Finding a new PCP. Has anyone tried Concierge Medicine.

[gallahadesquire]

No, not phencyclidine. Primary Care Physician.

 

When I was in practice, it was nice to have a doctor in the attached Primary Care clinic. But I’ve come to the point where he stresses me out and treats me as a petulant child. So I’m looking for a new one. The idea of concierge medicine is appealing.

 

Mass General has one such practice, and one of the docs is an alum of my own medical school. We’re both a Harvard trained. It’s pricey, and they do not take insurance, but I can afford their practice. It’s also inconvenient, but if I only go three or four times a year, that’s surmountable.

 

I’m tired of having ten minute interactions and twenty minutes of documentation.

 

Again, any experience with these types of practices?

[Beancounter]

No, not phencyclidine. Primary Care Physician.

 

When I was in practice, it was nice to have a doctor in the attached Primary Care clinic. But I’ve come to the point where he stresses me out and treats me as a petulant child. So I’m looking for a new one. The idea of concierge medicine is appealing.

 

Mass General has one such practice, and one of the docs is an alum of my own medical school. We’re both a Harvard trained. It’s pricey, and they do not take insurance, but I can afford their practice. It’s also inconvenient, but if I only go three or four times a year, that’s surmountable.

 

I’m tired of having ten minute interactions and twenty minutes of documentation.

 

Again, any experience with these types of practices?

 

My doctor changed moved his practice to a concierge practice and I followed him. Best $2,000 I ever spent just to be one of his patients. PM me and I’ll give you how concierge medicine benefited me.

[+ bigjoey]

My doctor changed to a concierge practice about five years ago. While it is expensive at $1,600 a year, he is a great doctor. I think he has about 800 patients.

 

My annual check-up is very extensive and he spends an hour with me going over the results and examining me. The different tests are done the week before. Any visits are just $10 and there is never a rush. Available by phone all the time.

 

If I am traveling, there is a network of these doctors and if needed, a referral is made. The doctor treats you just as if you were one of his own patients.

 

Love the service.

Edited May 6, 2019 by bigjoey

[+ FreshFluff]

I’d say a concierge worth it if you want a lot of attention and want someone who is willing to order imaging, dig deep to make high quality referrals and so on. But they vary in quality. I was referred to a concierge IM doctor who is amazing. He left me have one visit at a regular per-visit rate . I was impressed. Unfortunately, by the time I decided to sign on, he had become a lot more popular and increased his rate to 5-figures.

 

My insurance GP is a smart guy but a little impatient and can get hyper-focused on editing EMRs. I’m hoping to find a local concierge at a reasonable price..

Edited May 6, 2019 by FreshFluff

[gallahadesquire]

ADDENDUM

I live in Centrsl Massachusetts, so local would be good. And I have s really good handle on my health history (like: My pulmonary embolism wipes out 3/5 of my lung capacity. Should have killed me)

[Guest]

I'm curious. Would one of you who has concierge service be able to give an example or two of something your non-concierge doctor couldn't or wouldn't do? I'm thinking specifics, not something general like "He spends more time." I don't have a concierge doctor, but can e-mail him any time. There are RN's or MD's on call available any time, but why would I want to call my MD at 2 AM? Or what if he's been to a party and has been drinking? What if he's at an opera? Having sex? At the gym? I've heard of Doctors without Borders, but there also seem to be Patients without Borders. From the physician's perspective, concierge medicine is great. More money for less work. But how does this help the patient? If your doctor won't return your phone calls or e-mails, complain to the payer (i.e. insurance company) and switch physicians. I'm sure most organizations have standards about returning patient phone calls and e-mails.

[gallahadesquire]

I'm curious. Would one of you who has concierge service be able to give an example or two of something your non-concierge doctor couldn't or wouldn't do? I'm thinking specifics, not something general like "He spends more time." I don't have a concierge doctor, but can e-mail him any time. There are RN's or MD's on call available any time, but why would I want to call my MD at 2 AM? Or what if he's been to a party and has been drinking? What if he's at an opera? Having sex? At the gym? I've heard of Doctors without Borders, but there also seem to be Patients without Borders. From the physician's perspective, concierge medicine is great. More money for less work. But how does this help the patient? If your doctor won't return your phone calls or e-mails, complain to the payer (i.e. insurance company) and switch physicians. I'm sure most organizations have standards about returning patient phone calls and e-mails.

It’s a question of quality of time with my practitioner.

