The amount spent on overhead gets cut down drastically when you stop taking insurance:
He also calculated that he needed to see 25 patients a day just to cover his overhead. In order to make his salary, he often saw 35 or 40. And he never could spend as much time as he’d like with them. According to his wife, Gena, practice employees had developed a ruse to keep Stein from talking to patients for too long. When a patient visit ran over, someone would knock on the door and tell him that another doctor was on the phone.“You can’t take care of 25 or 30 patients a day,” Stein said. “That’s not possible. What you’re doing is running a cattle drive.”
His new practice, he said, has an annual overhead of $50,000, and that number includes the flat screen television and leather couches in the waiting room, the Starbucks coffee brewing behind the reception desk, the electronic record software and the high-tech diagnostic equipment that Stein bought when he opened his doors.
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- Designing a physician waiting room
- Switching to concierge medicine?
- Transition to concierge care
- Buy a condo, concierge medicine included
- Is concierge medicine partly patient-driven?
- Concierge Quality for Low Income Patients
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{ 20 comments }
As a new physician about to start my own retainer based medical practice, I’m tired to the way the press tries to describe “concierge practice.” Stop describing the disgruntled doctors who are “fed up with the system.” Instead, they should focus on the win-win relationship for the patient and physician. Essentially, the doctor is free to practice good medicine. All the studies point to the fact that the more time a PCP spends with a patient, the better the care (AMA won’t officially allows us to say thins), lower chances of medication errors, decrease ER visits, plus the abiltiy to truely realistically modify lifestyle behaviors such as smoking, weight loss, excerise. If everyone stopped focusing on the “fee” and focused on the true improved patient doctor relationship/experience, then people would “get it.”
In terms of cherry picking, correct at $20,000 per year – of course your cherry picking. At $1000-$1500 – YOU ARE NOT. True people have to have the resources. But in this country, many do. Plus, patient select their doctor, not the other way around. If anything, patients are cherry picking their doctors because they want someone skilled and who can and will spend the time the patient wants or needs.
We buy auto insurance, life insurance, financial planners, LTC insurance, etc. On what premise? Shouldn’t then spending for your doctor’s time a bad investment. Especially, at often < $100 per month.
This is more than a good “business model”, it’s a good patient care model. Not only does it alligns incentives and removes the middle man who is beholden to not the hyacratic oath, but share holders, it bridges all teh current barriers that exist between patients and thier doctors.
This is medicine at it’s purest. Good medicine. And Criminalopath – I know you will have something to add. True, MDs earn more – but he/she also gives more in return. (And excellent MDs with busy practices – I’m not trying to take anything away from you, your skills, or abilties – but be true to yourself, if you could spend a little more time with your patient and not have to deal with adminstrative barriers, wouldn’t you be happier. And wouldn’t you try to spend that time to delvier better care – not reduce your golf handcap.). Plus because this system works extremely well for the doctors, many spend time doing more charity care, volunteer work domestically and overseas. So while i admit lifestyle helps to some degree drive this model, greed in it’s purest form does not.
Also, no one claims that this model is designed to replace our current healthcare system. It’s jsut another way for some of us to practice medicine to the best of our abilities. And ethicists, stop complaining about “concierge care” destroying our healthcare system. The system is already distroyed.. Theere is no massive shift of patients who were “abandoned” by their doc that can’t find another one in their town.
Two tiers- to anyone who practice’s regular medicine knows their is more than 2 tiers already with medicare, medicaid, veterans, etc. Dr. Goodall, and Dr. Caplan (U Penn), Dr. Annas (with whom I have had a pleasant conversation on this), and Dr. Reinhardt – please re-focus you well intended energies and excellent analytical skills on the real threats to medicine and real threats to access to healthcare. The small retainer based practice is not one of them.
PS – I apologize to the readers for my grammar and spelling errors. I still have 35 charts to dictate for today so not much time to proof read this blog.
Anyone who would have a problem with this article or what the previous poster said, just doesn’t get what this country is about. Freedom, that’s what this is about. Who is anyone to tell this physician what he can or cannot do or what is right. Anything to the contrary is forcing your beliefs onto someone else, pure and simple.
Got a problem with it, go to medical school and work for a crappy HMO.
