Doctor's office switching to "concierge" (additional cost outside of insurance)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Thank ACA.

This isn’t an ACA thing. It’s a privat insurance thing.

I would MUCH rather have a government bureaucracy making decisions about my health coverage and claims than a private enterprise trying to meet quarterly earnings targets.

Oh my God. You have obviously never worked with the government.

My mom was a VA nurse for 38 years. You do NOT WANT THE GOVERNMENT MANAGING YOUR CARE. So many unnecessary deaths due to poor docs. There was one surgeon they called "Dr. Death" because he nicked organs like weekly, leading to people dying of sepsis unnecessarily. Did the VA stop him from operating? Nope. He continued on for 15 more years doing this until he retired.

Same in private insurance care.

It’s not nearly as bad. It’s all fine to say it’s the same until it is your family member who dies at the hands of a butcher. This doc was kicked out of private practices. No doc chooses the VA

I mean—- aren’t many VA docs those people who enlisted / agreed to work for the military for a certain number of years, in exchange for the government paying for med school? In which case— yea, they probably had other options, like loans, but chose to join the military instead.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What are they doing extra for $2200 a year if you still have to pay for appointments and your insurance is billed? That's what almost $200 a month, and for that I'd expect one charge appointment at least monthly.

Seeing far fewer patients and spending more time with them.

People seem to be misunderstanding the concept of what you are paying for. Any doctor’s office has to pay for the office space and the salaries & healthcare of all of their employees. They either rely on insurance payments and book 5 patients an hour, 8 hours a day. Or they go concierge and see 4-6 patients per day and spend 1 hour with them. I view paying for concierge more as insurance (easy access when I need it) than fee-for-service. YMMV

+1000
That is exactly what you are paying for! My physical was 1.25 hours last week. I scheduled it 2 weeks before.
When I need to see a doctor, I always get in that day (it may be a different doc in the concierge practice but I get to see a concierge doc that day) and the "sick" appt is 20-30 mins, no rushing me out to see another 4 patients in the hour.
If I have a major concern at 10pm or 2am, I can text the doc on call and get a call back within 5 mins or less. They will sit on the phone to schedule appointments (so I dont' have to waste 20 mins doing it). For $200/month, it's worth it to our family.

Also, in our area many family/internal med docs are just quitting. There are not enough so you can be 3-5 months out scheduling a physical or appt with your normal doctor. I prefer to have easy access so will happily pay for it. That's worth me not getting Starbucks daily or the equivalent.

That's when I went concierge -- when the first available physical with my doctor was 6 months out.

Having recently moved, I was concerned about this, but was able to get an appointment quickly with an APN who is genuinely excellent, and seamlessly set up necessary referrals/labs.

There are challenges to this new approach (longer wait times), but I was very pleasantly surprised at the upsides. The staff is less stressed because the workload is more balanced and coordinated, having all of the info in one place is a safety and stress benefit for patients, and overall, the experience felt somewhat concierge-like, even in a huge health system.

Meanwhile, trying to coordinate dental health with several independent specialist providers has been much more stressful, with little to no electronic record management or autonomy on the patient side, occasionally very long wait times, and trying to discern what to do when the advice is conflicting (with second opinions often creating another round of the same process).

So while most providers have been excellent, the sense of continuity and oversight has been more notable in the larger system.

Head to Reddit/NP to see how NPs discuss how unprepared they are for practicing medicine. So many of them just go straight to NP online school and are all of a sudden made to take the role of a doctor and they are freaking out on online forums. Pretty scare stuff. But I guess this is where we are going… health systems love NPs because they care half as expensive as doctors but they charge the same for their services.

In the end, the rich will have concierge doctors and the not rich will have a rotating caste of under prepared NP/PA who will then refer to specialist NP/PA (and yes they are using NP/PAs in this role now too).

[Anonymous]

We cannot afford it. We switched MDs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Concierge gets me an email for urgent things even on weekends and an appointment in a day or so. Take insurance? 3 months.

Most concierge doctors take insurance.

bad.

