Concierge Doctors

[thyme4change]

I've heard of several doctors going private. They ask for an upfront fee, and then limit the number of patients they take. They guarantee a level of service that currently isn't available. They still charge you for each service, which can be paid for by insurance. I believe that they don't direct bill the insurance, but will help you fill out the paperwork to submit the claim for reimbursement.

Under what conditions would you pay for this service?
How much would you will be willing to give for an upfront fee?
Are doctors around you doing this? What are they charging?

In 5 years (or 10 years) will all moderately middle-class people be on some form of this system, or will this stay exclusive to the upper-middle class.

[zibazinski]

DF already has this service. But he has a LOT of health issues. Paid 2k and his doctor has a very limited amount of patients.

[thyme4change]

Is it working well? Does he get upgraded service? Easy to get appointments? Doc is on-time and has enough time to spend with each patient? Office staff that knows the difference between a their poop-shoot and a hole in the ground?

[Gardening Grandma]

I don't have this service. But an acquaintance of mine does. She has severe health issues. Her Dr's cell phone # is on her speed dial and he makes home visits to her.

He's a first rate dr. Used to be DH's primary care physician, but left the HMO to go into concierge medicine. He told DH that he wanted to spend more time caring for patients and less time dealing with insurance companies. (We stayed with the HMO - the annual fee for the concierge practice was $3000)

[zibazinski]

Doctor sees him WHENEVER he wants and DF will go to him if he cuts his finger. : ( I suppose if I were a cancer survivor and the host of other issues he has or has had in the past, I'd be paranoid for a scratch myself. I'm the total opposite. I go once a year for my yearly stuff and because of the colon cancer that runs in my family, I get yearly colonoscopy and since I ALWAYS have polyps, I never get a year off from having it done. : ( But I don't need the conceierge for that and since I wouldn't pay that fee, even though DF offered to pay it for me, I'm not on it. If I were a doctor, I wouldn't touch it with a ten foot pole because I wouldn't want those kind of pita patients. High maintenance people.

[bobbysgirl]

The doc I worked for has been trying to get docs to do this for years. 2000.00 up front, No building and overhead, one staff and you fill out the insurance forms. If a doctor sticks to 30 - 40 patients, he has an instant income of 30000 -40000 without working. Then he comes to you and charges a fee, but is easily available. He has control over more of his life and decisions. Maybe he doesn't accept insurance. You pay cash for a fee and only have catastrophic insurance. He insists it would work. I agree with him. Instead of paying 12000 in insurance premiums a year, the cost is 1/6 plus the actual visits. Sounds like a win win situation.

[Deleted]

I've heard of it but would use it only if I had chronic health problems that needed prompt attention when I had flare-ups. And that would be my concern: that docs might take on too many people because it increases their guaranteed income stream, but that the only people willing to pay would be those who need a lot of attention. Even DH, who has a condition in which his bone marrow makes too many red blood cells, can manage with non-emergency care in regularly-scheduled visits.

I can fully support the doc's motivation: no insurance company BS, immediate pay, not having to schedule patients 5 minutes apart to make enough $$ to pay off their student loans, and being able to get to know the whole patient, their history, their own health quirks. Someday I might do it if my health deteriorates and/or the standard of care available to the general public gets any worse.

[thyme4change]

If they get $2k from 500 patients thats a million bucks - cash money. Even if they see all 500 patients every month that would still be just 40 hours per week (assuming the doctor works 20 days a month and spends 20 minutes with each patient.)

And, he still gets to charge each patient for each visit - so the million has got to be half profit.

[zibazinski]

It is and DF's doc has 400 and is considering adding up to 500 total. Now to get him someone has to die and create a space.

[whoisjohngalt]

Zib,
how does he handle tests, even simple ones as blood work, etc? Does he have a contract with a lab, hospital, etc?

I don't know if I would do it for myself, but would do it in a heartbeat for bambinos. My oldest 2.5 and we are on our 3rd pediatrician and so far, they have all been terrible. If I could find a good one, I would pay up

I am a big believer in not being cheap and paying for a good professional, whether it is a plumber, lawyer or a doctor.

