Anyone ever do this? I was sitting in the waiting room the other day of my doctor in Manhattan for my yearly physical and his office/practice offers concierge medicine. So, out of curiosity I picked up the brochure and started reading it about what benefits you get. For instance, you can get same or next day appointments, the docs cell number for after hour calls, "personalized tests" to suit your medical needs, if you go to the hospital he will advocate and coordinate your care with specialists. if you get sick while traveling he will find you a doctor, etc. To join the program it was like 6K a year per member of your family.
It got me thinking, how is this ethically and morally sound when you cater or take the business to both concierge and regular patients. So, if I am sick I can't see my doctor who takes my money on a yearly basis so that some other guy who paid more money can get to see him? Or, if I have a problem after hours he might not call me back, but he would to the guy who paid him more money.
I was wondering if anyone had done this before (I am not considering doing), just curious if the benefits are worth it and curious what other people think about the ethical issues of a doctor basically creating two classes of patients. I get if he only sees concierge patients, but if you see both don't you owe the same level of care to all of your patients?
Sorry for the long post, but I was curious about some people's thoughts on this.
Morality? Does not concern me at all. I am purchasing a service that is available to us 24/7. I can afford it now. I look at it like when I hire an attorney or buy a car. You get the best you can afford.
Morality? Does not concern me at all. I am purchasing a service that is available to us 24/7. I can afford it now. I look at it like when I hire an attorney or buy a car. You get the best you can afford.
Right but when you hire an attorney you pay them per hour his rate. Attorneys dont have to tiers of clients and it would be unethical to treat clients differently in the legal field.
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But it is about 60% of that for both of us total. Is it worth it? Probably not, but I hate going to the doctor for a 10 minute poke and check. What is worth it is he is exclusively concierge so he will spend as much time as needed with you. We both go the same day for annuals. Both of us are pretty much healthy and he even says we don't see him enough.
Morality? Does not concern me at all. I am purchasing a service that is available to us 24/7. I can afford it now. I look at it like when I hire an attorney or buy a car. You get the best you can afford.
Right but when you hire an attorney you pay them per hour his rate. Attorneys dont have to tiers of clients and it would be unethical to treat clients differently in the legal field.
Even with an attorney you get what you pay for. $250 per hr vs $1000. Plus, you always need a doctor. Hopefully you rarely need an attorney and only for wills....
We already have tiers in the medical field. I have to wonder how "ethical" it is to squeeze as many patients as possible into a daily/weekly schedule and charge the same amount to each patient - one that is healthy and is in and out in 15 minutes vs the chronic ill that needs repetitive care and delaying their appointments because of over scheduling.
sure there is a Hippocratic oath doctors take, but that doesn't mean they can't make a profit.
sure there is a Hippocratic oath doctors take, but that doesn't mean they can't make a profit.
Ok then run it conceirge only, but if you pay a doctor on the lesser track, you should not have to sacrifice your health. And yes, doctors have ethical standards for licensing. An attorney can't mail it in because he agrees to take a case at a certain rate per hour and another person pays him a different rate. Not only could you get disbarred , but you would be sued. A business has to run within the ehtical confines--the doctor is still taking the money. If you don't want non-conceirge patients or want to practice with that, do it exclusively.
I’m saying I can’t afford to pay staff and myself. Costs have gone up about 45% over the last 10 years whereas the gov is cutting Medicare payments.
This isn’t a woe is me post- I’m still happy with my career and choice. But the reality is the options for patients are going to become increasingly cash pay based with an increasingly smaller pool of available doctors as the economics of it drive us in that direction.
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have to do with it? is your doctor running a business or a charity?
sure there is a Hippocratic oath doctors take, but that doesn't mean they can't make a profit.
Ok then run it conceirge only, but if you pay a doctor on the lesser track, you should not have to sacrifice your health. And yes, doctors have ethical standards for licensing. An attorney can't mail it in because he agrees to take a case at a certain rate per hour and another person pays him a different rate. Not only could you get disbarred , but you would be sued. A business has to run within the ehtical confines--the doctor is still taking the money. If you don't want non-conceirge patients or want to practice with that, do it exclusively.
