- What Are the Pros and Cons of Functional Medicine?
- 3 Common Functional Medicine Rip-Offs
- Alternative Medicine Pros and Cons
- What Is Concierge Medicine and Should You Try It?
- Concierge Healthcare
- A primary care physician finds peace of mind in concierge medicine
- Why I chose concierge medicine
- Switching to Concierge Medicine: Pros and Cons
What Are the Pros and Cons of Functional Medicine?
First the Jimmy Fallon version:
- Functional Medicine has the word “Fun” in it, so can’t be all bad.
- Functional Medicine is way better than Dysfunctional Medicine however you slice it.
- Functional Medicine doctors believe you can eat a lot of fatty foods and these doctors think butter is better for you than margarine, a rib eye steak is absolutely fine and sour cream is healthy as long as it’s from grass fed cows that have had deep tissue massages while living in Marin County within sight of the Pacific Ocean.
- Functional Medicine means you have to stop all alcohol, coffee and energy drinks and the most you can do for stimulation is a cup of green tea chock full of antioxidants.
- You have to eat your vegetables.
- You’re going to have conversation after conversation with waiters about what on the menu is gluten free. Ok, moving on to the serious side of this, let’s figure out what really makes functional medicine tick. What makes it special, how does it work and why would you want to find a functional medicine doctor. Let’s contrast that with the pro’s of conventional medicine, what it’s best at and in what circumstances one should rely on conventional treatments.
Pro’s of Functional Medicine
Functional medicine gets to the root cause of health problems and results in long term solutions that help patients avoid exposure to potentially harmful treatments. Functional medicine treatments tend to have very few side effects, if any, making them less risky than drugs or surgery. Avoiding medications unless absolutely necessary prevents exposure to many dangerous side effects. Surgery also can generate many complications in the recovery process such as infections and the dangers of using antibiotics in how they impact the GI tract microbiome.
Functional medicine empowers patients to act to help themselves. Reality is most of the reasons we are all sick, tired, overweight and stressed are self-generated and now amount of medications is going to resolve the underlying problems. By becoming part of the solution and modifying behaviors such as food choices, exercise time and sleep habits people learn how to take care of themselves. In the long run this creates a multi-layered level of benefits that can last a lifetime.
Functional medicine in my experience costs a fraction of the amount of money as conventional procedures, saving us all in the long run from the downward spiral of economic ruin our country is looking at as health care costs escalate year after year.
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Con’s of Functional Medicine
The main problem is people don’t like to change. Honestly, if it’s a choice between eating broccoli, cabbage and swiss chard every day to lower your cholesterol and you could drop it faster with a one pill a day statin approach, and still eat all the cheese, fried foods and sodas you want, why not go for the pill? It’s an easy out and is appealing to our sense of indulgence whereas the asceticism involved in eating vegetables with every meal and reducing fried foods and junk food is hard to swallow for a lot of people.
There’s the whole lazy factor. Would you rather relax and watch TV or go on a vigorous bike ride? Would you rather stay up late and watch a movie or go to bed at 10pm? We all want everything we can get. The ice cream, the late movies, the sitting around stuff of life. Hard exercise, early to bed, meditating and eating super healthy food just seem like unpleasant options to a lot of people, taking the fun out of life.
Another huge Con of functional medicine is that it’s complicated. Taking an antidepressant pill once a day is pretty simple. Taking supplements, initiating diet changes and the complexity of many functional medicine treatments turn people off.
One area that conventional medicine is always ahead on is emergency medicine. Broken bones, trauma from a car accident, a sudden heart attack or stroke, all of these require immediate conventional care and functional medicine doesn’t even attempt to address emergency conditions. So a world without conventional medicine would be a world without much needed medical care. Urgent surgeries such as a ruptured appendix and so on.
Problems Facing Functional Medicine
I think the biggest problems facing functional medicine relate to education. We simply don’t have thorough, well thought out functional medicine curriculums that take doctors from the intellectual underpinnings of the theories of functional medicine, through the science, the research and then ultimately the clinical applications the field demands of us. There are fine institutions such as the Institute of Functional Medicine that educate doctors but they are no integrated into our medical schools, hospitals or the sprawling medical delivery systems we have developed.
Therefore we have a problem in delivering the volume of care needed. I hope through the Kalish Institute and our training programs to make a small dent in this problem and feel like our courses are one component of an as yet to be created more comprehensive system of education for physicians.
