A patient takes exception to her physician’s conceirge fees. “Moreover, upon further reflection, I came to realize that, instead of feeling blackmailed by this unexpected surcharge for services I thought I was already paying for, what I really should be doing is following my doctor’s lead.

And so, like the doctor, I will begin collecting fees each fall for the coming year, from just about everybody with whom I interact.”

If you’re not happy with this, you can simply change physicians.

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  • Elliott

    The writings not that great, but Kevin I’m amazed that you don’t see what’s wrong with the practice. If a retail store did this it would be called bait-and-switch.

  • Anonymous

    No, Elliott, bait and switch is advertising one item and then trying to pretend that the item is unavailable, then trying to up-sell.

    This physician is changing his whole practice. He isn’t advertising one service and demanding that you pay for a more expensive one. It is no diffeent than joining a private club that imposes a membership fee or a base fee for active members.

    The choice is simple. If you don’t want to pay the fee, then buy your medical services elsewhere. Free market, you know.

  • Anonymous

    Go to a different doctor if you don’t like it. See what the market will bear. I see the writer is a lawyer. A good lawyer will charge more than a lousy lawyer.

  • Anonymous

    “I’m amazed that you don’t see what’s wrong with the practice”

    Elliott, I thought you’re an Economist. You should know that there’s nothing wrong with being an entrepreneur in a free market. The doctor will be competing with other doctors who don’t charge conceirge fees. That’s not an easy task.

  • Elliott

    Actually, I was going to make my first comment by giving the economics argument against this practice, but was afraid that would not be as effective in communicating. The physician has formed a relationship with her patients which cannot be reproduced. It is not free to switch doctors even if there is no dollar cost. This physician is interested in extracting monopoly rents on the established relationship with their patients as well as converting the opportunity cost of switching doctors into real money in her pocket. I don’t believe that is fair. This is actually worse than bait and switch because the retail outlet is only able to commit the second economic “sin” of extracting some portion of the opportunity cost of having made the trip to the store hopefully to sell you something else. (Remember bait and switch is illegal most places.) If this physician was instituting the practice only for new patients then I could support it as free market economics, but that is decidedly not the case.

  • Elliott

    The best example that I can think of comparable to this is if your accountant (who you had been using for years) told you in January that he was instituting large fee increases for preparing tax returns this year.

    Now I only have one side of the story so I don’t know how long this physician gave people to make a transition. I think if this internist were to provide some recommendations and give people 4-8 months to find a new doctor then there could be few, if any, complaints.

  • Anonymous

    The monopoly rent theory is of minimal importance.
    Nothing guarantees the patient continuity. If the doctor croaks, there is just the same amount of loss.
    Secondly, there is no money paid for continuity, the patient is the inherent beneficiary–free rent, as it were. And what exactly is the cost? The price of copying records for transfer, if she chooses. Again, likely minimal.

    If the market behavior I have seen is representative–and I believe it is– patients will change doctors rather than pay anything additional out of pocket.

  • Anonymous

    My accountant that I have used for seven years raises his prices every year. I have kept paying it because I like him and his work. If the price gets too high I will either decide to do it myself or go to someone else. What is the big deal?

  • Anonymous

    I really don’t see the big deal. If you don’t like how a physician runs his or her business go somewhere else. I once changed doctors because the receptionist was nasty. I liked the doctor so I addressed the issue with him, nothing changed I finally decided I had had enough – so I moved on. No since getting all worked up about it. It’s your money, spend it elsewhere.