Monday, February 12, 2007

Many Questions - Limited Time

I received a call yesterday from a friend who wondered if I knew of any physicians who are offering "concierge" medical services. This is the new trend where a physician limits his/her practice to a few hundred patients and charges a membership fee ($1000 to $5000 per year)to those patients. The fee is in exchange for perks like same day visits, prompt return phone calls and more time with the physician at each visit. It doesn't cover the costs of the office visits or tests, but is a retainer for better service. Reports show that patients in these relationships are satisfied and the physicians enjoy having the "financially protected" time to spend with the patient.

A recent study reported in Health Services Research and referenced in The New York Times, studied videotapes of almost 400 primary care visits. They found the median time for visits was just under 16 minutes and patients tended to bring up 6 subjects. About five minutes was devoted to one major topic, with the other issues receiving as little as one minute. When a patient presented a complex problem, the doctor had two basic choices: limit the time or make another patient wait while he extends the visit. If the doctor extends the visit of several patients a day, he will soon be so far behind that every patient will feel rushed and no one will feel well cared for. This treadmill pace is not good for the patient or the physician and is one reason so few young doctors are choosing the primary care field as a practice choice.

Is concierge medicine the answer? For my friend, who says "I've had three doctors and it just isn't working for me anymore" it probably will solve his problem. He can afford the fee and will enjoy the relaxed pace of his new doctor's office.
But this model is the solution for only a few patients and a few doctors and will only make the primary care doctor shortage worse.

Unrushed quality time is something Physicians want to give and something patients want. With our current insurance and Medicare reimbursement structure, the solution seems a long way off.


Raymond Bouchayer said...

Doctors have a lot of patients to see every day . All of us are guilty of trying to squeeze the allowed time into a long session. All Doctors that I have met spend the time that was necessary for me , sometime cutting on other people. Doctors are overworked and under paid , thanks to the Insurance companies.
We should all have access to medical care , the same one we give our employees , Senators / Congress/ President etc....and Doctors should be paid what their charges are .The only people that object to this plan are of course the insurance companies .

Linda Fairchld said...

I am a dual citizen with Canada and was outraged when my elderly father could not ask his 2nd question at his doctor visit (clearly posted in the waiting room - one issue per visit!) My 88 year father was fine with that, gets excellent health care and loves his doctor, who I thought was pretty fast to process. But so many of the issues we have in the US have to do with perception and expectations that other countries with socialized medicine do not have. In Canada, although the system is far from perfect, I find that people are generaly well cared for, particularly if there is a hospitalization, and live to be really old! What does not exist there is absolute panic around medical insurance, loss of insurance, "What is going to happen to me if I get sick?" kind of feeling that is overwhleming the middle class. While I am happy that there will be concierge services for rich folks, this does nothing to solve the larger issue of retaining the number of doctors needed to care for the population. How can we have basic medical care included in our taxation system and adequate funding to compensate medical professionals for their highly skilled work?

I continue to be horrified that we have billions of dollars to pour into invasions of other countries and have no interest in basic health services as part of our annual budget. Needless to say, I will be retiring in Canada.