 

1. I had a thirty -odd year career in medicine, and I feel like a petulant child with my current doctor. We don’t converse; he talks, I listen. My ideas are inconsequential.

2. Appointments are two to three months out.

3. The clinic is mostly poor and indigent. Great for when I worked there, but inconvenient now.

4. Urgent care can only be scheduled day of appointment. If you think you should go in the next day, no can do. And you get whoever in the clinic, not your own doctor.

 

I don’t so much NEED a concierge, but I need a doctor who will respect me and listen. And the middle ground appears to be all but absent.

[Guest]

It’s a question of quality of time with my practitioner.

 

1. I had a thirty -odd year career in medicine, and I feel like a petulant child with my current doctor. We don’t converse; he talks, I listen. My ideas are inconsequential.

2. Appointments are two to three months out.

3. The clinic is mostly poor and indigent. Great for when I worked there, but inconvenient now.

4. Urgent care can only be scheduled day of appointment. If you think you should go in the next day, no can do. And you get whoever in the clinic, not your own doctor.

 

I don’t so much NEED a concierge, but I need a doctor who will respect me and listen. And the middle ground appears to be all but absent.

Even if you didn't have a medical background, any physician who won't converse with you shouldn't be practicing medicine. Also, there are laws about how far out appointments can be for HMO's. 2-3 months out is illegal (in addition to bad medicine). It sounds as if you should just change insurance and/or practice situation. I treat mostly the poor and indigent myself. Obviously, if you need to be seen in one or two days, it may not be your PCP, but appointments are available. If your physician can always see you within 48 hours, then he must schedule a good deal of time in which he doesn't do anything. Obviously an expensive proposition.

The conditions you describe are unacceptable in any situation. Concierge practice is definitely not the only alternative. If you're retired, I'm guessing that you may be eligible for Medicare. If so, just change plans.

[+ Charlie]

My spouse's doctor was so popular that he had a ridiculous number of patients, and my spouse almost always ended up seeing the doctor's P.A., who was very good. However, when the P.A. moved to San Francisco, the doctor decided to change to a concierge practice (MDVIP), to dramatically reduce his patient load and see them all himself. My spouse decided it was worthwhile for him to spend the money ($2200/yr) to become a patient in the practice, and we have had no regrets. He gets lots of consultation, and it is much easier to get appointments than it used to be. The doctor is oriented very strongly toward preventive care, so he is always doing tests and monitoring results. He also is very connected to the local medical network, so his referrals are uniformly excellent. When my spouse first mentioned that he was having short term memory problems, the doctor immediately sent him to a neurologist friend of his who was running a nationally funded study, which included a free (!) PET scan of the brain, that revealed the typical Alzheimer's plaque on my spouse's brain (Medicare didn't routinely pay for the expensive test before the study, but the study results have apparently convinced them that it is worthwhile to do so, and they will probably soon include it as a standard benefit). During a routine exam, when my spouse casually mentioned an odd symptom, the doctor immediately ordered an MRI, and called us on a Sunday from his office (!) to say that he had just contacted a vascular surgeon whom he wanted us to see the next day; the surgeon confirmed that his carotid was 90% blocked, and operated a couple of days later. Normally my spouse would have completely ignored the symptom, which didn't seem problematic. To us, all this coddling seems worth the price.

 

I had a different P.C.P. until last year, and although I liked him very much, it was obvious to me that he was winding down his practice as he grew old (well, he's actually younger than I am, but still...). I was getting tired of calling the office but frequently being told that he wasn't available and I should go to urgent care instead. Since I go with my spouse to all his appointments anyway, because I manage his care, I decided it made more sense for me to pay the concierge fee and switch to his doctor myself. Suddenly I find my own health being much better monitored than it has ever been before, and chronic problems that my old doctor passed off as "just getting old" are looked at seriously. One of them has even been eliminated with medication that my old doctor never considered. I admit to feeling a little uncomfortable at paying to get special treatment, but it really has been an investment that has paid off.