The other problem facing functional medicine that will likely slow it’s growth more than anything is the fact that it’s so cheap to fix problems using functional medicine it works against the traditional health care profit centers of pharmaceutic sales and conducting expensive medical procedures such as surgeries. It’s challenging for an upstart, unregulated and unknown field like functional medicine to carve dollars away from the well-entrenched medical/financial conglomerates we’ve created since the late 1940’s.
I have a very positive attitude toward all this counting on us humans figuring this all out sooner or later. And in my practice and in my teaching programs I see progress and results that encourage me to stay in the “Pro Functional Medicine” camp.
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Dr. Dan Kalish
Dr. Daniel Kalish is dedicated to teaching doctors Functional Medicine philosophy and practices. Through The Kalish Institute’s educational programs he has trained over 1,000 practitioners worldwide in The Kalish Method which solves patient challenges through a proven lab based approach.
3 Common Functional Medicine Rip-Offs
You avoid spending money on tests that you don’t actually need. And, you avoid spending money on tests that have already been done, too.
Rip-Off Two: You’re told you don’t need ANY testing.
Some doctors think they don’t need to do any testing on you because they can figure out your case just from your symptoms and a detailed history.
In my opinion if you’re doctor’s not testing that means they’re GUESSING. And they’re wasting your time and your money.
In order to find the underlying cause of your health problem a certain amount of testing must be performed to see what’s out of balance…and what’s not. I’ll give you a common example…
Many doctors think they don’t need to test your vitamin D levels because ‘everyone is deficient’. (Which is, for the most part, true for us here in Canada. Just about everyone I tested last year was vitamin D deficient or insufficient. Ideal vitamin D levels are 125-250nmol/L.) But, then they prescribe a generic amount of vitamin D for everyone to take – usually 1,000iu-2,000iu daily.
(Again, a one-size fits-all approach rarely works for anyone…)
Here’s the problem with this…
Vitamin D deficiency can be all across the board – mild deficiency…moderate deficiency…or severe deficiency – regardless of symptoms. Depending on how SEVERE the deficiency is it will obviously require a different dosage to fix. Your doctor won’t know that unless they test you first. Plus, vitamin D deficiency does not correlate with any specific symptoms.
In fact, vitamin D deficiency mimics many, many different diseases…
So without a test the doctor usually takes you on a wild goose chase based on your symptoms alone…
And just wastes a lot of your time…
And your money.
(That’s just one example with vitamin D. I could give you many other examples.)
Doctors that do not test either don’t know what to test or are not comfortable with interpreting the test results – this means they’ve never been fully trained in the Functional Medicine approach.
(You don’t want this doctor.)
Or, it’s entirely possible that they fundamentally cannot legally even run tests because they’re not even a real doctor, or they’re practicing outside their scope of practice!
(Crazy, I know…but I’ve seen it happen!)
A good Functional Medicine doctor will always have a plan for testing you, and will explain the pros and cons of testing based on your case, so you can decide whether or not you want to go ahead with testing.
Tests can be expensive…I know that. But, in order to find the underlying cause and not waste any more of your time and money oftentimes the best investment in your health is running the right tests.
Again, when you’re not testing…you’re guessing.
Rip-Off Three: Re-running tests that have already been done.
Unless you’re retesting to measure progress…why test twice?
To pad the doctor’s wallet…no other reason.
I especially see this with blood tests. Doctors needlessly re-running tests that have already been done by someone else because they’re too lazy to get copies of your medical records.
That’s why a good Functional Medicine doctor will request all your medical records from all your doctors to see what has already been tested and avoid repeating tests unnecessarily.
Now, most test results are only good for about a year or two. Tests older than this don’t hold as much relevance to your present state of health. In this case retesting is usually necessary to get an accurate picture of your present health.
Make a promise to yourself starting today:
Stop feeling lousy…rotten…awful…crummy…miserable…terrible…crappy.
Find a good Functional Medicine doctor to help you get to the root cause of your health problems.
Like I always say:
Find the cause.
Fix the cause.
Feel normal again!
Dr. Carri Drzyzga, DC, ND – The Functional Medicine Doc
Find the Cause. Fix the Cause. Feel Normal Again!
Alternative Medicine Pros and Cons
A basic principle behind many kinds of alternative medicine is balance. Acupuncture, tai chi, and various forms of energy medicine are designed to bring the body into balance, which in theory, can help restore health.
This principle of balance is an important one to keep in mind when considering alternative medicine for yourself or a loved one. There are many benefits of using complementary and alternative medicine for a wide variety of conditions, but there are also things to be cautious of. Before trying out any new therapy, it is a good idea to consider the pros and cons.