No, they could do 4 days regular practice and 1 day concierge (or 3/2). In the end, you wean off the traditional by either death or patients moving away without taking new patients.
In the end, your guy may actually be heading in that direction - strictly concierge. They may be gauging their patients to see if it is feasible.
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have to do with it? is your doctor running a business or a charity?
sure there is a Hippocratic oath doctors take, but that doesn't mean they can't make a profit.
Ok then run it conceirge only, but if you pay a doctor on the lesser track, you should not have to sacrifice your health. And yes, doctors have ethical standards for licensing. An attorney can't mail it in because he agrees to take a case at a certain rate per hour and another person pays him a different rate. Not only could you get disbarred , but you would be sued. A business has to run within the ehtical confines--the doctor is still taking the money. If you don't want non-conceirge patients or want to practice with that, do it exclusively.
What do you mean? you have your doctor on retainer?
The way my relationship with my primary care doctor works today is I schedule a visit, I see him, he treats me, I pay him.
How does that change if he has concierge customers?
If I don't have concierge service, I make an appointment, I see him, he treats me, I pay him.
not sure I understand the dilemma. What am I missing?
How does concierge customers with an elevated level of service and access in any way change my relationship?
Ive talked to physicians about it in the past. When the Affordable Care Act came in, it adversely affected reimbursements for some Dr.s. Nurses and Drs left the state after forced vax requirements, they havent come back.
NYS really wants a single payer system, where the Gov. takes over healthcare.
I would gladly pay more for DRs. to keep my wife alive and healthy. Its been a terrible 4 years of healthcare here in NY.
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In comment 16464557 pjcas18 said:
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have to do with it? is your doctor running a business or a charity?
sure there is a Hippocratic oath doctors take, but that doesn't mean they can't make a profit.
Ok then run it conceirge only, but if you pay a doctor on the lesser track, you should not have to sacrifice your health. And yes, doctors have ethical standards for licensing. An attorney can't mail it in because he agrees to take a case at a certain rate per hour and another person pays him a different rate. Not only could you get disbarred , but you would be sued. A business has to run within the ehtical confines--the doctor is still taking the money. If you don't want non-conceirge patients or want to practice with that, do it exclusively.
What do you mean? you have your doctor on retainer?
The way my relationship with my primary care doctor works today is I schedule a visit, I see him, he treats me, I pay him.
How does that change if he has concierge customers?
If I don't have concierge service, I make an appointment, I see him, he treats me, I pay him.
not sure I understand the dilemma. What am I missing?
How does concierge customers with an elevated level of service and access in any way change my relationship?
I have seen the same doctor for 15 years, if I call him up and say I am feeling sick, I feel like I want to be seen sooner rather than later--not because I am special because I am sick and he is my doctor. I don't want him telling one track of customers you can get it that day or the next day, but if I am home with an infection, I have to wait days to get an antibiotic and remain sick.
I don't know about the ethics, but I wouldn't want that to be my primary care if I wasn't paying for the concierge service.
I have seen the same doctor for 15 years, if I call him up and say I am feeling sick, I feel like I want to be seen sooner rather than later--not because I am special because I am sick and he is my doctor. I don't want him telling one track of customers you can get it that day or the next day, but if I am home with an infection, I have to wait days to get an antibiotic and remain sick.
Where did it say that you would not get the same level of care? All MDs have built in time in case of "emergencies."
It only says he is offering an elevated level to those who join the service.
Did yo ask him these questions after reading the brochures?
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In comment 16464569 Essex said:
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In comment 16464557 pjcas18 said:
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have to do with it? is your doctor running a business or a charity?
sure there is a Hippocratic oath doctors take, but that doesn't mean they can't make a profit.