I misspoke. Yes they bill insurance and I get some pathetic reimbursement. But they don't participation so they bill me the full amount. No copay/coinsurance thing. My old gyn that "participated" cost $20 copay and took 3 months to see. My new one doesn't and charges $300 and I get $85 from Carefirst.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Thank ACA.

This has nothing to do with the ACA.

Oh oh we have an expert here with first hand experience. Smh...all doctors will tell you ACA has made providing care harder, quality has come down etc etc. I know you're a dem but sometimes you just have to accept "facts"

Spoken like a true “always wrong but rarely in doubt” MAGAt.

Actually. I am a doctor and this is the sentiment. We have seen the changes first hand since ACA kicked in, you start to insure more and more with lower compensation = more people to treat for the same amount of money = quality of care goes down.

fun fact, the cost of these procedures has not increased for decades. For god sakes how can you PCP annual visit only be worth $50 for the provider??? How much is a meal for a family of 4? thats BS and you know it.

You must be on the younger side. This has been happening long before ACA. The American Medical Association (AMA) found that Medicare reimbursement for clinicians dropped by 22% from 2001 to 2021. AMA wasn't passed until 2010. No PCPs that I know (and I've been one since 1999) feel this way. The issue has always been that Medicare does not value preventative care and reimbursements for procedures have always been far higher. It's been that way since the start of Medicare in 1965, but now there is so much more bureacracy with medicine and there is barely reimbursement for anything. The Primary Care practices just can't afford it. You can't squeeze water from a stone.

But you guys carry on as we go out of network.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’m a doctor in primary care. If you want an MD pcp doctor in the future with good appointment times and someone who has time to listen etc this is what the future holds. For many it’s either this or leaving medicine all together because the current landscape is not sustainable.

In the future it will be either MD via concierge for the rich and a rotating group of NP/PA with less training for everyone else.

nah, we dont want to pay and think $50 for a annual PCP visit is more than enough SMH at how brainwashed the patients/consumers are these days.

$50 is more than enough. It’s shocking how brainwashed Americans are. People on South Korea or Japan go to the doctor every year for free, or when they need to pay it costs something like $5-10 per visit. US healthcare blows.

It's not "free", rather it's subsidized. So is their education. So physicians abroad don't graduate with $250-300K in loans that need to be paid back. They also don't have to pay $100k annually in malpractice.

I spend 90 minutes with my patients for their annuals. Do you honestly think I could even pay staff on $50 for that time? Much less rent, staff, etc? If you want that, make sure you vote for a single payer system. That's what they have in countries with socialized medicine and I think that would be great. But you can't ask physicians to pay for their education and not entitle them to be able to pay back their loans. That's absurd.

There are actually pieces written about physicians lifetime earnings vs. plumbers and it only seems to be more for physicians around age 61. A PCP has the same spending power throughout their lifetime as the plumber and literally nobody says $50 is enough to pay the plumber. Who are you thinking will want to go into medicine??? Certainly not the "best and brightest"...you should consider seeing an NP.
Here is the calculations with a urologist and it evens out around age 41...they make 2-3X what a PCP earns, for example. https://www.studentloanplanner.com/doctor-vs-plumber/

I'm not sure why you think the physicians having gone through the rigorous training that we do and literally putting your lives in our hands shouldn't be compensated for that. This is the attitude that is literally killing medicine. Physicians don't want to deal with patients like you who don't value their time but will pay $400 for highlights and $800 for their dog's annual.

[Anonymous]

My gyn did this a few years ago. After many letters and phone calls from them (I ignored them), I answered the phone once and spoke to someone in her office. I think the annual fee was $4k. I'm a single parent and a teacher (which my doctor knows since she's a single parent too and we've talked about this topic). I told the person that I do not have $4k to spend per year for someone I see once a year. That's a ton of money to me and I told her that. That's more than I net per month. I assumed they called and sent tons of letters because they didn't get enough takers.