Alternative Medicine: Pros
Recently, the National Center for Complementary and Alternative Medicine (NCCAM) reported that about 38 percent of U.S. adults and about 12 percent of children are using some form of alternative medicine. Here are some of the reasons:
- Whole-person treatments. Traditional medicine views disease as a distinct entity from the person who carries it. The growing trend toward specialization in medicine has led to many treatment advances, but also has distanced physicians from the “healthy” parts of their patients. A key difference between traditional and alternative medicine is that most forms of alternative medicine emphasize whole-body care. Practitioners of alternative medicine address not just the physical body but also the patient’s emotional and spiritual health. According to the Osher Center for Integrative Medicine, a growing interest in a more holistic approach to health is one of the main reasons alternative medicine is on the rise.
- Personal attention. Because of the emphasis on whole-body care, alternative medicine practitioners often offer patients a great deal of personal attention. Traditional physicians can be strapped for time and pressured by insurance companies and packed waiting rooms. Alternative medicine practitioners, because of different philosophies and fee structures, typically place greater emphasis on one-on-one attention.
- Focus on prevention. Another draw to alternative medicine is its focus on prevention. Whereas traditional medicine tends to intervene once disease is present, many types of alternative medicine encourage patients to have “well visits,” treatments that are focused on preventing disease before it occurs, in addition to being cared for when sick.
Alternative Medicine: Cons
Before trying a new kind of alternative medicine, there are some key factors to keep in mind. The following concerns should not prevent you or a loved one from using alternative medicine, but offer more information in the decision-making process.
- Limited scientific research. In response to increased consumer demand, funding for research studies on alternative medicine is growing. But compared with traditional medical methods, evidence is still limited, which has left many questions unanswered. Currently, there are several studies under way. In order to learn about ongoing studies on alternative medicine, NCCAM recommends asking your primary care physician or other health care provider, visiting the “Research” link on the NCCAM site, or going to your local library and inquiring about scientific journals or online resources.
- Confusing marketing. It’s easy to confuse the words “natural” and “safe” — but the two are not synonymous, despite some marketers’ attempts to make us think otherwise. Many dietary supplements and herbal remedies, both of which fall under the alternative medicine umbrella, are mislabeled as “natural.” A red flag should also go up if a manufacturer makes unrealistic claims that their products are “miracle cures” or have “secret ingredients.”
- Potentially dangerous interactions. Even in cases when the product contains no artificial substances, supplements and herbs can still potentially interact with prescription and over-the-counter medication. And some of these natural products have side effects of their own.
Research what the relevant government agencies, such as the National Institutes of Health and the U.S. Food and Drug Administration, have to say about the dietary supplement or herbal product you’re thinking of taking. Reports on many alternative medicines can be found by visiting the various agencies’ Web sites.
When considering alternative medicine, think balance — taking the best health care from both the traditional and alternative sides of medicine could be your best option.
What Is Concierge Medicine and Should You Try It?
It’s no secret that many are frustrated with today’s health-care system: the maternal mortality rate in the U.S. is rising, access to birth control is under threat, and some states have it really bad.
Enter: concierge medicine, a different-and not totally new-approach to healthcare that’s gaining popularity thanks to the fact that it puts the patient in the driver’s seat. But what is it, and how can you tell if it’s right for you? Keep reading to find out.
What is concierge medicine anyway?
“Concierge medicine means you have a direct relationship with your doctor,” says James Maskell, a functional medicine expert and founder of KNEW Health, a community-based health plan. “Unlike most medical systems where the doctor works for the hospital system, and ultimately the insurance company, a concierge doctor is typically in private practice and works for the patient directly.” That means you generally get more face-time with (and access to) your doc.
The way they work is a bit different too: “Most concierge practices have a range of included services for the extra monthly or annual fee paid to the practice directly, outside of insurance.” So while some people who use concierge medicine have additional health insurance just in case, others do not. Much like choosing a low or high deductible plan with regular health insurance, people often choose to add additional insurance based on their health status and level of disposable income.
But lots of people would prefer to be safe than sorry: Many who use concierge medicine opt to take out catastrophic or disability insurance in case of a major accident or serious illness to ensure they’re covered. These plans tend to be less expensive than regular health insurance, but can still add up on top of the cost of concierge health care.
What are the benefits?
