Today, primary care doctors are forced by insurance industry pressure to manage two or three thousand patients each, over twice the numbers of a few decades ago. The problems they manage are also more complex. Many doctors are “burning out” and quitting.
By Dr. Thomas LaGrelius
Contributing writer
People ask me about the pros and cons of concierge medicine. There are now more than a dozen concierge practices locally. Millions of patients have concierge doctors, thousands in our own community. Why is this practice design, around only for the past 20 years, rapidly growing?
Why do people join? Can’t they get the care and service they want without paying a membership fee? Doesn’t their health insurance cover them already? Haven’t they got anything better to do with their hard-earned money?
These good questions often are asked by people unaware of the growing challenges facing doctors. Today, primary care doctors are forced by insurance industry pressure to manage two or three thousand patients each, more than twice the numbers of a few decades ago. The problems they manage are also more complex. Many doctors are “burning out” and quitting.
That is why concierge doctors limit their practices to hundreds, not thousands, of patients. It’s a critical difference allowing them to spend more time, perhaps five times more time, with each patient, in a relaxed setting.
I spoke to a mother of two who wants to join such a practice. She called her doctor’s office to schedule a school physical for her daughter. She was told the next such appointment was in three months. “Three months?” she said, “‘That won’t do. The school needs it now!”
She asked me how far in advance it would take in a concierge practice. Things like that are done in a day or two, certainly within a week.
Another person complained about telephone trees she endures, which now seem universal. “If you have an urgent medical problem hang up and dial 911 or go to the nearest emergency room.” It gets worse. “Please listen carefully to the entire message as our options have changed. For billing issues press 1. For prescription refills press 2. For scheduling press 3.” When a harried human finally answers they often cannot do what you need and put you on what seems like terminal hold.
She asked what happens when patients call a concierge office. Usually a friendly person answers immediately and asks how she can help you. Then she helps you, setting up a same-day or next-day appointment for urgent problems. Many problems are solved by phone without an appointment. Concierge doctors generally give their cell phone numbers to patients for after-hours use anytime, and see them outside office hours and on weekends if needed.
Another man told me he waited an hour past his scheduled time for an appointment it took three weeks to get. When finally brought from the crowded waiting room to the exam room he was told, “We have time to discuss only two issues. If you have more than two issues please make another appointment.” He had six.
He asked how many issues he could discuss in a concierge setting. He was told, “Your appointments are on time. The small “non-waiting room” is comfortable and uncrowded. Subjects are unlimited. We usually do not end visits until we have discussed ALL your issues.”
There is a cost. Membership fees vary. They can be as low as $80 per month. The national average is under $200 per month. Some are more. Is it worth it?
Emergency room visits and urgent hospitalizations are drastically reduced for members of those in the “personalized preventive care” model, according to a study published in the American Journal of Managed Care in 2012. That’s because patients can reach their expert personal doctor directly any time and be treated promptly, so minor problems do not become major problems that require the hospital.
House calls have been revived, not necessarily on demand, but done when needed. Your own familiar doctor usually takes care of you if you must be hospitalized, not one the hospital hires and assigns to you. Time lost from work and waiting is greatly minimized, which could save more than the membership fee. Care is prompt.
In a way, delayed care is denied care. So, joining a concierge practice could be smart. Want to know more? Go to acpp.md the concierge medicine professional society.
Live long. Be well.
Dr. Thomas W. LaGrelius, M.D., F.A.A.F.P., is a certified specialist in family medicine and geriatric medicine. He is the founder and president of Skypark Preferred Family Care, a concierge primary care/geriatrics practice based in Torrance www.skyparkpfc.com. He is a staff member at Torrance Memorial Medical Center and Providence Little Company of Mary Torrance Hospital. Email questions and topic suggestions to office@skyparkpfc.com or call 310-378- 6208.
