After three years of visits, my primary care physician still didn’t know who I was. During my final appointment, as I sat on the exam table swinging my legs, she barely glanced at me. Instead, she swiveled her desk chair toward her computer monitor and began, in a robotic monotone, to read questions from the screen. I never got around to asking her about several nagging health concerns, because when she finished typing my answers on her clacking keyboard, our time together was up.
I would not have accepted this treatment from another professional—say, my accountant or lawyer. And right then I decided this was not the kind of relationship I wanted to have with my physician. I was fed up with the culture of unavailability. I yearned to put myself in the hands of a persevering detective who would get to the bottom of things, no matter how long it took, and bear witness to a menopausal body so mysterious that at times I swore it belonged to someone else. In short, I wanted a medical home.
Ten years earlier, I’d lost an internist I’d liked and trusted to retirement. Since then, I’d been riding the Blue Cross preferred-provider circuit, delivering my medical records into the hands of one local physician after another—three in quick succession. In my Northern California town, you took what you could get: Several well-established doctors no longer accepted health insurance reimbursement, and others had closed their practices to new patients.
But now I was determined to do better for myself. Opening my Facebook page, I typed a question into the “What’s on your mind?” box: “Does anyone have a terrific primary care doc?” For several days, the comment box remained empty. Then my friend Jennifer wrote back. She’d been a patient of Dr. Mei-Ling Fong’s for more than a decade. Dr. Fong, Jennifer assured me, was a great physician, as well as a true friend. There was just one catch: A few years ago, Dr. Fong had transitioned to a “concierge practice,” which meant that she now collected an annual retainer of $2,100 from each patient. This allowed her to limit the size of the practice and to provide an impressive level of personalized care.
As a self-employed person, I thought this sounded a little too rich for my pocketbook. The fact that I was already shelling out $435 per month for my own health insurance plan was irksome enough; I balked at the prospect of spending even more. Discouraged, I returned to the Blue Cross Web page.
And at first I believed my luck had changed. One doctor, a woman in her early forties, had excellent reviews on Yelp. She accepted my insurance, and although she practiced primary care, she was also board certified in rheumatology, which sounded promising. My perpetually aching joints were one of the nagging concerns I’d never had time to bring up with my previous primary care doctors.
After the receptionist ran my credit card for the $30 insurance co-pay (“get-to-know-you” appointments aren’t free), I learned several things. This doctor, every inch as youthful and attractive as she appeared in her Yelp photo, worked only three days a week. She was, in fact, an employee of the other physicians in the practice, all of whom happened to be orthopedists. This wouldn’t be of much help if I came down with the flu on her day off. At least she was young, I told myself—she’d be there for me as I grew old. But no. As we chatted, she mentioned that within the next 10 years she intended to retire and move to Kauai.
I took my charts with me when I left. It was time to call Mei-Ling Fong and investigate “concierge medicine.”
A Different Medical Model