The biggest upsides of concierge providers? Longer visits and more personalized attention. People like that. And because of those benefits, more and more versions of concierge medicine are popping up. Parsley Health (New York, Los Angeles, and San Francisco), One Medical (9 cities nationwide), Next Health (Los Angeles), and Forward (New York, Los Angeles, and San Francisco) are just some of the options available at the moment.
“They all offer a much-needed change from the traditional medical model of 15 minutes with the doctor and rare same-day appointment availability, sending many people to urgent care or the ER, or leaving them with their symptoms for days (or months even),” says Dawn DeSylvia, M.D., an integrative physician in Los Angeles. (Related: When You Should Think Twice Before Going to the Emergency Room)
Concierge medical clinics offer timely access to care, dramatically shorter wait times in the office, and longer visit times with the provider, in which the patient’s true health care needs are more fully meet and treated, says Dr. DeSylvia. Those are pretty huge pros. Making appointments is generally done via an app, online, or by calling the doctor’s office directly.
Plus, with concierge medicine, you may have more choice over the treatments and tests administered, and, for some, this may mean better health long-term. “Many people don’t have adequate insurance coverage or access to medical providers and information and therefore may lack the knowledge to identify health problems and prevent major illness,” explains Joseph Davis, D.O., a reproductive endocrinologist in New York City. “Concierge medicine allows doctors and patients to have a closer relationship and ready access to knowledge and experience. This can help prevent illness by identifying and treating it early.”
Are there any downsides?
So you’re getting more personalized care, more control over which treatments you want, and less time waiting around for your doctor to be available. That’s awesome. But one of the biggest cons of concierge medicine is the price. “Concierge medicine is always more expensive than health insurance, as they do bill your insurance where they can, but then charge an extra cash fee for non-covered services,” says Maskell.
In some cases, that may mean it’s not a good financial option for those with pre-existing or chronic health conditions. “Concierge care typically only covers primary care type services, and so for the severely chronically ill, the majority of the services will be provided by their health-care plan,” explains Maskell. Things like prescription medications and tests that need to be performed in a hospital environment often need to be billed to traditional health insurance.
And just like regular health insurance, there are different price options-from $150 a month for services like Parsley Health (which is meant to be used in conjunction with regular health insurance) to up to $80,000 a year per family for the most exclusive personalized concierge medical practices. Of course, there are plenty of options in between those price points.
That said, if you have the means, adding concierge medicine on top of your regular insurance can be a good idea for those with existing health conditions. Leland Teng, M.D., who runs the first hospital-based concierge medicine program at Virginia Mason in Seattle, says that it’s particularly beneficial for those who have complex medical conditions, travel frequently, or have otherwise busy schedules. Patients are able to contact their doctor from anywhere in the world via cell phone at any time, and they’re also able to schedule house calls as needed.
How to decide if it’s right for you
Interested in trying out a concierge medical plan? Do this first.
Go say hi in person. If it’s possible, visit the concierge medical provider you’re considering. “Go and meet the doctors offering it,” Maskell suggests. Do you have a good rapport with them? Do you feel comfortable in their office? How does it compare to the doctor’s office environments you’re used to? If you got really sick, would you feel okay going there? It’s important to consider the answers to these questions before making the switch.
Find out what they’re offering. These days, there are lots of different types of concierge medicine. “Some offer ongoing primary care with your own doctor, and others are more akin to kiosk medicine, offering science-based cutting-edge medical tests and treatments, where you can literally walk in and tell them what tests you want, and what treatments you would like to receive that day,” says Dr. DeSylvia. Based on your health status, you’ll want to decide which approach is best for you.
Figure out how much you spent on medical care last year. What did it cost you out-of-pocket for medical last year? Maskell recommends considering this before considering your budget further. Is your current health insurance plan working for you? Did you spend less or more than what you’d be paying for the new concierge service? For some, money may not be as big of a concern, but if you’re trying to *save* money by switching to a concierge practice, understanding what you’ve spent on medical care in the past is essential.
Set your budget. Once you know where you stand, decide how much you want to spend now. Some concierge providers are really expensive, while others aren’t. Some require monthly payments; others work yearly. Ask questions until you understand all the potential costs of the provider you’re considering.
Our concierge services are for individual looking for more accessibility to their physician. If you sign up for our concierge services, doctor Joshua Jacobi, MD is available to you 24/7. He is your personal doctor who is literally a phone call away for your health needs.
Rather than wasting time waiting in the office to see the doctor, Dr. Jacobi will see you right away without having to wait. Your appointments are not the average 7 1/2 minutes at a typical doctor’s visit. Instead you can take your time and all your questions are answered. We also provide after hours and telemedicine visits for our concierge patients who have very busy schedules.
