Is ‘concierge care’ in your medical future?

A few years ago, my physician retired and I had to find a new one. One seemed good until I discovered that they had this tiered pricing scheme where the more you paid in the form of an annual subscription, the more services they offered. For example, with my previous physician, if I went for my annual check up, he would order the usual tests and then later his aide would call me and tell me what the results were (if they required no further action) or he himself would call me to tell discuss with me what I should do if the matter so warranted it.

With the new doctor, they would not release to me the results of my tests that had been paid for by my insurance company. She said that I had to make a second office visit to just get the results, whatever they were. Not only was this time consuming, it meant that I would be charged by my insurance company for an extra doctor visit. However, if I paid extra for the ‘premium’ service, I would get the results mailed to me, just like my former doctor had done for free.

I felt that this was a form of extortion and quickly changed doctors.

But now I hear from reader Norm that this may be a trend, and that there is something called MDVIP that some physicians are switching to. He sent me some links that describe how this new system that comes under the heading of ‘concierge care’ or ’boutique doctors’ works. (See here and here.)

But as Scott Isaacs says:

In order to provide this level of care, your doctor has to cut his practice down from 2,000-3,000 patients to 600 patients. What is the criteria for selection? The simplest criteria there is: money. MDVIP costs $1,500 to join. No, that’s not a one-time fee to join. That is an annual fee to maintain your membership in the MDVIP program as well as stay a patient of your doctor. This comes out of your own pocket and goes on top of all your insurance payments to your doctor.

Doctors claim that they are doing this because they want to practice better, more in-depth medicine. I don’t buy it. The hefty up-front annual fee is what points me in the direction of the motivation for the doctors. They get more free time because they are dealing with 20% of the patients they used to see and they get $900,000 in dues straight away not counting any money they collect from your insurance provider. Who wouldn’t like more vacation time and a raise?

Norm’s doctor was charging an annual fee of $1,800. He explained why he declined to participate in the system, reasons that I echo.

1) I typically see my doctor only 2 or 3 times per year. That means each visit will effectively cost me $600 to $900 per visit under the new plan–on top of my normal insurance premiums. That’s a lot of money.

2) It bothers me that under this new system those who can afford it will get better healthcare than those who can’t.

3) If a doctor using MDVIP typically reduces his caseload by 75%, that’s thousands of patients who will be “put back out on the streets.” This will place an even larger burden on primary care physicians who are not switching to the MDVIP system, and who must pick up those extra patients.

One of the objections that people who already have good health insurance have to providing expanded health coverage to all was that this would enable more people to have access to doctors and that hence they would find it harder than before to see a doctor. It was a callous and selfish response and this ‘concierge care’ may be trying to target such people, and take advantage of their need to have access to better care so that they can continue to ignore the plight of others.

Here’s a video about this phenomenon.


  1. says

    Seriously, you guys need to socialize health care.

    It seems to be working in those countries that are rated as “best place to live in the world” year after year.

    Why is the U.S. so afraid of equal health care?

  2. Rob Grigjanis says

    Janice, I live in Toronto, and my mum’s GP was handing out leaflets to his patients several years ago, listing the benefits of subscribing to his ‘premium care’ program. Not quite the level of extortion exhibited by Mano’s GP, but it definitely implied that his patients wouldn’t get the best care without paying him extra, and most of his patients were elderly. I encouraged her to change her doctor ASAP.

    I should add that this GP seems to be the exception. My own GP, and my mum’s new one, are nothing like that.

  3. mudskipper says

    I’ve got mixed feelings about this. As a patient who could easily afford concierge care and who has been suffering from a number of strange symptoms that I call “my syndrome” over the last few years, I’d love to have a doctor who would see me for 30 minutes and actually spend some real mental cycles trying to resolve my symptoms in some way.

    On the other hand, there is no question this is bad news for society as a whole and is just a continuation of the increasing inequality in American society. It feels as if we’re going through a massive shakedown in America, with the majority of the people being firmly and inexorably pushed into the “have-not” population. Baring any personal catastrophe, I’ll probably be in “have” population throughout the rest of my life (thanks to a career in high-tech), but that’s small comfort when many of my friends and family members have already slipped into the have-nots.

    Clearly we need to fix our broken healthcare system. But I am not optimistic.

  4. snoeman says

    I agree with the concerns, but on this point:

    2) It bothers me that under this new system those who can afford it will get better healthcare than those who can’t.

    I think it’s fair to point out this feature/bug -- i.e., the wealthy getting better care than the non-wealthy -- is already a fact of life no matter which country’s health care system you are talking about. It’s just that the level of inequality varies widely. France, Germany or Canada all have excellent systems, and yet the wealthy can always go around the existing infrastructure and get care that just isn’t available, or can short-circuit the queue in a way the non-wealthy cannot. But the level of care for all is much better overall (and cheaper).

    Here in the US, it just makes a bad system even worse.

  5. Mano Singham says

    I agree with you. i really don’t care if very wealthy people get perks such as special hospital rooms that have whirlpools and personal chefs and whatever the hell they want to make them feel special. I just want everyone to get the best medical care.

  6. MNb says

    “get the best medical care”
    You get the best medical first line care in Iceland, where there are so many doctors that many of them need a second job.
    Snoeman means that even in countries with excellent health care systems the rich get better medical care than the poor. The simple fact remains that physicians always will make more money by curing/nursing them. This even applies to the heavily regulated Dutch health care system:

    This is obviously much better than the American system, but it still doesn’t guarantee the best medical care for everyone. The only way to get that done is free medical care for everyone, ie paid in the form of government taxes. This invariably leads to abuse, ie people visiting doctors for every single trifle.
    So you always need to compromise.

  7. Timothy says

    ‘Freedom’ … LOL!

    Now seriously. Janice, I think fear has nothing to do with healthcare here in the USA. Consider greed. A few small percentage of people are making enormous amounts of money off of the current US healthcare system.

  8. snoeman says

    Yes. Any health care system involves some tradeoff or constraints. For example, that may mean queues for treatment (Canada) or limitations on what is covered (UK). (The phrase I’ve heard for the UK goes something like, “everyone is covered, just not everything“.) Whatever the particular constraints may be, the wealthy often have the means to circumvent them, and I think that will always be true.

    To Mano’s point, whether you’re talking about the French, Dutch, German, Canadian, UK, etc., system, at the very least, everyone (or nearly everyone) has access to quality medical care that will not result in the patient having to declare bankruptcy, and provides outcomes that are at least as good as the ones achieved by that of the US system. If, within those systems, the rich get a gold-plated bed, a platinum sphygmomanometer or can jet to the Mayo clinic some weekend, that’s reality, and not likely to change.

    For the US, “concierge care” just makes an already inequitable system worse. The tradeoffs in our system beggar belief. It’s the most expensive care in the world, which fails to cover a large portion of its citizenry, exposes them to a high risk of financial ruin, and often has worse outcomes than those countries with systems of supposedly evil “socialized medicine”. All of that, for what…?

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