[Anonymous]

Anonymous wrote:My gyn did this a few years ago. After many letters and phone calls from them (I ignored them), I answered the phone once and spoke to someone in her office. I think the annual fee was $4k. I'm a single parent and a teacher (which my doctor knows since she's a single parent too and we've talked about this topic). I told the person that I do not have $4k to spend per year for someone I see once a year. That's a ton of money to me and I told her that. That's more than I net per month. I assumed they called and sent tons of letters because they didn't get enough takers.

If you are in the DMV ... they are very likely "getting enough takers."

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’m a doctor in primary care. If you want an MD pcp doctor in the future with good appointment times and someone who has time to listen etc this is what the future holds. For many it’s either this or leaving medicine all together because the current landscape is not sustainable.

In the future it will be either MD via concierge for the rich and a rotating group of NP/PA with less training for everyone else.

nah, we dont want to pay and think $50 for a annual PCP visit is more than enough SMH at how brainwashed the patients/consumers are these days.

$50 is more than enough. It’s shocking how brainwashed Americans are. People on South Korea or Japan go to the doctor every year for free, or when they need to pay it costs something like $5-10 per visit. US healthcare blows.

It's not "free", rather it's subsidized. So is their education. So physicians abroad don't graduate with $250-300K in loans that need to be paid back. They also don't have to pay $100k annually in malpractice.

I spend 90 minutes with my patients for their annuals. Do you honestly think I could even pay staff on $50 for that time? Much less rent, staff, etc? If you want that, make sure you vote for a single payer system. That's what they have in countries with socialized medicine and I think that would be great. But you can't ask physicians to pay for their education and not entitle them to be able to pay back their loans. That's absurd.

There are actually pieces written about physicians lifetime earnings vs. plumbers and it only seems to be more for physicians around age 61. A PCP has the same spending power throughout their lifetime as the plumber and literally nobody says $50 is enough to pay the plumber. Who are you thinking will want to go into medicine??? Certainly not the "best and brightest"...you should consider seeing an NP.
Here is the calculations with a urologist and it evens out around age 41...they make 2-3X what a PCP earns, for example. https://www.studentloanplanner.com/doctor-vs-plumber/

I'm not sure why you think the physicians having gone through the rigorous training that we do and literally putting your lives in our hands shouldn't be compensated for that. This is the attitude that is literally killing medicine. Physicians don't want to deal with patients like you who don't value their time but will pay $400 for highlights and $800 for their dog's annual.

I.e. if you aren't in a position to afford concierge, it's in your interest to vote for single payer. Physicians want to be paid like they're a luxury service, which prices out the vast majority of people. We need far more residency seats and we need to accept that NPs and PAs will be PCPs because there simply aren't enough MDs to go around

[Anonymous]

Anonymous wrote:

Anonymous wrote:My gyn did this a few years ago. After many letters and phone calls from them (I ignored them), I answered the phone once and spoke to someone in her office. I think the annual fee was $4k. I'm a single parent and a teacher (which my doctor knows since she's a single parent too and we've talked about this topic). I told the person that I do not have $4k to spend per year for someone I see once a year. That's a ton of money to me and I told her that. That's more than I net per month. I assumed they called and sent tons of letters because they didn't get enough takers.

If you are in the DMV ... they are very likely "getting enough takers."

for a gyn? Doubtful. How much demand is there for a 4k a year concierge gyn?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’m a doctor in primary care. If you want an MD pcp doctor in the future with good appointment times and someone who has time to listen etc this is what the future holds. For many it’s either this or leaving medicine all together because the current landscape is not sustainable.

In the future it will be either MD via concierge for the rich and a rotating group of NP/PA with less training for everyone else.

nah, we dont want to pay and think $50 for a annual PCP visit is more than enough SMH at how brainwashed the patients/consumers are these days.

$50 is more than enough. It’s shocking how brainwashed Americans are. People on South Korea or Japan go to the doctor every year for free, or when they need to pay it costs something like $5-10 per visit. US healthcare blows.

It's not "free", rather it's subsidized. So is their education. So physicians abroad don't graduate with $250-300K in loans that need to be paid back. They also don't have to pay $100k annually in malpractice.