Discover the benefits of concierge medical care. Trust triple board certified doctor Joshua Jacobi, MD, and Healthy Living Medical (near Huntington Memorial Hospital) for compassion and convenience. Call us at 626.716.9206 from San Marino, South Pasadena, Pasadena, Arcadia or Los Angeles in LA County, CA or use our convenient online Request an Appointment form to schedule your consultation.
I came to Dr. Shira Miller about 10 months ago with severe migraines, fatigue and lots of personal intimacy issues. At 58 I felt that I would have to accept life the way it was. I can’t thank Dr. Miller enough for the changes in my body, the new found energy and substantial decline in health issues. There may be plenty of hormone doctors but I wanted one who was thorough and one that cared about me and my issues and I found that with Dr. Miller.
Lisa, 58 (Los Angeles, CA)
We went over every test result, what they meant, the implications if abnormal, and corrective actions. I filled out a personal health history and we reviewed it again thoroughly. I have never had a doctor pay such attention to my well being, I mean after 2 and 1/2 hours I understood what a comprehensively medical evaluation was like. It is up to me, with her help and guidance, to take charge and responsibility for my health. Dr. Miller sends me articles that relate to what we talked about and we talk about how this will help me. Everyone should call Dr. Miller and schedule an evaluation, its well worth it. You won’t regret it, and it may save your life.
Richard, 71 (Beverly Hills, CA) Thanks for the consultation and lecture. It was very informative, useful and probably should be a requirement for all patients of all MDs.Mike, 50 (Beverly Hills) I want to thank you for yesterday… fantastic!!!!! My mom wants you to help her too.Karen, 45 (Westwood, CA) I can’t say how much better I feel and how fast I felt it happened. I didn’t know how bad I felt until I felt better!!!Georgianna, 50 (Arcadia, CA)
A primary care physician finds peace of mind in concierge medicine
On a typical day two years ago, Steven Fugaro, M.D. ’81, saw a patient in his solo primary care practice every 10 to 15 minutes. Onerous paperwork and economic difficulties made it hard for the San Francisco-based physician to provide the quality of care he felt his 3,000 patients deserved. “I was becoming increasingly dissatisfied with what I was doing,” he said, “although I was probably too busy to be reflective of it at that point.”
Then MD², a concierge medicine group, based in Bellevue, Wash., approached him. Would he like to join them as a concierge physician and gain the time and resources to provide extraordinary care for a small number of patients? His decision to do so changed his life and made him part of a controversial trend in primary care.
Fugaro had opened a private practice after an internal medicine residency at the University of California, San Francisco, and eight years in academic medicine. Although he loved primary care, physicians in that field are under tremendous pressure to see patients in great numbers—time is tight, reimbursement rates are stagnant and preventive care must take a back seat to immediate problems. Few medical students choose the field, and many weary primary care physicians are retiring early or taking jobs in industry or administration. These doctors are in short supply.
Enter concierge medicine. In this model, introduced in 1996 by MD² founder Howard Maron, M.D., patients pay a yearly fee ranging from $15,000 for an individual to $25,000 for a family of four. In return, physicians make themselves readily available, offering prompt appointments, house calls and other extras.
Critics of the practice, also known as “boutique medicine” or “retainer-based medicine,” call it unethical. The retainer is beyond the means of many people and because concierge physicians care for fewer patients than other primary care doctors, the practice increases colleagues’ burdens and may endanger access to care. But many concierge doctors say that they would have quit practicing altogether if not for this option. Fugaro agonized for months over his decision. “I was worried about what my colleagues would think. I was worried about … leaving patients. I wondered if I would be intellectually stimulated,” he said. “On the plus side being able … to have basically unlimited time with , to be able to care for them in a very holistic way and to have balance back in my life.” For Fugaro that meant more time for such pursuits as mountain biking and spending time with his wife of 22 years and their son, who studies theater at Northwestern University.
In 2007, Fugaro arranged for the patients in his primary care practice to be cared for by a successor, Allan Treadwell, M.D., relinquishing the practice free of charge. Then Fugaro joined MD².
He cares for just 50 families now, and on a typical day sees or speaks to six to 10 of his patients. The office does many of its own tests, with results available on the spot. He makes regular house calls. Many of his patients have complex medical conditions and he is better able to anticipate problems before they arise. “I was juggling so many things before,” Fugaro said, “it was clearly possible for something to fall through the cracks, and that’s far less likely now.” He also accompanies patients to specialty appointments and the ER, and enjoys learning from subspecialty colleagues at such times, “as opposed to just communicating through a consult letter.” For about 5 percent of his patients, the retainer fee is waived.
