This morning I received a follow-up telephone call from a physician in the Southlake, Texas (Dallas) area who is involved in concierge medicine. He described a few essentials to success. First, he weds an "executive physical" model, to a concierge model, by which he gets more reimbursement and risk stratifies his patients. "They come in and spend the whole day with us," he described. Secondly, he believes that "you have to have corporate investment to make this successful." He secures contracts for large numbers of patients from corporations to provide the revenue to do all he feels is needed to make his model work. He was very candid about these and other aspects of concierge medicine.
This call, others, and online reading has me thinking that it is not concierge care for which I'm looking. Not at least as it seems to be commonly represented today. I really have an ethical problem with the "executive physical." Why should any complete physical exam be different from any other? I swore to treat all equally. Executive physicals imply that they are better than other exams, ostensibly because more testing is involved, and imply that those who cannot afford it get a less thorough exam. I don't know which I like less, the patient who insists he is better cared for because he gets an executive physical, or the patient who feels he is missing out because he does not get one. The key here is to get what you need, not more, not less.
I also found myself in an unusual minority in my search for concierge medicine. Most companies that sell their networks and resources to you want to help you transition your existing practice into a concierge one. Virtually no one knows what to do with the individual physician who wants to start such a practice. I am leaving an physician employment position, with no patients to bring with me. But my wife is very supportive, and she has a good job.
Here are my ideals: I want my patients to have my number so that they can call me directly. I want to meet, wherever possible, my patients where they are. While I hope to have a clinic, I anticipate going door-to-door as well. I want to provide more than the standard of care, but not to ridiculous extremes like "executive physicals." I want to draw people away from traditional delivery systems by showing them the value of the convenience of direct, 24-hour access, with therapy provided at the point of care wherever possible. No drives to the pharmacy at night. No antibiotic prescriptions to fill. No paperwork headaches. And I will be the same doctor for them every time.
I am persuaded, in part from having employed some of these principles in my private practice, that patients really do not want to disturb their physician. But they really like knowing that they can, if they need to.
More to come...