Lena

[whoisjohngalt]

The only bad thing is that I HATE HATE HATE paperwork and would probably have to find someone (for a fee, I guess) to file all the claims

Lena

[share88]

A friend of mine signed up for one of these just last week. Her theory was that they would all go that way eventually, might as well stick with doctor she liked. Her fee was $1500 but I don't know any other details.

[zibazinski]

They still do all his paperwork. The fee he paid was just for the privilege of staying with this doctor. The doc went from over 2000 patients and a LOT of hours to less than 400, like 390, to start with and then signed up 10 more for his 400. He is seeing how that goes before adding anymore patients. Most go up to 500 but he has kids at home still and wants to be a dad sometimes a bit more than he has been. DF talked him into going concierge. The doc was thinking about it and DF pushed him over the edge. Lab work is still done at various places just like xrays. Only thing concierge is the doctor but IF DF was too sick to go to doc, doc will come to him.

[Deleted]

How do they handle vacations and holidays? If, say, 4 weeks out of the year, they referred all their patients to a regular doc where you had to wait for an hour in a waiting room full of sick people and then sit on an exam table in a paper gown waiting for another half hour in the exam room, and all the doc knew about you was what he/she learned from skimming your records while walking into the room, I would not be happy.

[zibazinski]

Got me hanging.

[Gardening Grandma]

"How do they handle vacations and holidays?"

In the case of DH's former dr, he's with two other doctors. They don't schedule office visits during vacations/holidays, but they cover for each other in emergencies.

[debtheaven]

I have never heard the term "concierge doctor" before ....

If anybody is curious, here in Europe, there has always been a "two-tier" system (if I'm understanding the definition correctly.

This system would not apply to a GP, however, only to a specialist. GPs are NOT on the "two-tier" system. If your specialist in in the public hospital system (pretty much guaranteed) you can wait 6 weeks to 6 months to see him or her. You pay about 11e.

If you are in a rush, you ask if he or she also has a "private consultation" at that same hospital (or their secretary offers that option when you call and find out they can schedule you in five months hence). They generally always have private consulations at the same hospital, it's one of their perks. Depending on the doctor, his / her principles, ethics, workload, etc, you may get an appt the following week, at 120e or 150e. You will then pay 120e or 150e to see the same doc in the same office at the same hospital, but you will see him / her sooner.

Some docs encourage the discrepancy between the wait to see them "publicly" or "privately". Others discourage it, and have the same wait times for both. My neighbor was a renowned orthopedic surgeon who hated this system so he made sure his private patients waited LONGER. I'm guessing he was pretty unique LOL.

My DD had significant knee issues for years before she was properly diagnosed and operated on. She still has follow-ups. When she'd start limping, I'd ask for a "private appt" (my insurance covered it then, my current insurance would not, I would pay it anyway but I can afford to even if I have to cut back elsewhere). When they'd then ask me if I wanted to make the six-month follow-up appt publicly or privately, I'd say, publicly. No point in spending that money if I could make that appt six months in advance.

I'm like Lena, if I were in the US I wouldn't do it for myself but I would do it for my kids in a NY minute if I could afford to.

[thyme4change]

I would pay $150 per incident to be able to see a doctor when I needed to (I'm thinking of my urgent care issue last night) but I wouldn't pay my current doctor $1500/year unless he could come to my house and do stitches on Saturdays.

Granted, I might have to make that decision anyway. Hopefully the market will sort this out at a lower price for non-frequent users of the system. I don't mind being one of a thousand, but I only want to pay $500/year.

[debtheaven]

Thyme I don't like the "prepayment" system either. Everything is relative but I find that quite shocking. Pay X to just sign on with me, and hope I'm around if / when you have an emergency.

However, I have no problem with paying more to see a doctor sooner rather than later. I firmly believe that time is money and money is time, so I like having that option, especially if a child has an issue and I don't want to wait three or six months.

This said, it is weird to see the same doc in the same office in the same hospital, and sometimes cut a check for 11e, and sometimes cut a check for 150e LOL.

[Deleted]

Feb 1, 2011 19:39:24 GMT -5 thyme4change said:

I would pay $150 per incident to be able to see a doctor when I needed to (I'm thinking of my urgent care issue last night) but I wouldn't pay my current doctor $1500/year unless he could come to my house and do stitches on Saturdays.

Yeah, I'd go for that- a pay-as-you-go version.

[zibazinski]

DF's doctor WILL come to the house if necessary.