I posted earlier about my parents doing concierge service. I should note they don't live in DC. They go to separate practices and both of them have really enjoyed the concept. I don't know how much extra it costs them, but they are self-insured and have had problems getting insurance in the past b/c of supposed pre-existing conditions. They can't afford to shuttle around to different doctors for various ailments b/c their co-pays are too expensive (several hundred dollars per co-pay), so having a doctor who can take the time to sit down and really discuss problems/options for them is worth whatever extra they pay. My parents are very frugal and wise with their money so I would have to assume they think this is worth it. I know my mom does have her dr's cell phone number and her dr. is super responsive, especially when my parents travel out of town (like to see us here) and medical issues arise.

Anonymous wrote:

Anonymous wrote:This is normal with the advent of all the damn lawyers driving up malpractice insurance and obamacare.

+1

Hogwash. It has to do with the insurance companies. Our doc instituted a similar fee structure this year. They simply could not sustain the practice at the rates the insurance companies were paying them. The insurance companies, on the other hand, are pressed by increasing technology/medical costs and the fact that there are not enough healthy people in the insured pool. (Plus, they need to pay their executives bonuses and salaries that would make Imelda Marcos blush!)

I haven't made up my mind on Obamacare, and malpractice is no small issue, but these fees are coming from someplace considerably more complicated than the pp's politically motivated pablum makes clear.

concierge service - Look it up.

Better care to me means a dr spending the time with you to listen and to figure out what is actually wrong. Better care is the opposite of what i get at my gyno, reiter hill, where i wait for an hour to spend 1.5 mins with the dr. It's awful. I pay privia so my internist doesnt become my gyno. So he doesnt have to take on a ton of patients and see them all for 5 mins to make money, which seems to be what my gyno has decided to do.

Better care = what?

a typical internist/PCP in this area who TAKES insurance (if you've noticed, many are cash only in DC) makes about $150K take home seeing 25 to 30 patients per day. Overhead is very high in this area, liability insurance is high and reimbursement is low (reimbursement rates vary by state).
So it's a decent salary when compared to the population at large but not so great when it entails 7 years of post college training, huge amounts of debt (most medical schools-GW, Georgetown, Hopkins--are now $65K/year tuition only), 60+ hour work weeks and the liability and stress of dealing with life and death matters (and PEOPLE!) all day, every day.
Reimbursements are continually shrinking and many solo practice PCPs are really, really feeling the financial pinch. Those employed by hospitals, etc. can breathe a little easier because their salaries are paid in part by $$ brought in by higher paid specialists.
Most internists I know do it only because they LOVE it, and not all for the financial reward.

There's still money to be made in medicine (many other specialties pay 3, 5 and even 10 times what internal or family medicine or pediatrics pay) but it's not across the board by any stretch.

Anonymous wrote:I would pay $100 a year to be able to email a doctor and get an answer back within a day. That would be very cool.

That was one thing I loved about Kaiser. I could log onto the website, email my doctor, and she was always very good about getting back to me.

My husbands internist went to this, he doesn't pay. If I was someone with a chronic condition, I would consider it, the convenience of weekend availability, email responses, would be worth it.

PCPs and Pediatricians make less than other MDs. I wouldn't doubt that managed care has something to do with it. Have you seen what an MD gets paid for a consult vs what their overhead is? I'm talking primary, not specialist.

On the other hand, my PCP accepts medicaid and medicare and they generally respond to an email within 24-48 hours. So far, no concierge type charges from them.

I pay $45/month for privia for my internist. He's wonderful and I'm willing to pay it to remain in his practice. SIL pays 5,000 per year in CA to be in her internist's practice - yes, FIVE THOUSAND DOLLARS and has the doctor's cell phone, etc. Worth it to her because she's older and has some medical issues. Makes me feel like I'm getting off easy with $45. for privia. For my dr, I dont think he kicks you out of his practice if you don't pay, but I think the idea is that if enough people don't pay willingly, he's going to move to somthing similar to what my SIL has, where each person pays a LOT and people with less $$ are kicked out. So because I can pay, I pay. I'm fine that people who genuinely cannot afford to do not, but people who can and choose not to should leave the practice.

Are other drs doing the same?

Phone your insurance company and ask them. They should cover at least a portion of it.
You will need to give them details like the name of the practice and the doctors name etc, but doable.

I did that with my dentist and the next time I called they refused to see me

Anonymous wrote:Ours is $100 annually.

http://www.gimg.com/ppa.shtml

I go to this practice and the $100 annually is an optional feature for online features like making appointments, getting lab results, etc. I work in a cubicle with no privacy so for me, making appointments online, etc. is a huge benefit well worth the $100 annaul fee. That's different from what the OP is describing.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This is normal with the advent of all the damn lawyers driving up malpractice insurance and obamacare.

+1

Yes, Obamacare has pinned the doctors to a wall. They are suffering from all of the horrible changes that have been put upon them.

Now can you tell me what provisions are actually directed at doctors?

"Obamacare" has nothing to do with this. Do your homework...

I would pay $100 a year to be able to email a doctor and get an answer back within a day. That would be very cool.

Anonymous wrote:

Anonymous wrote:This is normal with the advent of all the damn lawyers driving up malpractice insurance and obamacare.

+1

Yes, Obamacare has pinned the doctors to a wall. They are suffering from all of the horrible changes that have been put upon them.

Now can you tell me what provisions are actually directed at doctors?