Friday, August 3, 2012

The Future of Medicine aka My Doctor Left Me for Someone Wealthier

I think I've spoken before about my primary care doctor. We'll call him Dr. Wonderful. I have to tell you - I love this man. Even though he is in a huge practice with tons of patients, he has never once rushed me through my appointments. He asks not only about my physical health, but also about how KG and I are doing on an emotional level. He kept up to date on all my infertility treatments (since they sent him reports on every single procedure) and trusted my judgement and instincts about my own care. He even trusts me to self diagnose my annual sinus infections, and call in meds for me, without dragging me in for an appointment. He calls me back within hours every single time I leave him a message. I completely trust him with the ickiest of medical issues and even KG is willing to see him, and he hates going to the doctor. Truly, he (along with my RE and my psychiatrist) set the bar for all of my medical care.

My warmest memory of Dr. W. was the night he found out about my failed fertilization during IVF #1. The man called me at 7:00 pm and spoke to me for a half hour about everything I was feeling and gave his opinion on next steps. He stayed after a day full of patients, just to comfort me. I cried after that call, simply because I felt so completely safe and cared for as his patient. 

Then, on Wednesday, I got a letter from Dr. W. At first, when I saw his name on different letterhead, I just assumed he was switching practices (maybe one closer to my house?!).

Then, came the blow.

He is opening his own practice based on the "concierge" model of care. According to the letter, he would be opening a smaller practice, with much more personalized care, but you had to become a member in order to continue to see him. The annual membership fees would cover such things as longer appointment times, an in-house lab, 24/7 phone access to the doctor, wifi and snacks in the waiting room, and lots of other bells and whistles. Additionally, you also need to continue to pay for regular medical insurance to cover the actual office visits, labs, hospitalizations, etc. The fee is simply to join the practice.

How much could this fee possibly be, you might ask? A few hundred a year? A thousand?


We are talking about $5,000 per year for me and KG. $5,000. A number so completely out of reach for us that it isn't even a remote possibility.

When I read the letter, my stomach sank. I immediately searched the internet and got quite the education about this issue. It's becoming more and more popular for PCPs to do this, to avoid pressure from insurance companies to pack in patients, with more and more paperwork. It's a total win for the doctors. Fewer patients, less red tape, appointments that run on time, and better quality of care. Similarly, for those who can afford it, it's a win for the patient too. I mean who wouldn't want all of that?

But I have to tell you, this makes me feel a little sick inside. Simply because I can't afford this extra fee, I am going to lose out on the care of the best doctor I have ever seen. It feels elitist. It feels exclusive. It feels like I am being shut out of an opportunity because I am not among his wealthiest patients. It feels that way, because it's true.

After the sadness, came anger. It just isn't FAIR. I stomped my feet. I pounded my fists. I called my mom to complain (who said her own PCP did this a year ago, but is only charging $300 per year.) Then I called Dr. W. and left a message to please call me back.

And he did. At the end of a long day seeing patients, he did what he always does: called me back promptly to discuss my concerns. He did so with grace and warmth. He explained his point of view (feels like he can't be the doctor he wants to be in his current practice, never sees his family, etc.) and expressed how much he appreciates me as a patient. I couldn't even stay angry. He's just that sweet.

The problem is, I see Dr. Wonderful *maybe* two or three times a year at this point. Other than infertility and the anxiety/depression issues (both covered by insurance), I have no reason to see him, other than physicals and the occasional sicknesses that come with everyday life. So, there is no way I could ever justify the cost to join the practice. So, I made a last ditch effort and asked him about a sliding scale for his fee. He said that I should call and inquire about it in a couple of months, after the new practice is on its feet. In the meantime, he referred me to another doctor and asked about how the pregnancy is going.

Although I can't stay mad at Dr. W. I am thoroughly freaked out by this trend. I know more and more PCPs are going to start following this model, and it scares the shit out of me. Really, it just means the richest people will get the best care, and the rest of us will have to deal with crowded waiting rooms, wait lists, and appointments that never run on time. Maybe this is the way it has been in America on a smaller scale, but it's becoming obvious that the disparity between the haves and the have-nots is going to affect the medical care of more and more people.