The only thing that would have to add is why have more physicians not gone the route of congierge practice? The work product of a physician and the charges for their services are their own unless the cost is being payed by other productive members of society to provide services for non-productive members. My advice for any physician with a sufficiently large patient base would be to follow this route. It makes little economic sense to the provider not to go this route and is certainly a better deal for the patients in both quality and quantity of service. Just be careful in how the perception of concierge medicine is marketed. If the Dems see you as abandoning their voter base then the Dems will turn on you and force you to provide your services with little to no economic benefit.
I probably have around 100 physicians who have contacted us this year about trying to switch from primary cary or OBGYN practice.
if becoming credentialed to become a doctor required simply taking a state exam… this system would be fine. The problem is carrying the MD/DO brand is restricted to an artificial number. There already is an finite supply of doctors, this makes the system all the more restrictive.
If doctors were dealing with free market forces, ie competition, then deciding to go high-end is within their rights as free market agents.
Given that the basis for medicine run as an oligarchy is public safety or service, or “public good”- actions like these by doctors require congressional level hearings (which i understand has been proposed?).
For these type of high-end service to be justified, market competition (ie removal of market scarcity) must be introduced.
If doctors want to compete, then we will all be served better. However, doctors operate in a highly subsidized and regulated marketplace, far divorced from enterprise. In this environment, actions such as this border on negligence and dereliction of duty…
“Got a problem with it, go to medical school and work for a crappy HMO.”
yes, i agree…
problem is going to school/residency cost 100K+, limited number of slots to keep salaries up…
if this is eliminated, (and their r ways to credential/maintain safety), then concierge is legitimate market enterprise… w/o its a violation of the contract put in place for doctors to operate w/o market competition.
“fed up with the system”… doctors inflated salaries would never stand up w/o the system. This is simply an attempt to hold on to high income status by rewriting the already unfair rules.
If policemen, software engineers, actuarials, (ie the rest of us) are subject to market uncertainties, so to should the ever protected physician.
Thats what makes our country great, and thats what would at the end of the day provide real value for society.
concierge practice at 250K profit…
give me a break, increase the number of providers and market competition will give everyone a basic concierge practice but at 80-100K profit, with docs that provide real high-end services fighting to earn more.
“In this environment, actions such as this border on negligence and dereliction of duty…”
Sounds like you are one of those older physicians that got us all into this mess. If so, your generation of physicians failed us. It is time for a new direction.
“increase the number of providers and market competition will give everyone a basic concierge practice”
Please go ahead. I doubt we will see the rush into medicine that you so envision.
“if becoming credentialed to become a doctor required simply taking a state exam… this system would be fine. The problem is carrying the MD/DO brand is restricted to an artificial number.” For good reason, you want to let everyone with a GED take our your appendix by taking a state exam then by all means go ahead. It’s not like you can change DeVry from TV/VCR repair into a medical school.
“increase the number of providers and market competition will give everyone a basic concierge practice but at 80-100K profit, with docs that provide real high-end services fighting to earn more.”
You are dreaming. No one will go into 100,000+ in debt and give up the best years of their lives stuck on call and in the hospital to fight for 80K a year when they are done. You will never find enough providers. You think we are going to open our borders to a bunch of foreign doctors after 9/11. There are a vast majority of people that still want to pronouce their doctors last name. It’s easy for those with no medical education to think it’s easy and that anyone can do it.
“There are a vast majority of people that still want to pronouce their doctors last name.”
So racism is a defense for the artificial scarcity that stifles real market value?
lets extend this, r u saying that the O’Malleys, Polskis, Steins, Kumars, Phoe, Wang, Ramirez, Kawamuras, Obis cannot practice medicine in the US?
(ill just assume at this point that u mispoke and drop it)
elitism:
“It’s easy for those with no medical education to think it’s easy and that anyone can do it.”
