I do. About 7 years ago my longtime PCP switched to this sort of practice. He's a superb doctor, so I didn't want to change. I can be seen the same day in many cases, or at most the following day. When I go for my annual physical he spends at least 30 minutes with me, and sometimes more (for part of that time we're just chatting).

When I had a serious, and unusual, condition 5 years ago, he was invaluable in getting me in to a specialist, and a surgeon, right away.

So in my case I consider the yearly fee (which is actually quite modest compared to some) well worth it.

One aspect that I've heard about but never confirmed is that if your concierge doctor orders tests or medications or is your clinician during hospitalization, your insurance considers all of those to be out-of-network.

i have friends who swear by it. You are wise to think ahead as ive never considered it … none of have any health issues and now that annual physicals have been de bunked im not inclined.

MD-VIP (Medical Doctors -(placing) Value In Prevention). You see physicians only, no NPs or PAs. It’s a fantastic program. Thirty minute appointments regardless of what you initially go in for catch a lot of medical problems before they become big or serious (hence the ”value in prevention). And, their yearly physicals, especially the lab work is extremely in depth. They’re closely affiliated with the Cleveland Clinic.

We had a concierge physician before we moved. I had very few medical issues; DH had more. The fee was based on our general health and age. Our doc took a limited number of patients. If we needed something, we were seen that day. We never ever waited. Generally, walked into the office, told the receptionist I was there (she knew it already because she knew each of us by name on sight). Usually before I could sit down, the nurse was showing me back to an examining room.

All lab work that had to be sent out was charged to us at the cost to the doc. All in-house lab work was included in the fee.

Bookwoman, that is exactly the kind of problem I worry about. We have tons of friends who are doctors and they are all very concerned about their own medical care, unable to get into their PCP, unable to get a new PCP, huge wait times for specialists and these are university affiliated doctors who say the supply and demand situation is not in anyone's favor right now. The fee is in the low 4 figures per month per person.

Fun, this was discussed with the practice, yes, they are out of network, but they work with specialists and hospitalists, not on their own in those circumstances, so no worries about their charging anything. The monthly fee covers all their services, including lab work and such. Specialists are handled through your regular inurance.

Mtn, aside from having children I am not a big medical consumer, though I have an oddball, chronic knee condition which requires a minor operation every 10 years or so, plus I need to keep a prescription form an inhaler on hand as I have exercise induced asthma. My BFF is a plastic surgeon, so she keeps me in Renova prescriptions.

WRT the uselessness of yearly physicals, that is the paradigm I subscribe to. That said my doctor friends all insisted on getting a better relationship with their doctors once they reached 40 to 50 years of age. They say it's so much easier to get proper care if you and your doctor actually know each other at some level and for them, that is the point of yearly physicals.

So the short story is, this concierge service is just an additional layer of insurance, which seems exorbitant, especially since I could not conscience buying it for myself and not my children. My fears are driven by the amount of retirements and shortage of doctors in general we are seeing in medicine, and are likely to grow in the coming years.

Lynn, One of my MD friends, an orthopaedic surgeon, just had some heart issues and had to see a PA and an NP before being seen by the cardiologist. Between the amount of time it took to get the cards appointment and then see the midlevel providers my friend was pretty darned anxious.

bbstx, I was hoping there was some healthy person fee schedule, but no, same charge for everyone. There is a bulk buying discount which is risible.

bpath, with the practice I am considering all internal medicine/paediatrics appointments and lab work are covered by the monthly fee. Your access to your MD is 24/7, aside from his or her days off, which are covered by an MD colleague. House calls are cheerfully made apparently.

Prescriptions, immunizations, advanced imaging, specialists specialists, are billed to your regular insurance.

The fee is in the low 4 figures per month per person.

Yowza. I pay $1,850 per year, and a friend pays $2,500 for her doctor.

They say it's so much easier to get proper care if you and your doctor actually know each other at some level and for them, that is the point of yearly physicals.

Yes, this. Other than that one situation, now completely resolved, I'm in excellent health, take no medications, and rarely see my doctor except for the physical. But when you need a physician, it's great to know that they're immediately available *and* that they know you as something more than a name on a chart.