Fugaro is partnered with another physician; neither leaves town unless the other can stay. Though always “on call,” Fugaro said he has more time now for nonclinical professional pursuits. In 2007, he was elected president of the San Francisco Medical Society, where he pushes for such public health measures as restrictions on secondhand smoke, and partners with the California Medical Association to battle Medicaid cuts. He also has volunteered at a clinic in Mexico.
Fugaro says his colleagues’ reactions have been mostly positive. Indeed, several are opening retainer-based practices of their own, including Treadwell, the physician who took over his old practice. Fugaro acknowledged that access to primary care is a tremendous problem in American medicine. “We need to create a better model for primary care doctors to continue doing what they’re doing and be emotionally rewarded for it, as well as deriving reasonable economic compensation. And right now our system is broken in that regard.”
Additionally, health insurance does not reimburse for concierge medicine payments, but some patients are able to use money from health savings accounts to cover the cost.
READ MORE: Low-Income Patients Cite Financial, Cultural Barriers to Care
Concierge medicine arrangements can cost anywhere from $1,200 to $3,000 annually, according to industry trade group Concierge Medicine Today. These payments are usually split into monthly fees.
Per a separate analysis published in the Journal of the American Board for Family Medicine, the average monthly cost for concierge medicine is $93.26, although there are some arrangements targeted at low income patients that only cost about $30 monthly.
Interestingly, the JABFM article found that the terminology used to describe a concierge medicine arrangement impacts the cost of care for patients. Providers who offer “concierge medicine” versus “direct primary care” or “retainer-based medicine” charge more per month, an average of about $182.
As of 2016, there were 141 concierge medicine practices with 273 locations in 39 states, according to the JABFM article. Most of these practices had four or fewer providers and lower patient panels than traditional practices.
These cost and patient panel arrangements are what distinguish concierge medicine from traditional practices. As such, they have the largest impact on patient care in concierge medicine and are important factors to consider when a patient is choosing concierge medicine.
How does concierge medicine impact patient care?
READ MORE: High Patient Financial Responsibility Reduces Positive Outcomes
As noted above, concierge medicine emerged from a desire to meet patient experience needs. Long wait times and administrative burden often bog down patient care access, but with concierge medicine those issues are less pronounced.
Patients are able to quickly access their doctors and spend more time with them, thus increasing patient satisfaction, according to Jim Williams, MD, a primary care provider who delivers concierge medicine.
“The benefits for the patient are that they find their doctor is far more accessible in person because the office visits last much longer – as long as the patient needs, in fact. The shortest visit is 30 minutes,” Williams said in a previous interview with RevCycleIntelligence.com.
“There’s no sense of being rushed,” he added. “Furthermore, the practice is much smaller so the doctor and his/her staff gets to know each patient far more intimately. Far more time is available on the telephone – not just with the doctor, but with staff, the business manager and the nurse as well.”
Those benefits are attractive for doctors transitioning to concierge medicine, too. Doctors will experience more job satisfaction and less burnout because they do not have to answer to as many administrative requirements and they can spend more time with patients.
READ MORE: Top Strategies for Collecting Patient Financial Responsibility
However, critics of concierge medicine say that the arrangement could also have consequences on patient care access and health equity.
“Critics of concierge medicine say they’re concerned that if many doctors choose this type of medical practice, the result will be fewer doctors to go around, leaving it increasingly difficult for patients, especially lower-income ones, to find a doctor,” according to AARP.
This issue is especially salient for pediatric populations, according to the American Academy of Pediatrics.
“The ethical concept that all children should have access to pediatric care is an important consideration for those choosing practices that have the potential of being discriminatory against underserved populations,” the organization says.
“Practice models that, by design, exclude certain categories of patients should be understood to create a greater potential of being discriminatory against underserved populations. Additionally, practices that downsize their patient panels also must be aware of ethical and legal considerations relating to patient abandonment.”
Considerations for selecting concierge medicine
Concierge medicine may not be the best solution for all patients. Just as when selecting any other type of medical provider, patients must consider their specific needs when opting into concierge medicine.
AARP suggests patients think about their current medical care when considering concierge medicine. If a patient is able to access timely appointments, have a positive rapport with their current providers, and are satisfied with their current care quality, it’d be beneficial to stick with that provider.
