My two cents, it doesn't bother me that doctors do this (and since I have had some major health issues, I might be willing to pay for good service); however, I do think it takes away some of the noble aura around practicing medicine: i.e. your pricing excludes certain parts of the population who can't afford $500 a year. That's your right. But if you have one of these practices, I do look at you a little differently: your motives are not about helping all those in need. Your motives are about helping those in need who can afford to pay.

My in laws have a primary care physician who changed to this model within the past 5 years. The doctor charges about $1k per year per patient, and caps her patients to a certain number at a time. She explained that this fee is so that she can continue to provide the same level of service she always has--I.e. Not have to cram in as many patients as she can per day to pay the rent. She apparently did the math that if she has x number of patients and sees them an average of xx times per year, she will earn a certain amount of money that isn't enough to stay in practice without adding more patients.

I'm assuming that most of her other patients are middle class suburban retirees like my inlaws are. They aren't rich--don't have a vacation home or anything like that-- but aren't struggling in their retirement either. Both of my inlaws have serious enough health conditions that the annual expense was worth it to them for a more personalized level of care.

IMHO, this isn't keeping people who can't afford a doctor from seeing one. This doctor is located in a suburban medical complex, not convenient at all to the homes of the poor patients being discussed in previous posts. I refuse to believe that one medical office out of who knows how many in the county not taking new patients and charging an annual fee to current patients who want to stay with the practice is going to effect anyone who is truly being hurt by the disaster that is our health care system.

PP who changed to an internist who does not take insurance. The main difference I noticed is not so much the quality of care but things like getting an non-urgent care appointment for our annual physical. I can make an appointment a week in advance instead of at least three months in advance for our in-network doctor. Our new internist will prescribe lower cost meds or generics if they are available which makes up for the higher cost of seeing him. We've been healthy and see the internist once or twice a year so the extra cost is negligible and worth it for the convenience.

^ Yeah, the difference is if you get a bad haircut, no big deal. You get a bad doctor, diagnosis, or treatment, the stakes change.

Sad state of affairs when we compare healthcare to entertainment.

Anonymous wrote:

Anonymous wrote:

I found this extremely disturbing. I have all the respect in the world for healthcare providers but what this is saying is if you have the extra money and pay us more you will get more attention and better care. What about those who can barely afford the deductables, copays, coinsurance and the monthly insurance premiums. I get doctor's are squeezed but excuse me, the solution is to squeeze the patients even more? How do you sleep at night knowing some of your "special" patients will get better care from you and others get what exactly? I would hope doctors choose their profession because they care about people and want to treat them well and manage their illness not because they hoped to be rich and have an expectation of living in a praticular type of house, in a particular neighborhood and drive expensive cars. I just can't feel sorry for them that they can't maintain a certain lifestyle they would like to have so threrefore they screw their patients.

Uhh, yeah - if you pay more, you have access to better care. Why is this at all surprising, let alone disturbing?

Uhhh, ofcourse this doesn't bother or disturb you because you can probably afford to pay more. What about the majority of americans who can't afford it? Their service will just suck becuase they don't have enough cash? Kinda wrong, no?

well, those who can't afford to pay (or pay as much) get worse in every walk of life--legal services, plumbing, hair cuts, education, entertainment and on and on and on. That's how the American free market economy works. It's not fair to hold doctors to a higher moral ground than everyone else who selectively chooses customers based on who can pay or pay better.
Most European countries provide exactly what is happening here in the US: a basic level of (often free) care to everyone and a second level of care (more convenient, etc) to those who can afford to pay.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My GP sent a letter about the new concierge service the office is offering, and I threw the letter in the trash. I thought it was BS.

Well in a few years I doubt you'll be able to find a single GP outside of university-sized clinics that won't charge hefty administrative fees, a concierge fee or take cash only. It just doesn't make sense for these physicians to work 60-70 hours weeks, pay $350K for medical school, train for 7 years and make 100K. Insurers aren't paying their share so patients will (out of pocket).

Many think the answer is mid level providers (Nps, PAs) but they don't want the primary care jobs either and every one I know (I am one) leaves as soon as a better (specialty) offer comes along. An NP can make 2 times the money (and work half as hard) in a dermatology or GI practice than in a GP office.

Until insurance companies start reimbursing fairly we're going to see more and more physicians opting out of the traditional insurance model.