I agree! Ill add plumbing, TV/VCR repair, firefighting, policing, golf… just about every human activiity under the sun is difficult and requires discipline, dedication, and sarifice to achieve proficiency. Ask someone trained to change an appendix to remove your engine’s head gasket (vice versa)… ull run into problems. By the way, go ahead and try to fix ur VCR/TV, its actually pretty darn complicated/dangerous even if u understand basic electronics etc, unless uve been trained specifically for that task. Someone mentioned Devry. Well as an engineer trained at one of the nations top five engineering schools, one of my first internships was under an eclectic guy that came out of Devry- a person who was in every way a consumate professional. Since then i have worked with several proficient coders from Devry. Ive also known bad apples, but we’ve all seen the ive leaguer with zero skills as well. The key factor to note, was that these people r not jockeying for academic laurels… they r simply working a job with a certain skill set, for $, to take care of their families, and live their lives… (very much like everyone else).
“No one will go into 100,000+ in debt and give up the best years of their lives stuck on call and in the hospital to fight for 80K a year when they are done.”
If $1-2K test cost credentialing were implemented, the real threat to the academic-industrial complex would be how the market reacts to the flux of providers. Ill assume that the ‘neuve riche’ insurance rates and salaries would initially be higher/lower respectively. But over time, the market embraces those proficient in their craft.
Now the real threat… If those harvard etc eligible level candidates saw no economic benefit (other then academic credentialing), a vast majority of people would have great enticement to circumvent the current regime (which enforces artificial scarcity through limited residency slots, etc.). Ur right its not fair to go 100K+ into debt just to be allowed to take tests- which i understand that schools like harvard yale do not even provide anylonger. So basically ur paying for the right to take a state exam. (Quite frankly, i think the situtation would transform into the highly motivated students studying with their own resources, and less motivated studying through testing agencies such as Kaplan etc, and the totally party animals deciding to shell out $Ks to med schools to credential/find jobs for them.)
The real questions r not P4P vs HMO (the market of doc services is overvalued, imho).
The real question is how many docs would the market need to bring average salaries to 100K? Would market competition improve safety (by removing the current culture of silence, hierarchy)? What about save the children arguements- how can security legitemetely be addressed?
Ultimately, as a doc if u think ur better than a fireman, policemen, programmers, waiters, plumbers, line cooks… get overself, because the market everyday is trying her best to.
so for my money- boutique, elitism, oligarcy, scarcity NO!
overseas, walmart-$40-RN, transparency, free-market, YES!
An extremely verbose Anonymous said: “Ultimately, as a doc if u think ur better than a fireman, policemen, programmers, waiters, plumbers, line cooks… get overself, because the market everyday is trying her best to”
It takes four years of college, four years of medical school and five years of residency to become a surgeon, not to mention hundeds of thousands of dollars in tuition.
Show me ANY other professional who needs the same amount of education and training before he or she can BEGIN working in his or her chosen profession and then we can talk about what doctors deserve to make….
Funny how no comparisons are being made between what doctors, who save LIVES, make and what people who bounce basketballs or scream into a microphone or show off lots of skin make…
“It takes four years of college, four years of medical school and five years of residency to become a surgeon, not to mention hundeds of thousands of dollars in tuition.
Show me ANY other professional who needs the same amount of education and training before he or she can BEGIN working in his or her chosen profession and then we can talk about what doctors deserve to make….”
uhh, thats kind of my pt. these things are set in place as hurdles to limit supply, ie artificial scarcity
by the way, to become world class in anything takes about 10yrs of work… things are set up in medicine that require those ~10yrs to fall under cartel contrl.
no comparisons were made to becoming athletes, celebrities because those cases require extreme talent/competition.
Becoming a surgeon requires the opportunity to train- any average person can do it. In fact in Europe surgeons are technicians with cerebral docs being the behind the scenes directors. What does take talent/competition is getting the cartel to grant u the opportunity to train.
Whats funny is how hard it is to find out what a surgeon’s stats r for a given procedure… then everything goes opaque.
whats sad is noone has called out the racist defense that was posted as being a reason for artificial scarcity.
to recap, what ive heard in defense of artificial scarcity is
1) elitism: we’re smarter, faster, stronger, + we paid more $ to train ?
2) racism: we dont like when u docs have funny last names ?
