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?

Nope.

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