerical staff takes your co-pay and insurance info before the appointment. No pay, no appointment. There's no further collection activity needed other than the billing (done electronically) to the applicable insurance carrier.

In my area, it's called some variant of a "concierge practice". It's usually some form of primary care practitioner - internal medicine or fam practice. These are the ones whose average earnings are SUBSTANTIALLY lower that docs who do "procedures" of one kind or another. That's where the bigger bucks are. Many PCPs do feel it to be a calling. The concierge approach allows them to spend more time with patients and earn more money, both wins for them. For patients, it guarantees priority access. There's nothing unethical about it, most of these docs have been slaving away for arguably substandard pay for many years, they want to make more money. That's human nature. And getting better service for a higher spend isn't unethical. That's how the rest of our society works for almost everything except public services. And it works that way even for some public services - an example is paying a charge as a solo driver to drive in the HOV lanes on a busy freeway at rush hour. Is that unethical too?

In the SF Bay area, the annual fee for concierge practices seems to start at around $5000 and moves upward. Many will bill insurance for you but don't accept it because their charges exceed the area's going rate. Many of the better and more highly skilled dentists are the same.

I heard of one very highly regarded internist who was going to accept 40 families into his practice and that was it. The fee was $40K per family per year. His book was full two weeks after the announcement.

++++++++++++++++++++++++++++

Bookwoman,

Other than people in an HMO, there's usually no need for a referral to see any doc. You can take yourself wherever and to whomever you want.

Elmer not understanding wherever and whomever in regards to this as some of those may also only accept patients who have paid a fee. Several thousands to see a series of doctors each requiring their own up front fee, not charge, should mean that only a few seek treatment.

Sorry, maifleur, it was a comment to a different person that I put in the same post of mine. I didn't make it clear.

Someone else had said that her doc referred her to "top specialists when necessary". My comment was, stated in short hand - "Unless in an HMO, everyone can take themselves to any doc they want. Referrals are rarely needed".

I tried to edit it lightly to make the thought more understandable. Thanks.

Thanks, Elmer However in this area some of the specialists, allergy in particular, you must be referred by your physician. I think it is to weed out patients that think they have allergies that do not and to provide the specialist the patients current medical information. About five years ago I wanted to be retested and was told I had to have my doctor refer me to that office.

So if you pick an allergist and tell your internist you want a referral there, the answer may not be "Sure, no problem" ?

I was just saying, you can pick your own and go wherever you want. The formality of the process (sounds odd anyway) doesn't change that. I've never heard of such a thing in my area.

I called my ENT two years ago. Made an appointment. Went through, "address is the same, employer is the same, insurance is the same ... blah, blah, blah ... "

Got a call back the next day, "What is the reason for your visit?"

"I have a sinus infection"

"How do you know?"

"I get them every few years"

"Who referred you?"

"I've been a patient (of ENT) for 25+ years"

She says, "No referral, no appointment" and hangs up on me!

Took me two months to be diagnosed with cancer.

Had to get an appointment with a general practitioner, who referred me to another ENT, who took a biopsy, and referred me to a cancer specialist, who was in the same office as my original, long-term, ENT.

In this area, you don't "pick your own and go wherever you want..."

I am trying to get an appointment for a root canal now. That's like pulling teeth. Made an appointment with my dentist, got there, he's retired, step-son took over the practice. He spent, at least, 45 minutes, trying to "upsell" me on teeth whitening, some kind of bone graph thing, before telling me I needed a root canal. His office made the appointment. The endodontist (sp) called today to make sure I understood that what my insurance didn't cover is due and payable before the procedure!

(She was pretty blunt about it!) I wanted to ask if a pig and six chickens would cover it. Didn't think she would get the humor!

This practice has much less to do with “quality care” and everything to do with money.

My doctor and I actually spoke about her plans for a concierge practice prior to her decision to go ahead with it. She is the mother of four girls and was very much into giving them time, as well as giving her patients time. She was frustrated by her then current office practice that scheduled too many patients per day, which did not give her the time to spend with patients and also led to late work days as she had to do her part in the insurance paperwork.

I can see in this day and age looking at everything with a jaded, jaundiced eye, but at least for my doctor I felt her motives were patient and family oriented.

Geez. I've never heard of this... yet! This is a yearly fee?

A friend of mine has this service and loves it. The doctors who are part of the program are highly credentialed. My friend gets physicals that are much more detailed and with far more tests than I get.