I spend 90 minutes with my patients for their annuals. Do you honestly think I could even pay staff on $50 for that time? Much less rent, staff, etc? If you want that, make sure you vote for a single payer system. That's what they have in countries with socialized medicine and I think that would be great. But you can't ask physicians to pay for their education and not entitle them to be able to pay back their loans. That's absurd.

There are actually pieces written about physicians lifetime earnings vs. plumbers and it only seems to be more for physicians around age 61. A PCP has the same spending power throughout their lifetime as the plumber and literally nobody says $50 is enough to pay the plumber. Who are you thinking will want to go into medicine??? Certainly not the "best and brightest"...you should consider seeing an NP.
Here is the calculations with a urologist and it evens out around age 41...they make 2-3X what a PCP earns, for example. https://www.studentloanplanner.com/doctor-vs-plumber/

I'm not sure why you think the physicians having gone through the rigorous training that we do and literally putting your lives in our hands shouldn't be compensated for that. This is the attitude that is literally killing medicine. Physicians don't want to deal with patients like you who don't value their time but will pay $400 for highlights and $800 for their dog's annual.

Did the AMA sponsor that post? The average 40 year old plumber has a net worth of $2m and is worth more than a urologist Do plumbers know this? I see a lot of doctors in their 40s with nice cars, expensive houses kids attending independent schools, but not so many plumbers with the same lifestyle

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Thank ACA.

This isn’t an ACA thing. It’s a privat insurance thing.

I would MUCH rather have a government bureaucracy making decisions about my health coverage and claims than a private enterprise trying to meet quarterly earnings targets.

Oh my God. You have obviously never worked with the government.

My mom was a VA nurse for 38 years. You do NOT WANT THE GOVERNMENT MANAGING YOUR CARE. So many unnecessary deaths due to poor docs. There was one surgeon they called "Dr. Death" because he nicked organs like weekly, leading to people dying of sepsis unnecessarily. Did the VA stop him from operating? Nope. He continued on for 15 more years doing this until he retired.

If your thesis is that the government employs substandard medical professionals, because they don't pay enough of for any other reason, you might want to think about what that says about your mother, and how much weight we should give her opinion.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’m a doctor in primary care. If you want an MD pcp doctor in the future with good appointment times and someone who has time to listen etc this is what the future holds. For many it’s either this or leaving medicine all together because the current landscape is not sustainable.

In the future it will be either MD via concierge for the rich and a rotating group of NP/PA with less training for everyone else.

nah, we dont want to pay and think $50 for a annual PCP visit is more than enough SMH at how brainwashed the patients/consumers are these days.

$50 is more than enough. It’s shocking how brainwashed Americans are. People on South Korea or Japan go to the doctor every year for free, or when they need to pay it costs something like $5-10 per visit. US healthcare blows.

It's not "free", rather it's subsidized. So is their education. So physicians abroad don't graduate with $250-300K in loans that need to be paid back. They also don't have to pay $100k annually in malpractice.

I spend 90 minutes with my patients for their annuals. Do you honestly think I could even pay staff on $50 for that time? Much less rent, staff, etc? If you want that, make sure you vote for a single payer system. That's what they have in countries with socialized medicine and I think that would be great. But you can't ask physicians to pay for their education and not entitle them to be able to pay back their loans. That's absurd.

There are actually pieces written about physicians lifetime earnings vs. plumbers and it only seems to be more for physicians around age 61. A PCP has the same spending power throughout their lifetime as the plumber and literally nobody says $50 is enough to pay the plumber. Who are you thinking will want to go into medicine??? Certainly not the "best and brightest"...you should consider seeing an NP.
Here is the calculations with a urologist and it evens out around age 41...they make 2-3X what a PCP earns, for example. https://www.studentloanplanner.com/doctor-vs-plumber/

I'm not sure why you think the physicians having gone through the rigorous training that we do and literally putting your lives in our hands shouldn't be compensated for that. This is the attitude that is literally killing medicine. Physicians don't want to deal with patients like you who don't value their time but will pay $400 for highlights and $800 for their dog's annual.