We were told $10,000. I saw that number and didn't even look further as to what it meant.

I see my primary care a year for my annual. Stop in every 6 months for kidney panel blood work.

We then see our specialists. If you developer a specific issue, DH needed a cardiologist, then you go to doctor.

I guess if you feel your fees are affordable and it gives you peace if mind, then no question about participating.

So far, we are not complicated and I don't see the necessity at this time.

If it’s the same charge for everyone, why not wait until you feel you need it. Maybe I’d feel differently if I’d had to wait for care.

My brother has a 'concierge' doctor, as do my SIL and her husband. The fees are not of issue to any of them (and I don't know what fees are now).

My PC joined that type practice and I did see her a couple of times after. We were self insured those years and I was already paying close to $2000 a month for our medical policies. The practice didn't have an orthopedist or a cardiologist and I needed both, so dropping our policies with hospitalization etc didn't make sense. I didn't subscribe to her practice annually, but she would take appointments for $150 cash, paid on signing in. That worked for a year or two, but she was offered a position at a major hospital in neuro-endocrine treating only pituitary so she was once again out of my reach.

I still don't have a PC this many years later. I see specialists, have a good dentist, get a full body skin check every year but I don't have primary care.

Bookwoman, I really was hoping for a different number too. Believe it ir not, at that price, there is waiting list. The earliest we may join the practice will be this fall. They don't even have an idea of what the movement on the list will be like yet. We will hear about that over the summer.

eld, we are not complicated, but medical care in our area has become very complicated. We have never been able to attract doctors to live here. The cost of living is too high. The major medical provider for us used to be amazing, and quite affordable. It is now a train wreck. So I am very torn about buying this insurance.

Mtn, since there is a waiting list to join the practice, you can't game the system that way. BTW, each doctor in the practice sees 250 patients.

Morz, that sounds super frustrating to me. Having a good dentist is golden.

We have never used a concierge practice though DH's cousin was part of one - as an internal medicine specialist. I haven't felt any need to look into it. Though I could not find an acceptable internist who was taking new patients, after ours retired, we have no problem getting in to see our current PCP, specialists as needed, etc. and they are not at all rushed during our appointments.

When both of our internists retired, and I couldn't find a new one with acceptable credentials, I decided to try a family practice doc when I discovered a colleague of mine with an advanced practice nursing degree (and multiple docs and other healthcare providers in his family) was seeing a family practice doc, even for a more serious condition. I found one I liked the sound of and had DH try her out first. She really helped him with an activity related injury so I signed up with her as well. We have more general than internal medicine needs and I've found her to be more well versed in some areas than my previous internist. She's younger and not bothered by electronic medical record systems - something that pushed some of the older docs into retirement.

It seems to me that you feel some anxiety about your healthcare options …,and what is that worth? id sign up. You can always change your mind later.

2katz, I am so glad you found a practice you like. I have checked and double checked no PCPs are taking new patients. There might be some at the big local practice, but that is not place I like any more. It used to be physician run and amazingly good. They sold to Sutter Health and neither doctors, nor patients like it anymore.

Stanford's concierge practice is run by a Family Medicine MD. It is more expensive than the place I am looking at, I think. And of course, they are not taking new patients either.

The irony of this Internal Medicine conversation is that since moving to PA in 1996, we have had the same woman listed as our PCP, she is an internist, and neither my husband or I have ever seen her. She fobbed us off to her PA the two times either one of us needed to be seen in the distant past.

Mtn, you are spot on. It is all some weird anxiety brought on by Covid, my friends' experiences and my being silly (I hope.) We are on the waiting list. My husband says we buy insurance for all sorts of things. And we have gotten away with spending so little on healthcare all these years, might well do this. I am grateful to have the option.

@Zalco/bring back Sophie! Yeah, we have some problems in MN these days but we still have good healthcare options. I give that serious thought as I ponder moving to a different state.

2katz, It's so weird to be next to Stanford and UCSF and still not feel comfortable with the PCP situation.

Well, wishing you luck Zalco. Feeling taken care of is important.

