Concierge Medicine: Premium Medical Care For An Additional Fee

Doctors don't get a lot of sympathy when they talk about their financial woes, the average internist in the United States earns $210,000 a year, after all, but the continuing squeeze from Medicare and insurance companies have caused some to reconsider how they want to organize their practices. 

A procedure that once was reimbursed with several thousand dollars, a colonoscopy, for instance, now just gets a check for a few hundred from the insurance company. Some office visits only bring in $20 or $30. The costs of keeping the office open, however, continue to rise, and the costs of keeping up with technological advances and fending off malpractice lawyers are staggering.

Some doctors, starting in the higher-cost, wealthier parts of the USA such as Manhattan and Beverly Hills, have come up with a different way to run their practices that both they and their wealthier clients enjoy, concierge medicine.

What Is Concierge Medicine?

In a concierge practice, the doctor quits taking insurance and starts charging patients a fixed, annual fee. For $1,000 to $5,000 per year, and often even less, the patient gets any of the doctor's services for no additional charge, and usually with very little waiting. The doctor can budget his income and expenses for the year, and the patient doesn't have to worry about insurance preapproval, copays, or limitations on the types of procedures the doctor can perform.

Why Would I Possibly Prefer a Concierge Doctor?

There really are doctors who practice medicine for the love of the challenge, or for the personal satisfaction of helping people, or for the prestige of the profession. There probably aren't many doctors who practice medicine because they are enthused that they might have $3 left over after paying overhead, office salaries, and taxes for a brief office visit. 

Doctors still do quite well financially, but the system is set up so that they earn vastly more for complicated medical issues than for simple medical issues. They earn more for treatment than prevention. If you want a doctor to focus on what's good for you rather than what builds up his bottom line, you may prefer to see a concierge practitioner if you can afford it.

Read More: The End of Doctors in the US Health System?

But Aren't Concierge Doctors Just for Rich People?

Concierge medicine is no longer an idea confined to the wealthier urban areas of the United States. Even in places like Jackson, Mississippi and San Antonio, Texas, there are doctors who charge a flat annual fee for their office services, sometimes as little as $150 to $200 a year.

On the other hand, there are also concierge services like that of Dr. Edward Goldberg and Dr. Daniel Yadegar of New York City who charge 400 patients $25,000 a year for truly unfettered access to medical care. Concerned that you might have a heart attack on your yacht when you sail around Tahiti? The doctors are only too happy to provide a doctor to sail with you. Need someone to hold your hand, or in one instance, your toe, when you are in an MRI machine. Your concierge doctor is at your service. Of course, with the practice bringing in $10,000,000 per year, maybe your doctor doesn't mind.

Concierge Medicine For The 99%

While concierge medicine started as a service offered by rich doctors to rich patients, more and more doctors are converting their practices to a concierge model because it allows them to practice medicine in the way they hoped to practice medicine when they first became doctors.

A concierge doctor typically only sees 16 patients a day. That's about half an hour per patient. Many times the patient walks into the clinic and is greeted by the doctor, not by a receptionist. E-mail contact is welcomed. And nobody gets put on hold when calling in.

Or at least that is the ideal. A few medical practices have actually pulled off concierge medicine for people who don't have lots of money.

• Greenhouse Internists, founded by Richard Baron, a physician and former chairman of the American Board of Internal Medicine, operates a concierge medical practice in Philadelphia that doesn't even charge an annual fee.
• Dr. Tom X. Lee, an physician trained at Harvard's Brigham and Women's Hospital and also a Stanford MBA and founder of the website Epocrates, organized One Medical to offer concierge medicine in New York and San Francisco for just $150 to $200 per year. With 31 physicians, One Medical routinely offers same-day appointments. It does not charge for answering questions by email or for issuing prescription refills. And unlike other concierge practices, One Medical will even work with Medicare and Medicaid for patients who cannot afford the $150 to $200 basic fee.
• GreenField Medical in Portland, Oregon, offers its services for a sliding-scale free of $195 to $695 per year, still vastly less than what other concierge doctors charge. Its doctors spend about half the day seeing patients and about half the day answering questions by email and by phone.
• Dr. Samir Qamar's 16 MedLion clinics in 7 states charge $59 a month for membership and $10 for each doctor's visit, never billing insurance.

Read More: What To Do When Your Doctor Won't Listen

Is concierge medicine right for you? Here are some things to consider:

• Even if you have concierge doctor, you still need medical insurance in case you have to go the hospital or see a specialist. If you just can't pay your premiums (and you should look at the possiblity of coverage with a company that gives you advanced credit for deductible assistance), consider a Bronze plan that may be low-cost or free or even come with a refundable tax credit before you go without any insurance at all.
• Don't expect to use your health insurance at the concierge doctor's office, however. About 40% of the expense of running a medical practice is billing insurance companies, and it's by eliminating this step that the doctors are able to charge less.
• If your medical insurance deductible is $5,000 or more, then it probably makes sense to look for a doctor who runs a concierge or membership medical practice. Since you would wind up paying for routine office visits out of pocket anway, it's easier to budget a monthly fee than it is to come up with a few hundred to a few thousand dollars when you get sick.
• You don't have to pay a lot for premium medical care. There are over 5,500 concierge medical clinics in the United States, and 2/3 of them charge $135 a month or less.