[Guest]

I'm glad you're doing better now, although I'd love to know more specifically about the "odd symptom," and the "chronic problem" which has been "eliminated." I'm also glad the study appears to have helped you out, although I doubt one needed to be enrolled in a concierge practice in order to qualify for enrollment in the study. If the "odd symptom" was suggestive of TIA's/clots being showered off into the brain or retina of the eye, then I'd think any decent neurologist (or even PCP) would order a carotid ultrasound and rule out atrial fibrillation. If the symptom was non-neurological (or, more specifically, not related to showering off blood clots down the carotid artery system), then the risk of getting a carotid endarterectomy exceeds the potential benefit.

carotid-artery-stenosis-screening

Adequate evidence indicates that both the testing strategy for carotid artery stenosis and treatment with CEA can cause harms. Although screening with ultrasonography has few direct harms, all screening strategies, including those with or without confirmatory tests (that is, digital subtraction or magnetic resonance angiography), have imperfect sensitivity and specificity and could lead to unnecessary interventions and result in serious harms. In selected centers similar to those in the trials, CEA is associated with a 30-day stroke or mortality rate of approximately 2.4%; reported rates are as high as approximately 5% in low-volume centers and 6% in certain states 1. Myocardial infarctions are reported in 0.8% to 2.2% of patients after CEA. The 30-day stroke or mortality rate after carotid angioplasty and stenting (CAAS) is approximately 3.1% to 3.8%. The overall magnitude of harms of screening and subsequent treatment of asymptomatic carotid artery stenosis is small to moderate depending on patient population, surgeon, center volume, and geographic location.

USPSTF Assessment

The USPSTF concludes with moderate certainty that the harms of screening for asymptomatic carotid artery stenosis outweigh the benefits.

[+ Charlie]

I'm glad you're doing better now, although I'd love to know more specifically about the "odd symptom," and the "chronic problem" which has been "eliminated." I'm also glad the study appears to have helped you out, although I doubt one needed to be enrolled in a concierge practice in order to qualify for enrollment in the study. If the "odd symptom" was suggestive of TIA's/clots being showered off into the brain or retina of the eye, then I'd think any decent neurologist (or even PCP) would order a carotid ultrasound and rule out atrial fibrillation. If the symptom was non-neurological (or, more specifically, not related to showering off blood clots down the carotid artery system), then the risk of getting a carotid endarterectomy exceeds the potential benefit.

carotid-artery-stenosis-screening

Adequate evidence indicates that both the testing strategy for carotid artery stenosis and treatment with CEA can cause harms. Although screening with ultrasonography has few direct harms, all screening strategies, including those with or without confirmatory tests (that is, digital subtraction or magnetic resonance angiography), have imperfect sensitivity and specificity and could lead to unnecessary interventions and result in serious harms. In selected centers similar to those in the trials, CEA is associated with a 30-day stroke or mortality rate of approximately 2.4%; reported rates are as high as approximately 5% in low-volume centers and 6% in certain states 1. Myocardial infarctions are reported in 0.8% to 2.2% of patients after CEA. The 30-day stroke or mortality rate after carotid angioplasty and stenting (CAAS) is approximately 3.1% to 3.8%. The overall magnitude of harms of screening and subsequent treatment of asymptomatic carotid artery stenosis is small to moderate depending on patient population, surgeon, center volume, and geographic location.

USPSTF Assessment

The USPSTF concludes with moderate certainty that the harms of screening for asymptomatic carotid artery stenosis outweigh the benefits.

I will send you a private conversation, rather than go into specifics here.

[Rudynate]

I'm curious. Would one of you who has concierge service be able to give an example or two of something your non-concierge doctor couldn't or wouldn't do? I'm thinking specifics, not something general like "He spends more time." I don't have a concierge doctor, but can e-mail him any time. There are RN's or MD's on call available any time, but why would I want to call my MD at 2 AM? Or what if he's been to a party and has been drinking? What if he's at an opera? Having sex? At the gym? I've heard of Doctors without Borders, but there also seem to be Patients without Borders. From the physician's perspective, concierge medicine is great. More money for less work. But how does this help the patient? If your doctor won't return your phone calls or e-mails, complain to the payer (i.e. insurance company) and switch physicians. I'm sure most organizations have standards about returning patient phone calls and e-mails.

 

I had concierge for a few months, found it was more care and more amenities than I wanted/needed. Im on medicare now, so I don't even know if a concierge practice would take me now.

[+ nycman]

Good doctors know they’re good and they know they can command

a premium to off set caring for less patients and delivering a better product.

It’s supply and demand plain and simple. You get what you pay for.

 

It’s also diagnostic of the problem with “socialized” medicine. Everyone wants

free care, as long as they can go onto the free market and purchase better

care if they want it. Unfortunately, true Socialism doesn’t work that way.