I learned that concierge doctors are physicians (most practice internal and family medicine) who have rebelled against the pressure cooker conditions typical of primary care: seeing 20 to 25 people a day for only about 15 minutes each and carrying a roster of 2,000 or more patients. Instead, they have set up personalized practices serving far fewer patients (usually 300 to 600) who typically pay a retainer of $1,500 to $3,000 a year—although about 20 percent of concierge doctors charge a lot more, in the range of $15,000 to $25,000. (Spouses usually pay separately, though some doctors offer a family discount, and dependent children under 26 are sometimes covered for free.) Because of that annual fee and a reduction in insurance-related paperwork (fewer patients means fewer forms), doctors are able to reduce their patient load but maintain their income level. Despite the economic downturn, business for concierge doctors is booming. The number of doctors engaged in what is often referred to as “private medicine” has exploded from 146 in 2004 to 2,800 in 2010 and now is estimated, by the American Association of Private Physicians, to stand at 4,400.
The financial aspect of concierge medicine isn’t complicated. For the patient, all the usual costs stay the same; you just add on the doctor’s yearly retainer. In other words, you continue to maintain your health insurance coverage. You foot the bill for your co-pay for all visits except your extensive annual wellness physical, which is typically included in the concierge fee. You’ll be charged for such extras as pretravel vaccinations. If you’re referred to a specialist, you’ll pay the fee set by your health insurance provider. You pay separately for your prescriptions, and you rely on your health insurance to cover what happens in a hospital.
What your retainer does buy is a variety of services and amenities. In most concierge practices, you get a two-hour, comprehensive wellness exam, including lab tests and other screenings. Often included are high-tech medical screenings, such as advanced lipid profiling, a test that goes far beyond the ordinary good-cholesterol/bad-cholesterol measurement. In some situations, the market value of such “free” tests exceeds the cost of the retainer.
Above all, the annual retainer buys you an astounding level of access and attention. You get same-day appointments with little or no waiting. You can text, e-mail or phone your doctor whenever you want, from anywhere on the planet, and he or she is very likely to answer immediately, even if it’s the dead of night. He or she will also customize a long-term wellness plan for you and coordinate all specialist care; the office may even intervene with those evasive preauthorization people at your health plan. If you are rushed to the ER, your electronic medical records will arrive there before you do—and you may find your concierge doctor waiting there as well. Then there’s the intangible payoff: the experience of feeling that someone besides you is deeply interested in your health.
I finished my research on concierge care knowing that this was the kind of treatment I was looking for. I was ready for a road test.
Up Close and Personal
When I called the number Jennifer had given me, Dr. Fong herself answered after the first ring.
Several days later, as I walked through the front door of her freshly renovated suburban office, she greeted me as warmly as if I were entering her home. Dressed in casual cords and a nice sweater, she looked like a college girl, even though she’s 44. Within moments, we were chatting like longtime girlfriends, swapping stories of kids and career paths. Here’s what I noticed right away: There was no professional firewall between us, no “You are the patient and I am the doctor, and you will stand in awe of my white coat.”