Patients should also assess their health needs. Patients who are fairly healthy and only utilize some preventive care and an annual physical will not reap return on investment with concierge medicine. Likewise, long travel time just to access concierge medicine may not factor positively into the decision.
However, patients should weigh the benefits of concierge medicine. If patients find a clinician with whom they click and will build a beneficial relationship, the arrangement may be suitable.
Concierge medicine does have both its critics and supporters. While the patient-centered benefits of quicker care access and better relationships abound, some stakeholders say the model does not promote health equity.
Ultimately, it will be important for patients to consider whether the model is beneficial for them to receive better treatment access.
Why I chose concierge medicine
I practiced internal medicine in a concierge medical practice for 12 years, and found it to be the best decision I have ever made in my career. Initially, there was a good deal of fear and insecurity about changing my practice. They turned out to be unfounded.
There were many people who advised me not to proceed for a variety of ethical, financial, or legal concerns. To be honest, initially many of my colleagues voiced their misgivings about giving up a busy practice to try an unproven practice model.
To be honest, I had the same misgivings initially, particularly ethical ones. This came down to the debate in my head of whether it was ethical to select a group of patients who were willing to pay an extra fee to remain patients. The model of practice I chose was a retainer-based model, MDVIP, perhaps the oldest and most established model in the country.
In this practice model physicians see a limited number of patients who pay an annual fee of around $1500.00 per year to cover non-covered services. I remained in all the medical plans I had been associated with, including Medicare. I wondered if I had the right to charge for the services I knew I was already providing without compensation. Another dilemma was wondering who would take care of the patients who couldn’t afford to join. What would they do without me?
MDVIP made great efforts to reach out to all the patients in my previous practice multiple times with different options to pay, or with a list of physicians I had recommended, who would be willing to accept them as patients. Additionally, they gave me the ability to accept a percentage of patients who could join without paying the annual fee.
I reached out to many of the patients I didn’t think could pay and offered to see them at a reduced fee. At the end of the day most of the 2,000 or so patients opted not to join the new practice. It turned out that the patients who didn’t join chose to leave me, I didn’t leave them. And despite my egotistical concerns about their welfare, they turned out to do just fine without me. As it turned out, 450 patients decided to sign up prior to opening the practice.
Several of my colleagues asked, “what if every doctor did this, who would take care of the large number of primary care patients?” As I started the new practice I quickly realized that about half or more of the daily patient visits I was doing were actually unnecessary. Many of these patients could be managed safely over the telephone or with remote monitoring devices, or didn’t need to come at all. I realized that we had been keeping our schedule full to keep it full.
Seeing only the patients who actually needed visits, allowed for walk-ins and add-ons, patients who might have been sent to the ED previously because the schedule was full. It turned out to be a great savings to the system. For example, patients with migraines could be managed in the office and not after a costly workup in the ED. MDVIP did a five-state survey which showed that MDVIP patients saved Medicare about $350,000,000 per year by avoiding unnecessary admissions, readmissions, and providing shorter hospital stays.
Some doctors and patients felt that I was looking to get wealthy by changing practice models. It is true that my income went up substantially after changing models, but it hardly made me wealthy. I had to get over the idea that physicians had a right like everyone else to be fairly compensated for hard work. Plus, because I was making more money I could afford to provide much more charity care, and only accepting co-payments for covered visits. It turned out there was no need to charge for every service or visit provided because the money generated from the annual fees was more than enough to keep the office running well.
I realized that after 20 years of hard work I was earning less than $150,000 a year. This was far less than most other professional people I knew, who had considerably less training than I, but it was a livable wage and that is that was what I was used to. After changing practice models I began to earn a salary more in line with what my skills were worth, but it took some time for me not to feel guilty. If you look at an MDVIP practice with 400 patients it would not be unusual to see earnings of $300,000 a year, which is more in line with what I think good internists are worth.
From my experience earnings are only estimates and will vary depending on things like how efficient the practice is at collecting copays, and how much money they choose to spend. I think that one of the things I needed to develop was better self-esteem, and accept that the things that internists do on a daily basis are grossly underrated by the medical community at large. We are held down by an unfair payment system that exploits us, knowing we will do the job even if we don’t get paid. That’s how I thought it would always be. I think many primary care doctors feel the same way at some level because we feel our obligation as physicians to patients transcend how much money we earn.
Having more time allowed me to continue to admit my own patients to the hospital instead of using hospitalists. This was not required by MDVIP, but it was something I felt was necessary. After all, the patients needed me the most when they were sick. Hospitals are dangerous place, lots can go wrong, and they need an advocate who knows them.