When one of my kids was working for UCSF, even she had months long waits to see a dr, then running tests took more months, then the follow up visit even more months out--all while working IN THE BUILDING.

All that said, the avenue of investigation with dd was exceptional, but the kicker was that by the time the pull the trigger on proper treatment appt came up, dd had moved crossed country and all that investigative work was for naught. Other health issues she had never did get an appt to be seen even after two years had passed. On the other side of the country, she was seen and treated with a one month wait time, for that issue.

We have a $10k deductable and less than stellar medical professionals within a half a day's drive of us. I've considered going "private" in recent years due to both reasons, but hold out as a monthly fee as the one you mentioned would put us in a not favorable place. I'm glad you are able to handle that fee, as having actual access to medical care is priority.

We went to concierge medicine a few years ago when our PCP and his practice went that way, although they kept a small percentage of patients that chose to not go that route. They are affiliated with MDVIP (the program Lynn mentioned) and we have been 100% happy. We are very pleased with the referrals to specialists and still are. Being in our 70’s, we like to keep up with our health and any red flags that might begin to creep up unexpectedly. The time our physician spends with us explaining results and advising is invaluable. Plus we hardly ever wait more than 5 minutes in the waiting room. We also receive informational emails (about one per month, not an overload) that I find useful almost every time.

We have never had any issues with insurance failure to pay for anything, but then we have never been hospitalized except for DH’s hip and shoulder replacements, which don’t fall into the question category asked above.

PAMF is evil.

Sorry, I had a bad experience. :)

Continue.

When I got divorced back in 2012, I lost Kaiser and had Blue Cross/BlueShield of Texas through my employer, which I hated. So I tried to fill the gap between what I wanted my medical to be like (I was pretty happy with Kaiser) and the BCBS nobody's-looking-out-for-me system that felt like they had an office full of lawyers in Texas doing nothing but plotting to deny any claims, and I signed up for a concierge service, One Medical. It didn't feel like it help. It still felt like I was alone in looking out for me.

I've been paying out of pocket for Kaiser for several years now, and it's low four figures to cover both me and my 17-year-old daughter for a silver plan that covers almost all outpatient costs with affordable co-pays (I'm 55, which I think is close to your age, Zalco, and I'm in Oakland, so I should be a good comp). It's a high deductible plan, but the deductible applies almost exclusively to inpatient care (I had a very minor outpatient surgery where the deductible applied so I was out-of-pocket, otherwise it's just the co-pay). The key thing for me is that I trust Kaiser's medical records system and how information is shared across doctors and departments within the system. I had one issue where I had seen my GP, a dermatologist, and and allergist, and it was clear that they were all getting looped in on communications I had with any member of that team.

SEA, Living in SF is amazing isn't it? I am so sorry for your daughter having to deal with a medical thing for so long. That would make me crazy with anxiety. I don't think the insane cost I have been quoted is normal anyplace else. Maybe you could find something more in line with Bookwoman's doctor's fees.

Outside, I will look into the MDVIP situation. I had not realized it was a national thing. I read lynn's post too quickly and missed the that important bit.

cawaps, thank you for the info. Yes, we are very similar ages. I will look into that.

I looked into the MDVIP out of curiosity. Interestingly they’re not in my state - maybe their isn’t a market for it here because we’re happy with regular care. I checked a few other places and every doctor said either not taking new patients or you may have to get on a waiting list. I also found it interesting that the company is owned by private equity.

The internist I've seen for many years for bioidentical HRT charges a flat office rate per visit rather than monthly or annual fees. Recently, my PC (another dr) referred me for a neuro consult but it was a three month wait and I didn't feel I had three months to wait around. Long story short, I went to the internist (one week wait) who made a dx and put me on a treatment plan. I suspect he will be retiring in the not too distant future which has led me to consider finding a concierge practice. The thing is, I kind of think the concierge practice is only as good as the doctor(s). I knew the internist was a pretty brilliant guy but have no idea about the other concierge practices in my area. If I do find one with a reputation as good as my internist, however, I will definitely sign up.

I think the concierge concept may depend on how 'connected' they are to EXCELLENT medical/surgical practioners in your area? I think - from a long, long background in this!- your best bet is making pals with people in medicine- ha! I am also in the Bay Area, and this has been invaluable to me of late.