For me, it feels personal. It feels like I've been abandoned. It feels like I have one less person in my corner.

So long, Dr. Wonderful.

Anyone else have a PCP who switched to concierge care?

"Mad World," by Tears for Fears


  1. That's really scary, like you said that all the best Dr's might be doing this and the rest of us are left with the lesser physicians. Ugh.

    I didn't know this was a "thing", I thought it was made up for entertainment purposes when I watch Royal Pains.

    I'm bummed out for you! Happy for you Dr., if he can get people to pay those fees, he is definitely on the right track and sounds talented, but I'm so bummed you feel so comfortable with him and can't see him anymore. Ridiculous.

    Ick, US healthcare is so crappy. My husband and I have Cigna and we had some infertility insurance that we blew through quickly, but most of our office visits were around 25-35 dollars, something changed and now we are paying 60 dollars for each OB appointment and 90 for each ultrasound. I'm too frustrated to call and inquire, because I know there's nothing they can do to change it back ,so I'm just paying hundreds of dollars a month to cover my maternity and my husbands orthopedic co-pays. I'm wondering how much it's going to be to have this baby!

    I'm with you girl! How's your little boy doin'? :)

  2. I'm sad for you.

    My prior PCP doc (like you I only saw him a few times a year, if that), started a private pay practice directed toward corporate health - companies would pay for intensive testing of their executives - only to be sued a year or two later for inappropriate touching of female patients and ended up losing his license. But I didn't really have the same connection as you so I found it annoying but not shattering.

  3. That sucks :(. Dr. Wonderful sounds absolutely amazing, I have never even heard of such a great doctor. Unfortunately, it probably will go more that way because with the obama care coming the drs will not want what it will inevitably bring (which is what we have in Canada - which is a joke). I don't even have a regular Dr. currently. Our wait times are insane and people literally die waiting for treatment. It is great in that you never have to worry about whether you can afford to go to the hospital or Dr and that you get the same treatment rich or poor - but sucks in that that treatment is not likely the best, and unless you are dying you will wait.
    On the bright side, Dr. W. I am sure has picked out a fantastic new Dr. for you since he clearly has high standards - I hope that the referral he gave you turns out to be even half as fantastic.

  4. Oh wow, that's ridiculous! I just got a letter from my PCP (who I'd only been seeing a short time but loved) a couple of weeks ago telling me that she was leaving her practice as well, but it didn't say where she was going...I hope she's not selling out too!

  5. WOW, I'm surprised his price is so reasonable. Hubs and I started feeling the effects of this last year when a trusted and highly regarded doc of ours switched over to this. Its called "executive care" but his price was $10,000 per patient for the year. Of course we can't afford that so we of course didn't do a membership but its become a huge trend here and in Miami where so many people can afford it it kind of makes me mad since all the best docs are going this route. One of hub's best friends is a doc thinking of going this route and I started really going in on him but at the end of the day he won't listen. Money speaks louder I guess. It just sucks all around I'm sorry you're losing your favorite doc. I hope the new doc turns out just as nice.

  6. I know a few people this has happened to here in oklahoma. It's a hard call. I get where the doctoris coming from, but ultimately we are the ones who suffer and I feel it's very unfair.

  7. Um, listen to your friend from Canada cause their reality is our future. This is the first step. Ack please don't kill me for being a tad political. I'm SO SORRY to hear about this, I know how much everyone loves him. I've got an apt with a new doc on Mt Auburn in a few weeks, I'll let you know how it goes.

    1. Def let me know how it goes with the new doc. I agree that the medical system in America is flawed. Just remember, it took many, many administrations to get us to this point, not just 1. :)

  8. First off, I'm so sorry you're losing Dr. W. He sounds fantastic.

    Unfortunately, this trend is becoming a reality. There are currently fewer PCPs than most other types of physicians. Blame it on the medical schools (there's still this mentality among medical students that it's not prestigious to be a PCP vs. specializing); blame it on the pay scale (PCPs still make far less than those who specialize); blame it on the HMOs (they flood PCP practices, demanding more from them than any other physician); blame it on society (only recently have we begun to value PCPs). To get around some of this, many established PCPs are moving to private practice. Those who follow love the model, as they get more one-on-one time with their PCP and the quality of care increases. In addition, the PCP is finally being compensated for their time. The cost, though, comes to those who can't pay for this service. In short, having affordable health insurance means many of us are missing out on good preventative care.