A higher salary allowed me to provide more charity care. I began to teach residents and students in my office because I had more time, and I began to read more and keep up on CME. It also allowed me to pay a fair salary with benefits to my staff, who were one of the keys to my success.
By directly contracting with patients we became equally committed to the relationship. They agreed to pay an annual fee, and I agreed to provide services. They had the power to terminate the relationship if I didn’t live up to my commitments. Unlike at my old practice, where, when a patient left, I barely noticed it financially, in the concierge model, a patient leaving was not only an emotional setback, it was a financial one as well.
It really was the way things should work in a free market system. When insurance pays medical bills to doctors instead of patients, it takes the power from patients who have little recourse for poor services. The doctor is payed regardless of how he or she performs. The government’s efforts to define and reward quality are so primitive they are laughable.
There are different care models where doctors drop all insurance plans and accept a reduced fee. I have a problem with those model because I think that many medical procedures, consultations and admissions require insurance coverage. In some states, patients have trouble getting coverage for those services if their doctor does not belong to the patient’s insurance plan. In the MDVIP model I could refer and admit as I always had because I remained in all the insurance plans.
I had been told when I started the concierge model that it would never work. No one would join. They were wrong. I quickly enrolled 450 patients. Later I was called the doctor for the rich and famous. They were wrong. The average family income of my patients was $71,000, and the typical occupation was retired teacher, professor, policeman or doctor.
Switching to Concierge Medicine: Pros and Cons
Some physicians suffering from chronic underpayment are turning to alternative payment models to increase profits.
One such model is concierge medicine, sometimes called “retainer” or “boutique” medicine, whereby patients pay an upfront fee in order to secure the services of a physician.
It used to be that only physicians in affluent areas used the concierge model, but times have changed. Physicians with a variety of patient bases are starting to practice concierge medicine.
Could concierge be the way to go for your practice? Today we’ll look at the pros and cons of switching over to the concierge model.
More Time for Patients
This is the most frequently stated benefit of switching to concierge medicine. The upfront fee, usually monthly, allows you to bring in more revenue per patient. Because of this, most concierge physicians can cap their patient base at around 300 or so with no loss of revenue.
Concierge medicine keeps you from having to rush patients in and out of the examination room.
By charging an upfront fee, much of the billing and collections procedure can be bypassed depending on the services included with the fee. For instance, you can choose to have standard visits covered by the fee. That way, if a patient comes in a few times in one month for standard visits, only a single monthly fee is collected.
The cuts are even greater if you plan to bypass insurance entirely, as some concierge practitioners do. By having patients simply pay the fee and then pay directly per service, you can do away with coding and collections staff.
Switching to concierge medicine means your practice can be targeted to meet your community’s needs.
If you’re practicing in a high-income area, your community might be willing to pay a higher fee for the extra care and features of concierge medicine. In contrast, if you practice in a lower-income area, you can charge a low fee like Dr. Rodriguez of San Antonio who targets patients who couldn’t normally afford healthcare.
Loss of Patients
This is the primary problem with switching to a concierge medicine. Many patients are used to the standard model of healthcare, and transitioning means you risk losing these patients.
In one study, physicians switching over to a concierge model from a standard model only kept 12% of their patient base on average. The study didn’t discuss how many patients those physicians eventually gained because of the switch, but that’s still a huge initial loss to take.
Fewer Patients, Higher Expectations
Seeing fewer patients doesn’t necessarily mean more time out on the golf course. And giving patients more time with you when making visits won’t be enough to get them to pay an upfront free for your services.
Patients seeking out the concierge model of care expect to receive the added benefits most concierge practices provide. These include things like 24-hour physician access, availability for house calls and the physician’s cell-phone number.
Although you should have fewer patients, they may take up even more time requesting the special services concierge practices provide.
Risk of Pricing Error
One of the risks inherent in adding any type of fee is that you may get the pricing point wrong. And just like with any business, doing so means you’re less likely to be profitable. Your product in this case is the expert medical care you provide.
Set the upfront fee too high and you run the risk that your community looks to cheaper solutions to their healthcare needs. Set the fee too low and you still have to take in the same number of patients you do under the standard model, eliminating one of the primary benefits of switching.
As you can see, concierge medicine can take your profitability to the next level or create substantial losses. With this in mind, would you ever consider switching your practice over to the concierge model?
For additional insight into practice management, take a look at our Complete Guide to Practice Management.