Forgive me if I don't explain this accurately, but my friend had been told years ago that he had a false-positive reaction on TB tests and to essentially ignore it. This doctor didn't accept that theory and suggested he go on a drug regime for almost a year to rid his body of the antibodies (?). The reasoning was that should he later in life need chemo, he would not be at risk of developing TB.

In addition, the doctor is available to him all the time by phone. When he was in the hospital having his gallbladder removed, the doctor visited him three times - the nursing staff and the surgeon commented on the attention he got from his doctor. If I lived near him, I would sign up for this service with his doctor. There are no MDVIP doctors in my area.

Other than people in an HMO, there's usually no need for a referral to see any doc. You can take yourself wherever and to whomever you want.

Elmer, yes, of course you're right. I should have used a different word than 'referral'; what I was trying to say is that my doctor has steered me towards the top specialists in the area. He's a gem.

Lucille, of course there will be exceptions to the rule, but trust me, I am not looking at this with a jaded or jaundiced eye. I’ve worked in the field now for many years and am in an average of 15-20 clinics per week. I talk to physicians and staff all the time. I hear the complaints and concerns. The system as a whole is broken and the whole model for clinical care is changing but if all the doctors started charging a huge annual fee to guarantee care that we’re already paying for, it would basically end up separating the priviledged from the not so priviledged and then what? Retirees, the disabled and/or those with chronic illnesses will be at an even greater risk. The insurance costs are just a fraction of the financial burden put on patients, when you add the costs of medicines, diagnostics, labs and/or hospital care that couple thousand a year is more than unrealistic for a large majority of the population.

Only a comment on the false positive on the TB test. Anyone that has been exposed to TB which is almost everyone of a certain age will test positive to TB because they were exposed to it and have the antibodies or the virus in their system. It was very common until the 1950's when new treatments and people started to rely on dairy's that tested their cows for it. I would not rely on any doctor who would think this nor people on here that have had positive TB tests over the years think they need active treatment. If they have concerns after testing positive they need to talk to their own doctor for reassurance.

Graywings, don’t you believe that ALL people deserve that quality of care? This trend is a symptom of a bigger problem, instead of putting a temporary bandaid on it that only puts people with less resources at risk.

My husband's aunt was doing this 20-30 years ago, so I don't think its new. I have heard it referred to as concierge health care.

Oh, yes, I believe all people deserve quality health care. Even people without health insurance. Even people who are in this country illegally. But the reality is that health care and just about everything else in life is not equal and fair. When I broke my wrist in a fall, I had to wait two weeks to get on the surgeon's surgery schedule. Then Secretary of State Hillary Clinton broke her wrist in a fall, and she had immediate surgery. (By the way, I voted for her).

Regarding the anti-TB drug regime my friend was on, the doctor had tests done before suggesting the regime, and the decision was not made lightly. My friend had to have his blood tested regularly to make sure there was no damage to his kidneys (or was it his liver?). He knew he had been exposed to TB through an office co-worker.

Maifleur you are correct. All students in my school district were tested for TB, and some were positive. The positive ones went on to get X-rays, and if those were negative they were not treated but often had a follow up exam 6 months later. Many exposed people will have antibodies but never develop TB.

I am appalled by the health care available in this country. It really is about the the haves and the have nots. I will likely leave and go back home in a couple of years. I would rather stay as my children and grandchild live in this so called great country. Only its not so great anymore, most especially for poor people. I happen to be one of those poor people these days.

DH and I have had MDVIP with our family physician for several years. He and his practice went that way together but maintained an option for a certain percentage to stay with him as non-concierge. We never have to wait in the waiting room more than a few minutes, have almost instant appointments, either same day or the following day, get a very thorough physical each year, and have access to MDVIP physicians in other cities when traveling. There are some other perks I can’t recall right now, but the website has wellness tracking tools and other updated medical info that some find useful.

We love our doctor. Similar to what Lucille said, he mainly went this direction to spend more time with his family and with his patients. He does spend a lot of time with us and explains th8ngs in great detail, makes wonderful recommendations as to our health and explains why, and has referred us to outstanding specialists. He also works one day per week as a hospitalist in the nearby hospital. He went to high school with our DD, and has shared many times that a family practice doctor is far from wealthy these days. He does great, don’t get me wrong, but with 4 kids, he is comfortable, but by no means living outrageously.

It works for us. But it may not be for everyone and that is clear.