I found this extremely disturbing. I have all the respect in the world for healthcare providers but what this is saying is if you have the extra money and pay us more you will get more attention and better care. What about those who can barely afford the deductables, copays, coinsurance and the monthly insurance premiums. I get doctor's are squeezed but excuse me, the solution is to squeeze the patients even more? How do you sleep at night knowing some of your "special" patients will get better care from you and others get what exactly? I would hope doctors choose their profession because they care about people and want to treat them well and manage their illness not because they hoped to be rich and have an expectation of living in a praticular type of house, in a particular neighborhood and drive expensive cars. I just can't feel sorry for them that they can't maintain a certain lifestyle they would like to have so threrefore they screw their patients.

If you feel so strongly, by all means go to medical school, finish residency, and open a practice and work 70 hours a week for peanuts. I'm serious: go to medical school and put your money and time where your mouth is. Until then, don't criticize others for wanting to be compensated appropriately for their time.

Everyone wants to be appropriately compensated for their time..........except that doesn't always happen. Are you going to base your care based on how much a patient puts in your pocket? That's just greedy and ugly.

Anonymous wrote:

I found this extremely disturbing. I have all the respect in the world for healthcare providers but what this is saying is if you have the extra money and pay us more you will get more attention and better care. What about those who can barely afford the deductables, copays, coinsurance and the monthly insurance premiums. I get doctor's are squeezed but excuse me, the solution is to squeeze the patients even more? How do you sleep at night knowing some of your "special" patients will get better care from you and others get what exactly? I would hope doctors choose their profession because they care about people and want to treat them well and manage their illness not because they hoped to be rich and have an expectation of living in a praticular type of house, in a particular neighborhood and drive expensive cars. I just can't feel sorry for them that they can't maintain a certain lifestyle they would like to have so threrefore they screw their patients.

Uhh, yeah - if you pay more, you have access to better care. Why is this at all surprising, let alone disturbing?

Uhhh, ofcourse this doesn't bother or disturb you because you can probably afford to pay more. What about the majority of americans who can't afford it? Their service will just suck becuase they don't have enough cash? Kinda wrong, no?

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My GP sent a letter about the new concierge service the office is offering, and I threw the letter in the trash. I thought it was BS.

Well in a few years I doubt you'll be able to find a single GP outside of university-sized clinics that won't charge hefty administrative fees, a concierge fee or take cash only. It just doesn't make sense for these physicians to work 60-70 hours weeks, pay $350K for medical school, train for 7 years and make 100K. Insurers aren't paying their share so patients will (out of pocket).

Many think the answer is mid level providers (Nps, PAs) but they don't want the primary care jobs either and every one I know (I am one) leaves as soon as a better (specialty) offer comes along. An NP can make 2 times the money (and work half as hard) in a dermatology or GI practice than in a GP office.

Until insurance companies start reimbursing fairly we're going to see more and more physicians opting out of the traditional insurance model.

I found this extremely disturbing. I have all the respect in the world for healthcare providers but what this is saying is if you have the extra money and pay us more you will get more attention and better care. What about those who can barely afford the deductables, copays, coinsurance and the monthly insurance premiums. I get doctor's are squeezed but excuse me, the solution is to squeeze the patients even more? How do you sleep at night knowing some of your "special" patients will get better care from you and others get what exactly? I would hope doctors choose their profession because they care about people and want to treat them well and manage their illness not because they hoped to be rich and have an expectation of living in a praticular type of house, in a particular neighborhood and drive expensive cars. I just can't feel sorry for them that they can't maintain a certain lifestyle they would like to have so threrefore they screw their patients.

If you feel so strongly, by all means go to medical school, finish residency, and open a practice and work 70 hours a week for peanuts. I'm serious: go to medical school and put your money and time where your mouth is. Until then, don't criticize others for wanting to be compensated appropriately for their time.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My GP sent a letter about the new concierge service the office is offering, and I threw the letter in the trash. I thought it was BS.

Well in a few years I doubt you'll be able to find a single GP outside of university-sized clinics that won't charge hefty administrative fees, a concierge fee or take cash only. It just doesn't make sense for these physicians to work 60-70 hours weeks, pay $350K for medical school, train for 7 years and make 100K. Insurers aren't paying their share so patients will (out of pocket).

Many think the answer is mid level providers (Nps, PAs) but they don't want the primary care jobs either and every one I know (I am one) leaves as soon as a better (specialty) offer comes along. An NP can make 2 times the money (and work half as hard) in a dermatology or GI practice than in a GP office.

