Medpundit sited a Boston Globe piece yesterday - Boutique Medicine. As long time readers know, I prefer the name retainer medicine as more descriptive and less perjorative. Maybe someone can develop a better solution to first contact care, but we really should examine the forces driving the retainer medicine movement. I understand that health care costs continue to increase, but underpaying physicians will not help. Physicians need the right amount of time with patients. Current fee schedules do not permit the proper length visit. Insurers (especially the government) have onerous documentation requirements which increase overhead. We need a better solution. This may be the solution, although we will need to modify our current understanding of health insurance. Maybe we could develop an option which allows for a retainer fee (giving unlimited access - visits, email, phone) but no visit fees. We could decrease overhead by not filing for insurance claims and not having to fill out so many forms. Such a system will require refinements, but I really believe it could work. Of course, some will argue that unlimited visits will encourage abuse of the privilege. We should consider that and start to study the options. A scientific approach to redesigning medical practice should start now. The current system is broken beyond repair.