Louise, many agree that more people should have healthcare coverage. But many others don't support the idea. In the meantime, I don't think anyone who can afford things in their life (as at a middle class level) that others can't need to be reticent or feel ashamed about any aspect of their lives. I certainly don't. Neither our society nor any other levels income and net worth among its citizens so there will always be haves and have nots.

Healthcare aside, in which country do you think poor people can lead a comfortable life? I don't think there are any. Be as angry as you want but the problem you describe is being poor, not what country you're poor in.

Diagnosed something over 10 years ago with varicose veins prescribed pressure socks.

I'd started to make a list, to point to another issue ...

... but ...

... this thread is dealing with M D and V I P, so it's only fair that I take my story to its own thread ... (which thread might involve some needlework?).

ole joyfuelled ... most of the time

More and more Family Practicioners and Internists are going to Concierge Service practices. I have friends in another city/state who have used this. It's very expensive - $5000 a MONTH for the two of them, but everything is included - lab work, x-rays - you name it. The doctor no longer takes any insurance, including Medicare. They have been very happy with this and have used it a great deal - orthopedic problems, cancer, auto-immune disease - you name it. Most of us could not afford such, but if one can, it's great.

Nearly all my doctors are in clinical practice at our local med school. They have a very small office patient load and can give one a lot of time with a short waiting time. The downside is if one needs to contact them - they only see clinical patients in their office 1/2 day a week. Getting the phone number of their "assistant" is vital - she can always reach the doctor.

bengardening - Not in Canada. But we do each pay $125.00 per year to each of our GPs in Ontario for "other services" - none of which we have ever used. Of course our health care is very difference from that in the U.S. But we do pay our fee to help out our excellent doctors. It is not required and does not cover everything that OHIP does not pay for - but does cover some things.

My doctor recently decided to switch to MdVip. I've been with her for 23 years and she's been a phenomenal doctor. After other horrible experiences I've had with other doctors, I decided no way I'm losing her and I look at it as gift to myself. Her fee is nothing near what others here have mentioned. Since the change, I have experienced no wait time to see her. I can get in same day and the time spent with me is much longer. I have access to her 24/7 if need be and she will make house calls.

Elmer, being "poor" in this country is quite different than being "poor" in other countries. Being poor here means I will die before my sixtieth birthday. I would rather stick around for a bit longer. Sadly, it will be elsewhere.

Louise, wonder where you are from? Read an article today from BBC earlier today, can't find it now, where a man made it to his mother who had fallen something like 8 hours of travel for him...got to his mom before the ambulance. She fell and broke her hip and laid there all that time. I tried to find the article and found multiple stories from the UK, Ireland and other countries where people waited 3 to 7 hours for an ambulance. I've never heard of that happening in the U.S.

I guess I never realized how blessed my family is with good health.

I can't imagine paying thousands of dollars a year to have access to a doctor in a timely manner. What?!?!?

I decided this year I should get myself a GP as I am in my mid-30s, and aside from the ob-gyn during each of my 4 pregnancies plus my yearly check up with them, I have not really needed a doctor in years!!

Two years ago I was sick with an upper respiratory infection over Christmas break and I went to urgent care. Prior to that, I stepped wrong on my foot and broke it and went to urgent care for a boot.

I go to my ob-gyn once a year for a check-up, to my eye doctor once a year for a check-up, to my dentist every 6 months for a check-up and cleaning.

My kids are very similar. They go to the eye doctor once a year, to the dentist every 6 months and they have a pediatrician they see once a year for checkups and immunizations; other than that, they have only needed a doctor maybe a dozen times in the past 5 years (that's a dozen times total for all 4 kids combined).

No one in my family has allergies or other ongoing health problems. None of us are on any recurring medications and none of us get sick often enough for this to be an issue.

I did have to call my pediatrician last Friday at noon because I picked my daughter up from school sick. They didn't have any more "sick visits" that day and advised that I go to urgent care/ER if necessary.

It wasn't necessary. I brought her home and in the next 12 hours it became quite apparent that she quite obviously has the flu, and we've been treating at home.

Are others really that ill that often? I'm trying to understand why ANYONE would pay thousands of dollars a year to have access to the same doctor? I mean, how often do you even need to see them?!?!???

Ireland. And no, my parents have never waited three hours for an ambulance. They receive excellent care on public health. When I had a stroke (in California) the doctor at the urgent care told my husband to drive me to the ER, he could get their faster than waiting for an ambulance. Health care in this country is abysmal. Especially for those of us that are not rich.

Texas_Gem,

You and your family are blessed.