3) safety, save the children- yeah right, thats why there exist a culture of silence, hierarchy, and hospital error in top 10 way to die
give me a break
again me and my $ go:
overseas because i appreciate diversity, transparency, dignity, walmart-$40-rn, specialty hospitals
Good luck and don’t let the door hit you on the ass on the way out. When you have your surgery overseas and they F it up. Don’t worry they will, I’ve seen their work and there is a reason why they don’t practice here. They don’t have the training, social skills or general know how to make it. Otherwise they would be here. They have no fear of lawsuits and its a long plane ride for the patients if they have any complications. Two great components for a job well done. Have fun on the plane ride back to have it fixed, because no physician here is going to fix these docs mistakes. I sure as heck don’t, I just say next patient to the nurse and go on to the 100 I have left to see.
Faster, stronger and smarter, I couldn’t have said it any better
dont let the door hit u in the ass…
yeah, its sad when the cartel (racist, and greedy) curtly stifles the free market, exists solely through artifical scarcity, and is bemused by the plight of others seeking equitable distribution.
by the way, those pts in need that u reject, do u refund the office co-pays?
fundamentally, docs are outdated dinosaurs, desperately clinging to their turf. in the face of real science, personalized medicine will make this sort of inequity merely a bitter memory.
in the mean time, middle america struggles to take care of our parents and rear our young… but there is hope, the free markets, democracy will ultimately prevail regardless of corruption, elitism, and rent collection.
real scientist r working while glorified waiter/resses now have tools such as google to contend with…
quite frankly, faced with this kind of arrogance, ill gladly go overseas for care
(by the way, how does one pronounce dr. pho’s last name?)
Google doesn’t cut. People can self diagnose all they want. When they learn how to put themselves to sleep and perform surgery, that I will want to see.
As far as the Medical hackjobs, ie. tourism, the patients needed somebody to do it right the first time. That’s the opinion they get and no they don’t get their copay.
Dinosaurs? We are the tip of the sword. Yes, We are arrogant and yes we are elite for good reason.
As far as going overseas, someone is going to die and the family is going to sue the employer. Its going to happen. Having surgery by some hack that didn’t have the intelligence or social skills to stay stateside, then taking a 12 hour plane ride afterwards is setting someone up for a fatal PE no way around it. Which doesn’t look good when you are trying to save a few bucks.
I though I put a good post (the lead post on this subject). Then the second half… elitism racisim..market forces…etc
Please, the more we a doctors detract, complain about YEAR of medical training, lawyers, etc, the more we loose. Focus on delivering the best care for our patients. No one can argue that. If the current system (socialist or free market) does not allow it, then we are beholdine to our patients. Do what we must to best care for our patient. If htat menas, charge a fee – so be it. Stop with all the distractions.
the arrogance proudly displayed in defense of the cartel is really no different than the arrogance that was once found on plantations, manor house, and among the aristocracy.
we are not dealing with a socialist system… that would perhaps manifest itself as doctors being apart of local fire dept, ie working through govt
we are not dealing with a capitalist system… that would allow for market efficiency, options to peoples needs, innovation, supply to match demand, etc.
what we are dealing with is feudal oligarchy… cartel style manipulation of supply.
cutting edge? those who code out the signal from noise of gene expression, those who study nanoparticle drug delivery… are cutting edge.
people who order tests, do procedures r glorified wait staff.
currently my dad needs another cataract surgery and has a bad ticker, well thats what overseas hospitals with better recovery rates and transparent stats than US counterparts come in. My kid gets ear infections… thankyou Walmart nurse!
in 30 yrs when my ticker goes bust, ill turn to gene expression for the diagnosis and a tech for the therapy…. um so yeah, u and more importantly ur attitudes are very much old hat.
heres to seeing u go out of business one day
Unfortunately the whole system has to fall apart before anything gets fixed. I think there will be a wave of old docs retiring and young ones going into cash only practices because of all the useless paperwork and red tape. The new universal provider ID number will be used by United and friends to delay and withhold payment of services.
Rather than spend the money to upgrade our software and retrain staff, I outsourced filing back to my patients. January 1, 2007 I am dropping all insurance. FEE FOR SERVICE.
I thought I was alone, however there are 5 other primary care doctors in town (population 100,000) doing the same thing.
B Dupon
I do think you right on the spot with this post, i could use a lot a struff for my new study thank you very much.
Greets
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