Ok then run it conceirge only, but if you pay a doctor on the lesser track, you should not have to sacrifice your health. And yes, doctors have ethical standards for licensing. An attorney can't mail it in because he agrees to take a case at a certain rate per hour and another person pays him a different rate. Not only could you get disbarred , but you would be sued. A business has to run within the ehtical confines--the doctor is still taking the money. If you don't want non-conceirge patients or want to practice with that, do it exclusively.
What do you mean? you have your doctor on retainer?
The way my relationship with my primary care doctor works today is I schedule a visit, I see him, he treats me, I pay him.
How does that change if he has concierge customers?
If I don't have concierge service, I make an appointment, I see him, he treats me, I pay him.
not sure I understand the dilemma. What am I missing?
How does concierge customers with an elevated level of service and access in any way change my relationship?
I have seen the same doctor for 15 years, if I call him up and say I am feeling sick, I feel like I want to be seen sooner rather than later--not because I am special because I am sick and he is my doctor. I don't want him telling one track of customers you can get it that day or the next day, but if I am home with an infection, I have to wait days to get an antibiotic and remain sick.
So your quality of care has not changed, and you have received no indication it will change, but you are concerned if he gets too many concierge customers it will change?
Do I have it right? You're worried about something that hasn't happened?
I have had my doctor a long time, maybe 15 years, and i don't know if he has concierge customers or not, but I do know if I'm sick I call him to make an appointment and often his office will call back (or reply on the portal) - got to urgent care for that they can see you quicker and do a strep test or whatever, but often he'll schedule next available appointment for me or give me a choice. He'll say I can squeeze you in tomorrow or you can go to urgent care today.
I don't know, maybe my expectations are just lower than yours or my service has been better, but even if my doctor offered concierge service I wouldn't view it as a potential degradation of my service, just an upgrade for the people who find it valuable to them. IOW I don't view it as a zero sum game where in order for someone to get better service a different person has to get less.
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In comment 16464667 pjcas18 said:
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In comment 16464569 Essex said:
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In comment 16464557 pjcas18 said:
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have to do with it? is your doctor running a business or a charity?
sure there is a Hippocratic oath doctors take, but that doesn't mean they can't make a profit.
Ok then run it conceirge only, but if you pay a doctor on the lesser track, you should not have to sacrifice your health. And yes, doctors have ethical standards for licensing. An attorney can't mail it in because he agrees to take a case at a certain rate per hour and another person pays him a different rate. Not only could you get disbarred , but you would be sued. A business has to run within the ehtical confines--the doctor is still taking the money. If you don't want non-conceirge patients or want to practice with that, do it exclusively.
What do you mean? you have your doctor on retainer?
The way my relationship with my primary care doctor works today is I schedule a visit, I see him, he treats me, I pay him.
How does that change if he has concierge customers?
If I don't have concierge service, I make an appointment, I see him, he treats me, I pay him.
not sure I understand the dilemma. What am I missing?
How does concierge customers with an elevated level of service and access in any way change my relationship?
I have seen the same doctor for 15 years, if I call him up and say I am feeling sick, I feel like I want to be seen sooner rather than later--not because I am special because I am sick and he is my doctor. I don't want him telling one track of customers you can get it that day or the next day, but if I am home with an infection, I have to wait days to get an antibiotic and remain sick.
So your quality of care has not changed, and you have received no indication it will change, but you are concerned if he gets too many concierge customers it will change?
Do I have it right? You're worried about something that hasn't happened?
I have had my doctor a long time, maybe 15 years, and i don't know if he has concierge customers or not, but I do know if I'm sick I call him to make an appointment and often his office will call back (or reply on the portal) - got to urgent care for that they can see you quicker and do a strep test or whatever, but often he'll schedule next available appointment for me or give me a choice. He'll say I can squeeze you in tomorrow or you can go to urgent care today.