I.e. if you aren't in a position to afford concierge, it's in your interest to vote for single payer. Physicians want to be paid like they're a luxury service, which prices out the vast majority of people. We need far more residency seats and we need to accept that NPs and PAs will be PCPs because there simply aren't enough MDs to go around

Physicians want to be paid, period. It's not "luxury service". Give me a break. They are professionals like an accountant or attorney. They just want to get paid for their time. Insurance should be for catastrophic care and not routine stuff because it's a joke. Doctors are going out of business left and right if they take insurance. And insurance just denies everything while those CEOs make millions.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’m a doctor in primary care. If you want an MD pcp doctor in the future with good appointment times and someone who has time to listen etc this is what the future holds. For many it’s either this or leaving medicine all together because the current landscape is not sustainable.

In the future it will be either MD via concierge for the rich and a rotating group of NP/PA with less training for everyone else.

nah, we dont want to pay and think $50 for a annual PCP visit is more than enough SMH at how brainwashed the patients/consumers are these days.

$50 is more than enough. It’s shocking how brainwashed Americans are. People on South Korea or Japan go to the doctor every year for free, or when they need to pay it costs something like $5-10 per visit. US healthcare blows.

It's not "free", rather it's subsidized. So is their education. So physicians abroad don't graduate with $250-300K in loans that need to be paid back. They also don't have to pay $100k annually in malpractice.

I spend 90 minutes with my patients for their annuals. Do you honestly think I could even pay staff on $50 for that time? Much less rent, staff, etc? If you want that, make sure you vote for a single payer system. That's what they have in countries with socialized medicine and I think that would be great. But you can't ask physicians to pay for their education and not entitle them to be able to pay back their loans. That's absurd.

There are actually pieces written about physicians lifetime earnings vs. plumbers and it only seems to be more for physicians around age 61. A PCP has the same spending power throughout their lifetime as the plumber and literally nobody says $50 is enough to pay the plumber. Who are you thinking will want to go into medicine??? Certainly not the "best and brightest"...you should consider seeing an NP.
Here is the calculations with a urologist and it evens out around age 41...they make 2-3X what a PCP earns, for example. https://www.studentloanplanner.com/doctor-vs-plumber/

I'm not sure why you think the physicians having gone through the rigorous training that we do and literally putting your lives in our hands shouldn't be compensated for that. This is the attitude that is literally killing medicine. Physicians don't want to deal with patients like you who don't value their time but will pay $400 for highlights and $800 for their dog's annual.

Did the AMA sponsor that post? The average 40 year old plumber has a net worth of $2m and is worth more than a urologist Do plumbers know this? I see a lot of doctors in their 40s with nice cars, expensive houses kids attending independent schools, but not so many plumbers with the same lifestyle

Hahahah....you must not be friends with any PCPs. Starting salary for a pediatrician is about $125,000 in this town. They earn that, if they went straight through, when they are about 30 years old. And then they have about $250K of loans to pay back. I don't mean to be rude. But can you not do math? This is pretty simple to figure out. It's not worth it to go into that much debt to be a PCP. That is why NPs and PAs are now mostly taking the PCP role. And they don't have nearly enough training for that position.

Licensed plumbers make about the same (look on Glassdoor), have earned that for many more years since perhaps they started their career at age 18 and have no loans.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My gyn did this a few years ago. After many letters and phone calls from them (I ignored them), I answered the phone once and spoke to someone in her office. I think the annual fee was $4k. I'm a single parent and a teacher (which my doctor knows since she's a single parent too and we've talked about this topic). I told the person that I do not have $4k to spend per year for someone I see once a year. That's a ton of money to me and I told her that. That's more than I net per month. I assumed they called and sent tons of letters because they didn't get enough takers.

If you are in the DMV ... they are very likely "getting enough takers."

I’m in Baltimore. Plenty of money here too but most people have no need for this service.