My GP doctor of 18 years and his practice, Chapel Hill Family Medicine, are converting to "concierge medicine", sometimes known as boutique medicine. What this means is that to stay with my doctor, whom I like, it will cost me $1500 per year, $1000 which goes to him and $500 which goes to MDVIP, the company which franchises this service. My doctor will reduce his patient load to a maximum of 600 patients. MDVIP limits its franchises to experienced established practices in high income areas.
What this buys is 24 hour access to your doctor, extended preventative medicine including expanded physical, all you records on a cd.. etc.. or to put it another way, high quality individual attention that should be available anyway.
This really poses an ethical dilemma both for the physician and the patient. What is driving this practice is the increasingly low reimbursements by insurance companies which require increasing work loads which gives less and less time per patient. Primary Care Physicians, PCP, are increasingly stressed and dissatisfied with the current system. In other words this is a prescription that is symptomatic treatment for PCP's and the economically advantage patients at the expense of the rest of the population due to a broken health care system. It furthers the class divide of accessibility to quality medical care.
While as I said I like my doctor and understand this siren song for him as sung by MDVIP, this move disturbs me and it looks like I will be searching for an new physician.
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My friend is a patient of that practice. After she attended one of the 3 information sessions, she was totally bummed out. As someone who primarily depends on Medicare to pay her health care, she is concerned about finding another primary care doctor in the area.
It certainly seems to me that this kind of shift in medical practice might be what finally makes the average American wake up and realize that our health care system as it currently exists is propped up with toothpicks. it cannot sustain itself in its current form. When it costs more for health insurance for your family than it does to rent your apartment or buy your car, something has got to give.
And the entire premise of tying your insurance to your job is just untenable. I am meeting more and more people 50+ who have been downsized, exhausted their COBRA coverage, cannot find another job with benefits, and cannot afford individual coverage at any kind of reasonable price. They are willing to pay, but not 2 or 3 thousand dollars a month. And yes, that is how much it costs for many of them to buy a comparable individual policy, especially if they've had any kind of health condition, even one like simply taking a recurring prescription medication.
She said it was slick. They had her name already pre-printed on a contract application to join the new practice--it had her name, address, phone number, etc etc, and they gave it to her when she walked in. They had a name tag for her. She said there was a bit of a "hurry up before it's too late" air to the proceedings--that once the 600 slots were gone, they were gone. Join now before it's too late. (a la time share).
. At one point my friend said someone said something to Dr. Guiteras to the effect of--I have been with you since you opened. Is there any provision for someone like me, who has been part of your practice for a long time. What happens to me?
She said that Dr. G did not know what to say, was visibly flustered by the question. She said that Dr. G's presentation had the air of true sincerity, that he said he had been struggling with this decision but that he wanted to practice medicine the way he thought it should be practiced, and the current patient load just didn't allow him to do that.
She said she wanted to ask him but didn't, what this arrangement would do to the bottom line of his practice. Would it be better, worse, about the same?
She left thinking that MDVIP was a pretty slick marketing machine and that the docs were in an uneasy alliance with the group because they see the end goal as practicing better medicine for the patients who will be part of the "elite 600." She also said the 1500 also included an executive physical that would be used to put together a comprehensive plan for your future health care.
I, like many of you, am also a patient of Chapel Hill Family medicine. During my last visit Dr. G, with incredible discomfort, announced his decision to change his practice as described above. He said that he currently has 3,500 !!?? patients and that has left him with little time to practice medicine the way he believes it ought to be practiced. He also said that under the current GP system doctors are forced to be MBA's rather than just doctor's and they are bad MBA's.
I didn't attend the sessions to learn more about the change in practice as I simply can't afford the additional expense per year and had made up my mind. With that said, in some strange way I am happy for both Dr. G and Dr. F. They are both incredible doctor's who have served our community for over 30+ years and deserve to be treated better by the system. I don't think they are doing this for financial reasons as they have both been practicing medicine for 30+ years. We should be careful to not blame them for a broken health care system as they certaintly have served their time to our community. It's time for us to start actually demanding real health care changes from our legislatures and president.
Good job, David, especially the part where you implicitly accuse the Herald of glossing over the real issues. CHFM's eye-catching ad in CHN made me wonder if they're not making their 600/per PCP quota. Is that a contractual stipulation? Did MDVIP pay for the ad?
I would have liked to see a harder emphasis on the ethical aspects of CHFM's decision. I'm surprised nobody has sued them by now. There are lives at stake. People are going to die either because their doc is off limits, or because their medical records are lost in the void. Serious stuff.
My evil twin thinks MDVIP serves its members (PCPs) by providing a sort of maid service. They do the billing. They provide IT in the form of instant medical records. (This is not a new concept. The UNC Hospitals network serves many local providers in the same way with on-line xrays, clinic notes, operative reports, etc. Carrboro Family Medicine is linked in.) They do a Concierge Medicine splash in local papers -- free advertising. They ease their PCPs into semi-retirement by reducing their patient loads in an organized fashion.
I've commented in the past that I fear for the long-term employees of a practice like CHFM. By taking over the administrative burden (billing = insurance claims and such), MDVIP supplants the on-site staff member who gives a shit about this or that patient's ongoing care. It's not only the docs who ostensibly care; there's a whole team of care-givers backing them up, and these people will lose their jobs.
A close friend of mine is stunned by this recent development at Chapel Hill Family Medicine. $1500 per year (not a one-time payment) to stay on her physcian's elite patient list ... another $1500 per year for her husband, both of whom have been patients there for something like a quarter of a century! When she last visited, her doctor somewhat bluntly said that his objective was to reduce his patient load to 600 from several thousand. In the waiting area was a representative of the Concierge group hoping to sell her on the new deal. Needless to say, she was very freaked out.
These physicians took the Hippocratic oath. What happens to long-time patients, many of whom are elderly, who can't fork out $1500 apiece to remain in their care? Will they retain these patients' medical records? This movement strikes me as unethical -- a cushy way for some docs to achieve semi-retirement.