I don't know, maybe my expectations are just lower than yours or my service has been better, but even if my doctor offered concierge service I wouldn't view it as a potential degradation of my service, just an upgrade for the people who find it valuable to them. IOW I don't view it as a zero sum game where in order for someone to get better service a different person has to get less.
yes, this is theoretical at the moment, but the offering of these two tracks definitely got me thinking about the ramifications of it. I will tell you this practice is backed by a major hospital in NYC, one of the very best in the country, so I can't imagine it is not within the rules.
Her nurse told me a while ago that it was more a matter of fleeing the world of corporate medicine, which she described as 'death by a thousand cuts'.
Not so sure it is all driven by greed and/or rooted in class warfare but I can understand the need and why it is being met. If you select the right doctors, I don't think your care will be compromised.
yes that is my point and the fact that I won't get that same level of care now because he wants to offer that as a premium service got me thinking whether this is the right practice. With that said, as PJ has pointed out, I have not seen a level of care drop, so I probably would not be looking for a new doctor until I saw something tangible to show that my medical care was now being compromised or "second-class." I have no issue with a doctor going all concierge as people have pointed out, this is a capitalist country and if they like that model and have a patient population who can support that--then go for it. It is the mixing of patient populations that makes me somewhat --if not uncomfortable--skeptical.
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charging people for a level of care and attention that you should already routinely be supplying for all your patients at the fees you'd agreed to accept
yes that is my point and the fact that I won't get that same level of care now because he wants to offer that as a premium service got me thinking whether this is the right practice. With that said, as PJ has pointed out, I have not seen a level of care drop, so I probably would not be looking for a new doctor until I saw something tangible to show that my medical care was now being compromised or "second-class." I have no issue with a doctor going all concierge as people have pointed out, this is a capitalist country and if they like that model and have a patient population who can support that--then go for it. It is the mixing of patient populations that makes me somewhat --if not uncomfortable--skeptical.
I also have no objection to a strict concierge practice, all that is really is a practice that charges higher fees. Ih someone can do that, fine. Just that too many people are fooled into thinking that a higher priced doctor is a better doctor. You don't always get what you pay for. I saw a bunch of very average guys in my graduating class open offices in expensive areas. My best friend, while building up a start up Perio office in Hewlett also worked part-time in Manhattan for the Chairman of Periodontics at Columbia Dental School. The fees he charged in NYC were 3 times what he charged on LI. Same guy, same level of expertise.
I think it's admirable you feel this way, and I believe you treated your patients this way, but I can say as a consumer I do believe there are limits to what my doctor could reasonably be expected to do for the fees I pay for my health insurance.
If a doctor wanted to offer to his patients going above and beyond that acceptable standard of care for an additional fee I see zero issue with it.
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In comment 16464738 Bill in UT said:
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charging people for a level of care and attention that you should already routinely be supplying for all your patients at the fees you'd agreed to accept
yes that is my point and the fact that I won't get that same level of care now because he wants to offer that as a premium service got me thinking whether this is the right practice. With that said, as PJ has pointed out, I have not seen a level of care drop, so I probably would not be looking for a new doctor until I saw something tangible to show that my medical care was now being compromised or "second-class." I have no issue with a doctor going all concierge as people have pointed out, this is a capitalist country and if they like that model and have a patient population who can support that--then go for it. It is the mixing of patient populations that makes me somewhat --if not uncomfortable--skeptical.
I also have no objection to a strict concierge practice, all that is really is a practice that charges higher fees. Ih someone can do that, fine. Just that too many people are fooled into thinking that a higher priced doctor is a better doctor. You don't always get what you pay for. I saw a bunch of very average guys in my graduating class open offices in expensive areas. My best friend, while building up a start up Perio office in Hewlett also worked part-time in Manhattan for the Chairman of Periodontics at Columbia Dental School. The fees he charged in NYC were 3 times what he charged on LI. Same guy, same level of expertise.
Want to bet his office in NYC cost 3x what his office on LI cost?
Not sure if that’s the deal with your doc but if not I don’t see the problem. They aren’t not going to take care of you when you come in.
