Does anybody have experience with concierge health care, especially MdVIP?

[BlueStreak]

I received a notice from my family doctor today saying that he is moving to the MdVIP system, which means if I want to keep seeing him, I'll have to pay an annual retainer. From what I can tell, this is a $1500 annual fee in addition to all the other charges, and that fee is not covered by any insurance. What I get in return is more focus on "wellness", and a a general hint that he will limit his practice to fewer patients and that will result in an easier time getting appointments.

I have tried to research this MdVIP thing and haven't really learned very much. They claim to have signed up 450 MDs across the country. They say that the practices are limited to 500 patients. No, let's make that 600. No maybe it is 700. I note that is a baseline of about $1,000,000 of guaranteed revenue into the practice before they dispense their first aspirin. I haven't seen a whole lot of complaints out there, so maybe the people who are willing to shell out the $1500 are happy with the "VIP treatment".

I guess I really have two questions for discussion. The first question is my own personal decision. I have been with this doc for about 3 years and really like him. But I figure "wellness" is primarily my responsibility. I don't need to pay him $1500 to take my BP more often or to tell me I should lose 20#. I can manage that on my own, and I don't believe my $1500 would result in any better health care. If so, what am I paying him for today? He is supposed to be giving me his best knowledge already. So I think I will move on, but I am interested in hearing from any others who have been confronted with the same thing.

The second question is broader -- about the direction of health care in general. We saw the big TIME article this week. The essence of that article is that the hospitals, drug makers, and device makers are royally ripping off the American public, but the docs and nurses are really not benefiting very much. Several personal anecdotes:

1) My ophthalmologist decided to get out of medicine altogether about 7 years ago. I believe he was about 55 at the time, so it definitely was an early retirement. He made it clear that he didn't like what was happening to the health care system and he just wanted out.

2) He referred me to another ophthalmologist, whom I've been with since that time. Now that guy is retiring, and he let it be known that he was quitting because of "Obamacare". That's bullshit. The problems were already in the system and "Obamacare" didn't change matters for him at all. When he put me through that Obama speech, I asked him politely for an example of how "Obamacare" made changes that caused him problems. He couldn't come up with anything. He was about retirement age anyway. I'm actually happy to move on. That guy didn't seem to embrace any of the new technology that is available in the field of vision.

3) A psychiatrist friend of mine tells me he's getting the same reimbursement rate today that he got in 1990 -- not adjusted for inflation.

The fact is that the Affordable Care Act was mostly about getting insurance industry abuses under control, and did not even attempt to deal with the other big problems. It appears to me that we are seeing the leading edge of a revolt by doctors. Is this a widespread pattern? Where could it lead?

[Scuba]

1. In many areas of the Country there is an abundance of primary care docs.

Shop around.

[cbayer]

3. It's estimated that there are about 9,000 fewer PCP's than would be

sufficient to serve the current population. This will likely get much worse when Obamacare fully kicks in, as many who have had no healthcare for years are going to be looking for a physician. It is estimated that that number will rise to a shortage of about 65,000 PCP's.

[Scuba]

4. Perhaps true, but they're not evenly distributed. In suburban Chicago there is a surplus ...

... resulting in PCP's having trouble finding work for more than a good Unix engineer can make.

Many rural areas are suffering shortages.

[cbayer]

5. True. The shortages tend to be in areas that are underserved in other ways as well.

The payment issue has less to do with supply and demand, imo, but in payment schedules and being ratcheted down by insurance companies.

[cbayer]

2. There are distinct advantages to these practices, but they may not interest you.

In general, you can get same day appointments and are generally seen at the time you are scheduled.. The physicians are able to spend more time with you. They will often do things other doctors don't - emails, phone calls, discussions with family. The reason for this is that insurance generally only pays for face to face episodes with the patient. They can also do office based things or alternative treatments that the insurance company might deny. It depends on what you want/need from your physician.

From the physician perspective, it often makes medicine a pleasure again. Instread of being financially driven to see as many patients as possible, having to deal with insurance companies about every little thing and being very poorly reimbursed, they are free up to actually spend time with patients.

There are, of course, problems. Patients who can't afford these "boutique" practices are shut out and may have to find another doctor. So it becomes class based medicine to a large extent.

This system began to show up about 10 years ago and I agree that it is a reflection of how broken the system is and how dissatisfied many physicians are.

[BlueStreak]

6. I can afford it. I just don't see why I should.

I have never had a major health problem, and if I do, I'll be in the hands of specialists, not the PCP. I probably see the doc 3 times a year, and that is just for a lipid test. He listens to my heart and lungs and may order a blood sugar test or a liver test. That's about it.

I know there are a lot of people who want to talk to a doc and get a pill for every little thing that happens to them. Not me.

So it really comes down to the question whether I can find another doc I like as well without having to spend the $1500.

[Gnarly1]

7. MD (Megalomaniac Despot) Cry Babies

Another greedy little Republican cry baby tactic to "show those damn liberals" that they can make health care suffer for the American people's vote - the re-election of President Obama - in support of the Affordable Health Care Act. Hopefully the majority of Americans will address this travesty by finding another doctor if faced with the MDVIP EXTORTION Program. Don't be surprised if this program initiates a pricing tier system for charging higher fees for those who are older and those with pre-existing heath issues. Shame on all of you and the AMA (American Megalomaniac Association).

[gopiscrap]

10. Welcome to DU

[Gnarly1]

8. MD (Megalomaniac Despot) Cry Babies

Thank you BlueStreak. I see this as just another "greedy little Republican cry baby" tactic to "show those damn liberals" that they can make health care suffer for the American people's vote - the re-election of President Obama - in support of the Affordable Health Care Act. Hopefully the majority of Americans will address this travesty by finding another doctor if faced with the MDVIP EXTORTION Program. Don't be surprised if this program initiates a pricing tier system for charging higher fees for those who are older and those with pre-existing heath issues. Shame on all of you petty little MDVIP doctors and the AMA (American Megalomaniac Association). BOYCOTT MDVIP physicians!

[BlueStreak]

9. I found another doctor I really like

He is somehow able to survive on an income that is probably at least $250,000 a year without asking me to chip in an extra $2900 a year on top of my regular charges.

PCPs are a real treasure. The big bucks are in the specialties. A person really has to be committed to wellness to work as a PCP today, and in many respects this is much more difficult work than the specialties.