Aside from those who may have to frequently visit their specialists such as those with diabetes or cardiac problems, there are other chronic issues such as mobility issues, difficult to manage pain, chronic allergies, and the growing number of seniors with wide ranging issues related to aging, and that is a fair amount of people that may well want to consult a doctor more frequently than an annual checkup.

And some medical issues, abnormal thyroid levels for instance require multiple visits and subsequent monitoring by a doctor.

Texas, I could have written your post when I was your age (although I only had two children). Now that I'm in my 60s I'm in good shape (no chronic issues, low cholesterol and BP, I take no medications), but even so I find myself at the doctor's office from time to time for a variety of ailments...the aging body will do that to you.

If my doctor hadn't gone the concierge route I would still be with him, but for all the reasons I mentioned in my first post I'm happy to pay the fee.

I wish you and your family continued good health!

Well, I'm not rich but I get good healthcare. When we were dirt poor we got free healthcare. Didn't pay anything when I had my daughter. Went to the health department and the little clinic in the nearest big town and everything was on a sliding scale based on your income. We didn't have heath insurance, couldn't afford it and ex's employer didn't offer any.

Being poor here means I will die before my sixtieth birthday

Sorry, but that is bunkum. As Kathsgrdn points out, there are multiple access points for free and reduced cost healthcare in this nation -- what is covered under Medicaid in my state is better than I have with my high-deductible employer provided plan -- and the fact is, that the most prevalent chronic health issues in this nation are the result of personal lifestyle choices.

Louise, go where you're happy. Unless your move in with family or are out in the boondocks, you probably know that the cost of living in Ireland is higher than in much of the US. Many basics, like gasoline, utilities, clothes, cars, many food items, etc, can be substantially more expensive. Not the least of reasons is that the 23% VAT applies to so many things people purchase.

If you have a fixed income, you'll find your purchasing power won't get you as much in Ireland.

raee_gw zone 5b-6a Ohio, Quality of health care in the U.S. depends a lot on where you live as well as what kind of health insurance you have. (There are probably not many on gardenweb who are living in a ghetto.) There are many doctors who will no longer take on new Medicare patients. And Medicaid (based on having very little income) can be terrible in some states and counties. Things have changed a lot over the years, too, so one's past experiences don't necessarily match up with current practice. I live near a teaching hospital that accepts Medicare assignment but I wonder if they still will when I reach the age of 65. My mother has seen her choices dwindle when it comes to medical care and home health equipment. She is unfortunate enough to have health issues that were not caused by her personal choices and hates to hear people's generalizations that imply that people are responsible for their own illness.

ETA - I want to apologize if this sounds like I'm ranting at you, raee_gw. Your post was just a starting point for some of my own thoughts.

Condo Home, I am aware that there are many diseases and traumatic injuries that occur out of anyone's control or fault. I didn't dispute that. Also I am inclined to favor a single payer system. However, health care is available to the poor, even if not in the form or variety or number of choices we might wish. It remains true that the most prevalent chronic illnesses in this country are the result of lifestyle choices. And despite several decades of public information campaigns to influence people to make better choices, there has been inadequate progress in that regard, and some issues are actually getting worse.

The statement that if you are poor, you will die before age 60 is just not supported by the facts.

The idea of a couple paying $5,000 a month for concierge medical care which would not cover everything (I'd imagine hospitalizations, chemotherapy, and other conditions would be excluded) is pretty shocking. I can see why those who can afford it might find it an attractive option, but that's $60,000 a year, which is about the average annual salary in this country. Our system is so broken.

It really is, but those who have had good employer subsidized, or are able to afford "Cadillac" insurance don't see it. The primary care MDs are frustrated with CMS cutting payments (and private insurers follow their lead), the insurance paperwork, time spent on the phone to get approvals, having to dedicate office personnel to those tasks. Our patchwork system is driving up their overhead while reducing their payments. So some have decided to stop dealing with insurance, and to make that palatable to their patients, they offer "concierge" service.

Louise stated, "Being poor here means I will die before my sixtieth birthday." Only Louise can say what she meant by that, but I did not take it to mean that all poor people in America will die before age 60. She used the word "I". My interpretation was that she may have a specific medical condition that she cannot get adequate treatment for in America based on her financial situation, but that she would be able to get adequate treatment for in Ireland.

As far as the statement that "the most prevalent chronic illnesses in this country are the result of lifestyle choices" goes, that is pretty much true for all of the developed world and it certainly does seem to be getting worse. I agree that it is an important piece of the puzzle of medical care.