Some Doctors Opt for Treating Fewer Patients
As a therapist, you find yourself on both sides of a health care
coin. Heads, you're a health care provider. Tails, a health care user. And just
as your day-to-day job descriptions have changed over the past years, so too might
your options in tomorrow's user department.
Doctors especially are trying to make sense of the current health
care imbroglio, sometimes changing their practices dramatically in an attempt
to create a more stable fiscal environment conducive to personal satisfaction.
Among the growing business models is a trend to set up concierge or
boutique medical practices. These are being adopted in response to declining
third-party insurance payments, worsening Medicare and Medicaid regulations and
reimbursement, and growing hassles in the workplace.
Pros and cons exist in creating such practices, according to
Virginia physician and author Jose DeJesus, MD. On the plus side for users are
fewer patients competing for care from one individual, fewer hassles with
insurance companies, and more personalized face-to-face contact with a doctor.
On the negative side: users pay out-of-pocket fees ranging from
$1,000 to $20,000 per year for the advantages of special care.
Advantages can be many including: house calls, preventive care, spa-like
amenities, fast access to doctors, and special programs for weight loss,
nutrition, and wellness. Boutique physicians limit their patient load to about
600 versus 2,500 in a traditional family practice.
Physicians like Ned Stolzberg of Arizona enjoy the pace of
concierge care. He cut his patient load from 30 patients per day to about a
"Now I can spend a lot more time working on the complicated cases,"
he told Tony Mecia of the Weekly Standard.
"It makes me feel like I'm being a real doctor now, like here's what I was
trained to do, and now I can do it." As a plus, he feels free to coordinate the
care of a cancer patient with a specialist or spend 45 minutes talking to a
diabetic about nutrition and exercise.
Other doctors have opted for a straight fee-for-service model. They
don't accept insurance and charge patients a set fee which is paid at the time
of service. Prices are listed almost like a restaurant menu: office visit, $49;
cancer screen, $30; splint, $41. Like concierge practices, physicians in these
services limit the number of patients they will see in a day.
In a nation already experiencing doctor shortages and a sizeable
number of veteran physicians reaching retirement age, if general practitioners
in large numbers adopt concierge/boutique practices, doctor shortages will
become more acute.
To date, the number of concierge practices is relatively small, but
they are growing in number. One conglomerate now serves 125,000 patients
in 29 states through a network of 365 doctors.
The prospect for potential service changes in your own doctor's
office can easily be seen in the types of surveys being distributed today.
Numerous patients have been asked to fill out questionnaires assessing perks
like house calls, longer face-to-face appointments, 24/7 availability of care,
and additions of special health care programs. Surveys themselves are not an
indication changes are definitely ahead, but they do provide a signal some thought
is being given to changes.
Hospital staff cannot help but be impacted if there are major
shifts in the physician provider side. First, it is likely to force more people
to ERs for primary care if they have access to only a limited number of physicians.
Second, a reduced number of doctors may
cut the number of referrals to hospitals or medical specialists.
Any way you choose to look at it, it's a coin toss for changes in future
medical care on both the user and provider side. Let's hope it doesn't turn
into a heads I win, tails you lose situation.