As a private practice specialist in an affluent metropolitan area, I am often inundated with requests for consultation by local residents and primary physicians. That’s fine — it’s what I do, and it’s what I enjoy doing. Hey, it pays the bills, and I won’t complain about that.
Concierge medicine has taken a foothold locally, and this means more referrals directly from doctors who insist we take care of their patients immediately. We all understand how this works. The physician takes a fee to make sure that their patient is navigated through the health care system expeditiously and hopefully appropriately. This obviously benefits the patient and certainly benefits the referring concierge practitioner. Does it benefit society as a whole? Probably not: Because if someone’s getting squeezed in, someone else is getting the short shrift.
One assumption that’s worth discussing is that it benefits the specialist as well. There seems to be a common misperception amongst my peers that these referrals directly from concierge practitioners means increased business for me and increased revenue as a result. “Oh, you get so-and-so’s patients? He does really well. Good for you!” But what is really happening here?
I make my living taking care of a large number of patients who have routine medical needs, my specialty’s chronic conditions, as well as some who are ill and need more acute care. When I get a call to move someone to the head of the line from a concierge practitioner, it is generally not someone who is acutely ill. Instead, it is usually someone who is a VIP, has met their deductible and needs a procedure before the end of the year, or I should see as a “favor” for the referring doctor who has bothered to call me personally. The vast majority of calls I get are for people for whom there is little yield in tests and are demanding and difficult, or who need special “handholding” about unrealistic health care concerns.
So to my referring concierge practitioners, I say this: Someone’s underlying anxiety disorder and chronic compulsion about their internal health do not make a medical emergency requiring me to squeeze them in before the end of the day. A 99-year-old lady with 25 years of symptoms does not need an urgent procedure just because her two sons are lawyers. A learning disabled student does not deserve an appointment sooner than all my other patients just because of her social situation and the heightened expectations of her parents.
I am happy that my concierge colleagues have done so well in a difficult fiscal environment. But let’s be clear — the money they get for expediting these patients through to me does not trickle down to me in any way. A marginal increase in patient volume does not translate to significant increased revenue on my part. I’m not charging these patients extra like the concierge practitioner — I take whatever their insurance pays, like most practitioners of a traditional variety. So what I get out of it is a few extra patients who take considerably more time, are more demanding, have ruined my schedule and have unrealistic expectations because their concierge physician connected them to me.
I’m happy to take care of anyone who is sick, even the difficult patients or the ones who just need some hand-holding. But I’m a little offended at being pushed into taking care of the concierge practitioners’ stable patients on an urgent basis just because they are being paid to do the pushing.
The author is an anonymous physician.
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