    What can be done? Well, Mo had a post today about this. A good one to boot. The other thing is we need to start changing the conversation. I encourage any of my students who are thinking about medical school to looking into PCP. That or nursing (NPs programs are FINALLY starting to award doctorates and many NPs are exceptional). In addition, I would contact your Congress person. Tell your story. Obamacare is still under attack by people who are utterly clueless and usually are taxing the system.

    In the meantime, I'm really sorry. Hopefully in a couple of months a sliding scale will become available at Dr. W's office.

  9. The trend towards concierge care really speaks to our need to move from a pay-for-service model to annual salaries. The US is unique in that we pay physicians per service, yet you see PCPs moving toward the concierge model because it allows them to remove themselves from this type of compensation model. Also, this past Sunday's NYTimes had an alarming article about the shortage of doctors, primarly PCPs. The combination of these two trends is going to be disastrous - especially for low and moderate income households.

  10. Ugh. I'm sorry that this is happening now, in the middle of your pregnancy. Since we're new to Boston, I ended up choosing a doctor based on location and crossing my fingers that I'd like her. Turns out, she's great. I hope you have the same luck when finding a new one. (Is he at least recommending another doctor? He must know that most of his patients can't afford that type of practice.)

  11. Definitely an important issue to call notice to. Everyone wins... except the poor or middle-income earners. Separation of the classes continues to grow rapidly. Too bad we are not modeling after other 1st world countries.

  12. I'm a nurse. I'm getting a divorce. My one request was for my soon to be ex to keep the kids on his insurance because it's so expensive for me. He got fired from his job. I don't think my lawyer believed me when I said I pay an arm and a leg. I had to bring in a copy of the difference between single and family coverage to her for child support issues. Her eyes got wide and she said, "you pay THIS much?". Yeah. And I'm a nurse. You'd think we would have good insurance.
    Anyway. I had never heard of what you describe! That's awful! I hope dr wonderful is able to give you a break. Or that you're able to find another dr wonderful.

  13. That sucks and pisses me off to no end. Middle class screwed again! And doesn't is always happen that way? You find a good Dr and they disappear in some way.

  14. oh no! How sad... I would be feeling the same way. I hope it works out for you to still see him

  15. I'm so sorry :( I wish I'd ever had a doctor like you describe, although I hate that you are losing yours. This is the problem created by the insurance companies being the middle-man between doctor and patient. I wish the doctor and patient could decide how long the appointment should be and the appropriate treatment. Instead we have "step therapy," "utilization management," and "in-network physicians." Most insurance employees who issue prior authorizations have no medical background! No medical background! And they are deciding if you can see the doctor or have the treatment??

    I'm sorry. I hope you find another doctor that you can trust.

  16. Yep. This happened to me, too. It's really awkward, because my former primary care doctor is a lovely person and our kids now go to the same preschool, but I could not afford the cost of her new practice. I live in the Bay Area, and it seems as if every doctor is moving to this horrible concierge model. I changed to a practice that charged us once a year $500 (cheaper than my previous doctor) and finally I have found a local practice that does not charge an annual fee. For now.

    I really, really hate this new model of medical treatment. THANK YOU for spotlighting this. I hate to think this is a trend :(

  17. I am so sorry you are experiencing this. My parents have dealt with the same thing. They have a fantastic doctor they have each seen for 22 years. She moved her practice to this new "rich person" style last year. I believe they had more than a $5,000 buy in for the two of them. It was horrendous. They are lucky they can afford this. Mr. Husband and I, though? Not a chance. Should my PCP who knows all my exhaustive autoimmune history change his practice I am absolutely shit-out-of-luck. As for finding a new doctor - my new policy is to set up an interview with them. This is exactly what we did to find Dr. B. I booked two interviews with two doctors and told them up front that this was me interviewing to choose. For me it worked well. I hope it does for you, too.


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