Adding- I am not concierge. I just work my medical/surgical consults. I have not felt the need to go that route.

Maddie, somehow I have a lot of friends in medicine and surgery, including very tippy top people, which means they are my age and close to retiring. Plus we are in a solid position at Stanford wrt obtaining specialized care should we need it. We needed it for my mother a few years ago and all the stops were pulled out for us. I was incredibly grateful for the TLC we received.

When I watched a few of my medical friends struggle to get timely care through the pandemic, for non pandemic related issues, I panicked. I am pretty sure should we need catastrophic care on short notice it would be there. I am more concerned with needing a multi step diagnosis and being at the mercy of very booked schedules.

As I write this, I realize I sound a lot like a head case. Between the pandemic and permenopause, I feel a lot of health related anxiety.

PS I do think this practice is well connected. It's Eric Weiss's group in Woodside.

Maddie,

PPS I am sorry your contacts have been important for you lately. I hope all is well and or mending.

Jumped ahead to say I think O know someone who has a concierge practice Marin. Let me know if youd like more info.

We very, very rarely go to the doctor and generally try to avoid it at all costs. However, my wonderful midwife does women's health as well as delivering babies and so I go to her for an annual physical and "women's exam."

Her costs are very affordable, there are a few midwifes in the practice who all really get to know patients extremely well, and appointments are for as long as you need them to be -- it is never, ever rushed. I feel like I get ultra-personalized, amazing care from someone who really cares deeply and who knows my entire family.

For those who need a woman's doctor for annual / periodic exams, I think it is definitely worth looking for a midwifery practice in your area. It's a much, much nicer and more patient-centric standard of care than a typical OB/GYN or PCP in my opinion.

Spanish, Bummer, I am on the Peninsula. Thank you so much for offering.

beagles, I am happy you like your midwife. I am a very traditional medicine kinda gal. I try not to consume much of it, but when I need medical attention, I am partial to physicians and surgeons. They have served my family in good stead over the generations.

Maddie, your comment about referrals had me call my friend who is an internist. Obviously, she agreed with you. So since I have no problems getting good referrals should I need them, why bother. Which brought us to discussing my friend whose need for a cardiologist was super delayed and required lots of hoop jumping, with my friend being an orthopaedic surgeon, and better connected than I am. There is no way of knowing what factors were at play she said, including the possibility that he was responsible for some of the delays. Since she refers people to cardiology all the time, she promises me that his situation was not one she experienced herself with her patients.

As for lacking a primary care physician, she is in the same boat. She told me where she was on a waitlist and I will get on the same one. Plus my insurance allows me to self refer, so no bottleneck is created by my not having one. We discussed what kinds of things would make it worthwhile to have access to an internist like I was considering and that seems unlikely to be helpful to me or my family.

I would never have called my friend and discussed all this had you not made your comment above, Maddie. Thank you.

I have calmed down significantly and will most probably not go with the concierge practice after all. I think I need to spend that money on a vacation instead!

As always, I appreciate everyone's helping me think things through when I am feeling at a loss for clarity.

PS I am once gain in Austin, feeling quite cut off from my normal life, which helps explain some of my irrationality here. Should I ever need anything while I am here, I have zero resources and no friends. This back and forth between home and here should be over by September.

I need to spend that money on a vacation instead

Now we're talking. LOL

As I said, sometimes we pay for peace of mind even if a strict economic analysis might not support our decision, and that is certainly fine.

Apparently the concierge practice has not caught on in my area. I do know one person who goes to such a group, but I am not familiar with her group of doctors. I was a state/government employee and still hold that insurance. I would be embarrassed to tell you what we pay per month for excellent coverage as I know so many people pay much more. We live in an area with good medical services, such as a teaching hospital with a level 1 Trauma Center, a great heart group at another hospital and an award winning joint replacement faciity. There is alot of research in our area due to the teaching hospital. We do not have to have a referral except for certain specialists. This is by far one of the very best perks of my employment and we do not take it for granted. Glad you are feeling better about things @Zalco/bring back Sophie!