Until insurance companies start reimbursing fairly we're going to see more and more physicians opting out of the traditional insurance model.

I found this extremely disturbing. I have all the respect in the world for healthcare providers but what this is saying is if you have the extra money and pay us more you will get more attention and better care. What about those who can barely afford the deductables, copays, coinsurance and the monthly insurance premiums. I get doctor's are squeezed but excuse me, the solution is to squeeze the patients even more? How do you sleep at night knowing some of your "special" patients will get better care from you and others get what exactly? I would hope doctors choose their profession because they care about people and want to treat them well and manage their illness not because they hoped to be rich and have an expectation of living in a praticular type of house, in a particular neighborhood and drive expensive cars. I just can't feel sorry for them that they can't maintain a certain lifestyle they would like to have so threrefore they screw their patients.

If you feel so strongly, by all means go to medical school and open a free clinic and work 60 hours a week for free. I'm serious: go to medical school and put your money and time where your mouth is. Until then, don't criticize others for wanting to be compensated appropriately for their time.

I found this extremely disturbing. I have all the respect in the world for healthcare providers but what this is saying is if you have the extra money and pay us more you will get more attention and better care. What about those who can barely afford the deductables, copays, coinsurance and the monthly insurance premiums. I get doctor's are squeezed but excuse me, the solution is to squeeze the patients even more? How do you sleep at night knowing some of your "special" patients will get better care from you and others get what exactly? I would hope doctors choose their profession because they care about people and want to treat them well and manage their illness not because they hoped to be rich and have an expectation of living in a praticular type of house, in a particular neighborhood and drive expensive cars. I just can't feel sorry for them that they can't maintain a certain lifestyle they would like to have so threrefore they screw their patients.

Uhh, yeah - if you pay more, you have access to better care. Why is this at all surprising, let alone disturbing?

You ^^ or your dh must be an insurance executive. When has the government ever mandated profit limits on insurers. If it's not big bad government, then it must be the lawyers. If anything circle around and at least acknowledge that there is likely more medical malpractice due to the pressures on doctors.

Most insurance (of all types) is filed with and approved by state insurance departments. Most of those approval processes include caps on loss ratios. Not exactly a profit limit, but don't pretend insurance companies can just charge whatever they want. They can't.

Anonymous wrote:I have a doctor who takes virtually no insurance, which means I pay out of pocket, submit my receipts, and get whatever percentage my insurance offers for out-of-network. But all that is worth it because when I have an appointment at 10:00, I get seen at 10:00.

DH and I recently changed to an internist who does not take insurance. What a difference in service. I saw him recently and he spends an hour with me. All labs are done in-house, no running to Quest/lab Corp. Seen on time and the waiting room isn't a zoo with nice, professional reception and checkout. Worth the money. Amazing...

This makes total sense to me and I don't have a problem with it.

I am a private reading tutor. I am able to handle a certain amount of clients. Right now I'm full up; I have no room for more. If I decide I want to earn more money over the next few years, I can either raise my hourly rate, or shorten the amount of times I will see my students.

Doctors who are primarily paid through insurance companies can't raise their rates, right? Insurance companies negotiate their rates at a certain level for everyone. And so to earn more money, doctors either stop taking insurance completely (if they can get away with that -- have to have a wealthy client base) or they start streamlining their patients -- what used to be a 20 minute appointment is now a ten minute one, and a 10 minute one becomes a five minute one.

I had one doctor stop taking insurance and I'd rather all the best ones not do that. I have found a few doctors whom I love, and would gladly pay extra to have access to their knowledge, to be able to see them the day I need them, and to have them be able to take more time with me when I really need them to.

$500 per year does not seem outrageous to me.

Anonymous wrote:I have a doctor who takes virtually no insurance, which means I pay out of pocket, submit my receipts, and get whatever percentage my insurance offers for out-of-network. But all that is worth it because when I have an appointment at 10:00, I get seen at 10:00.

I get this concept but it's different from paying $45 monthly fee for better service at your doctors office.

Anonymous wrote:Concierge service. Definitely a result of insurance micro managing the doctor/patient relationship. I am 50 and healthy--see my doc 1 or 2 times a year so I don't think the extra money is justified. However, if I had a chronic illness and needed to see my dr frequently, I would probably pay the fee.

I get this concept but it's different from paying a $45 monthly fee for better service at your doctors office.