When a primary-care physician goes “full concierge,” they say good-bye to a majority of their existing patients. Why do some of the patients stay? Is it because they believe in a program that gives them more time, and attention, as well as special care and convenience? Or is it because they just do not want to lose their physician?
Having developed many full model conversions, and even more hybrid model programs, the answer is that about one quarter will join because of the appeal of the type of care that they receive and three quarters because they do not want to lose their doctor. In short, they stay because they value the relationship they have with their physician.
Many physicians have concerns about full model concierge — they simply don’t want to say goodbye to their patients. In a hybrid program, physicians continue to see all of their patients —most take Medicare or other private or government plans. While fewer patients join than in a full model — typically about 3 percent to 8 percent — those that do select a concierge program typically don’t want to lose the time, medical care, and advice their physician offers.
When you consider what’s happened in medicine today, it’s easy to see why patients opt for concierge. Today’s emphasis on volume practice has resulted in physicians having less time with patients. More time must be devoted to administrative tasks such as entering data into EHRs, and there are many added distractions that challenge the maintenance of a strong patient-physician relationship. As a result, our healthcare system is at risk of creating a “factory” approach to medicine.
Volume care may be efficient (especially from a business standpoint), but when a patient is shared with a variety of providers, physicians become part of the “factory.” They are no longer a “craftsman.” When nobody cares which physician they see, his or her value goes down; they can be substituted easily.
I refer to factory medicine as the medicine of the future, but in many respects it is here today. Just look at the hospitalist system — a shift-based approach that has economic efficiency but is not always the best for the patient. Similarly, the team approach to primary care, an economic and professional necessity in many practices, depersonalizes care and devalues the physician. Some would argue that this is good for society as it is all part of reducing the cost of care while expanding access. While I applaud our efforts to expand access, I think we need to be careful, and ensure we protect valuable physician-patient relationships as well — while we give people choices in the type of care received.
Today’s physicians seeking to determine how they fit in the changing landscape, and who wish to maintain a degree of autonomy, have a decision to make: simply retire or start a new career; continue in business as usual mode, which is becoming increasingly difficult; join a healthcare corporation or large health system; move to direct pay; or transition to full or hybrid concierge.
It all depends on what you want for yourself, and your profession. I believe that the relationships good physicians build with their patients have value. I believe concierge medicine leverages those relationships and translates them into participation in programs where patients are willing to pay for an extension and expansion of the supportive relationship they want.
In concierge programs, the degree of success of a physician is directly related to the individual relationships that the physician has with their patients. People want the comfort and security of that relationship and are often willing to pay for it in today’s world. It all ties back to Business 101 — supply and demand.
Many physicians tell me that they already deliver concierge care but are just not compensated for it. These are the physicians who are almost always the best candidates for a concierge program. Most are more senior, but not always. The one thing they all share is exceptional clinical skills and the ability to build strong relationships that foster loyalty among their patients.
As the demand for more private physicians grows and the general level of care continues to stagnate or even decrease, systems that encourage strong doctor-patient relationships will be better able to benefit the patient, and the physician.
As a physician, what are your thoughts? Is concierge medicine simply a way to be compensated for excellent care from patients willing to pay? Do you believe it is an important choice for consumers and physicians due to the depersonalization of medicine today? Have we already reached the “factory” medicine stage? At the least, it’s a timely and important conversation to have.
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