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In comment 16464815 Essex said:
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In comment 16464738 Bill in UT said:
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charging people for a level of care and attention that you should already routinely be supplying for all your patients at the fees you'd agreed to accept
yes that is my point and the fact that I won't get that same level of care now because he wants to offer that as a premium service got me thinking whether this is the right practice. With that said, as PJ has pointed out, I have not seen a level of care drop, so I probably would not be looking for a new doctor until I saw something tangible to show that my medical care was now being compromised or "second-class." I have no issue with a doctor going all concierge as people have pointed out, this is a capitalist country and if they like that model and have a patient population who can support that--then go for it. It is the mixing of patient populations that makes me somewhat --if not uncomfortable--skeptical.
I also have no objection to a strict concierge practice, all that is really is a practice that charges higher fees. Ih someone can do that, fine. Just that too many people are fooled into thinking that a higher priced doctor is a better doctor. You don't always get what you pay for. I saw a bunch of very average guys in my graduating class open offices in expensive areas. My best friend, while building up a start up Perio office in Hewlett also worked part-time in Manhattan for the Chairman of Periodontics at Columbia Dental School. The fees he charged in NYC were 3 times what he charged on LI. Same guy, same level of expertise.
Want to bet his office in NYC cost 3x what his office on LI cost?
That could very well be true, butI don't think that's the issue. I'm talking about patient perception. Many NYers think that because someone has an office in Manhattan and is charging top dollar that he's a "top" doctor, and "you get what you pay for". Ain't necessarily so. There were people from the 5 Towns who travelled to the city office and paid 3 times what they would have paid if they'd stayed near home. All they paid for with that difference was rent and "bragging rights". Patients, for the most part, are clueless about the quality of their health care providers.
I'm not going to get into the weeds on this issue because doing so would probably get me banned.
Suffice it to say that in the US we have gotten the health care system we deserve.
So the rest of my practice is cash. I treat all of my clients the same.
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In comment 16464667 pjcas18 said:
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In comment 16464569 Essex said:
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In comment 16464557 pjcas18 said:
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have to do with it? is your doctor running a business or a charity?
sure there is a Hippocratic oath doctors take, but that doesn't mean they can't make a profit.
Ok then run it conceirge only, but if you pay a doctor on the lesser track, you should not have to sacrifice your health. And yes, doctors have ethical standards for licensing. An attorney can't mail it in because he agrees to take a case at a certain rate per hour and another person pays him a different rate. Not only could you get disbarred , but you would be sued. A business has to run within the ehtical confines--the doctor is still taking the money. If you don't want non-conceirge patients or want to practice with that, do it exclusively.
What do you mean? you have your doctor on retainer?
The way my relationship with my primary care doctor works today is I schedule a visit, I see him, he treats me, I pay him.
How does that change if he has concierge customers?
If I don't have concierge service, I make an appointment, I see him, he treats me, I pay him.
not sure I understand the dilemma. What am I missing?
How does concierge customers with an elevated level of service and access in any way change my relationship?
I have seen the same doctor for 15 years, if I call him up and say I am feeling sick, I feel like I want to be seen sooner rather than later--not because I am special because I am sick and he is my doctor. I don't want him telling one track of customers you can get it that day or the next day, but if I am home with an infection, I have to wait days to get an antibiotic and remain sick.
So your quality of care has not changed, and you have received no indication it will change, but you are concerned if he gets too many concierge customers it will change?
Do I have it right? You're worried about something that hasn't happened?
I have had my doctor a long time, maybe 15 years, and i don't know if he has concierge customers or not, but I do know if I'm sick I call him to make an appointment and often his office will call back (or reply on the portal) - got to urgent care for that they can see you quicker and do a strep test or whatever, but often he'll schedule next available appointment for me or give me a choice. He'll say I can squeeze you in tomorrow or you can go to urgent care today.
I don't know, maybe my expectations are just lower than yours or my service has been better, but even if my doctor offered concierge service I wouldn't view it as a potential degradation of my service, just an upgrade for the people who find it valuable to them. IOW I don't view it as a zero sum game where in order for someone to get better service a different person has to get less.
I mentioned above that I have cash clients and Medicaid clients - one pays twice the other. I do it for ethical reasons and the rest is to make a living. I'm a social worker - not a surgeon, to be clear.
That all being said - access to care is crazy depending on where you live. I live in the land of Optum conglomerates and financially owned orthodpedic practices. You can spend hours on the phone just to make an appointment. No direct numbers to offices are given out. There's a reason all of the New Yorkers who moved to my town still go to the city for medical care - it's not just the quality of the doctors.
If I talk to my in-laws in syracuse, or best friends in RI, there experiences are wildly different and have great access to healthcare. So I think you hit on a key point - people's experiences differ wildly right now in healthcare. I've given up re some appointments and just let some of my health stuff ride because I don't have the time to be on the phone, given I work hourly. Once they stopped giving out phone numbers to their physical location, you know private equity or a larger group has taken over.
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charging people for a level of care and attention that you should already routinely be supplying for all your patients at the fees you'd agreed to accept
I think it's admirable you feel this way, and I believe you treated your patients this way, but I can say as a consumer I do believe there are limits to what my doctor could reasonably be expected to do for the fees I pay for my health insurance.
If a doctor wanted to offer to his patients going above and beyond that acceptable standard of care for an additional fee I see zero issue with it.
Well said. When you see reimbursement rates - you understand why people have to do it.
Suffice it to say that in the US we have gotten the health care system we deserve.
No doubt there are serious holes in coverage that really needs to be rectified. But it gets to be a pissing contest like most high cost issues.
Aside from the reimbursement situation how about all the low-level practitioners (NPs and PAs) who have just flooded the market. I'm not saying they don't have their part they can play on the medical system but they have far less training than a normal doctor and ultimately no responsibility, but they are cheaper than an MD so the large corporate hospitals use them to provide care.
I could go on and on (not to mention the complete and utter burnout that PCPs are feeling these days) - but we are witnessing the end of primary care so good for your doctor if he wants to offer concierge.
Aside from the reimbursement situation how about all the low-level practitioners (NPs and PAs) who have just flooded the market. I'm not saying they don't have their part they can play on the medical system but they have far less training than a normal doctor and ultimately no responsibility, but they are cheaper than an MD so the large corporate hospitals use them to provide care.
I could go on and on (not to mention the complete and utter burnout that PCPs are feeling these days) - but we are witnessing the end of primary care so good for your doctor if he wants to offer concierge.
To your point about "low level practitioners", I assume you mean to state that there are more "primary care" physicians now than there have been in the past 40 or so years.
If that is the case, the health delivery system will be on the right track. One of the biggest issues in the American health care system has been too many tertiary tier (ultra-specialist) physicians and secondary care physians and not enough primary care physicians.
Having more primary care physicians providing care is a good thing. Now what should happen is that reimbursement rates for primary's so that the practice can provide for a solid upper middle class life style.
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But it is about 60% of that for both of us total. Is it worth it? Probably not, but I hate going to the doctor for a 10 minute poke and check. What is worth it is he is exclusively concierge so he will spend as much time as needed with you. We both go the same day for annuals. Both of us are pretty much healthy and he even says we don't see him enough.
Morality? Does not concern me at all. I am purchasing a service that is available to us 24/7. I can afford it now. I look at it like when I hire an attorney or buy a car. You get the best you can afford.
Right but when you hire an attorney you pay them per hour his rate. Attorneys dont have to tiers of clients and it would be unethical to treat clients differently in the legal field.
Really. Some Attorneys fees are out of reach of many. Fucking Kaiser's are more ethical than doctors. lol. There's no more unethical profession. Period. Please next time. You or your family gets cancer call a lawyer. People like you want a doctor to kiss your ass for 40 bucks but will gladly pay a Lawyer 400 an hour.