Comments on: Retainer medicine spreads

By: Laura

Laura — Wed, 24 Sep 2003 18:30:59 +0000

My generation is “BI” (Before Insurance) and we never had a problem. The Insurance industry inserted itself into the medical marketplace based on the greed in us all. “Just pay us a fee and we will cover all your costs”. The old “something for nothing” inticement. Then the monster took over, sucked the life out of medicine and made every man an insurance addict. This is the beginning of the end of the Insurance MONSTER! And they KNOW it! Look for them to pull out all the stops – legal and otherwise – to keep us maintain this system!

By: Dr. Lorne Stitsky

Dr. Lorne Stitsky — Thu, 28 Aug 2003 01:37:03 +0000

In July of 2003, I started my own “boutique style” practice. I charge $1500 per patient, offer house calls and business calls, 24/7 avail, and I love medicine again. I am not taking HMO’s, only PPO’s and could not be happier with my decision. I offer this plan to patient’s with or without health insurance. Those without health insurance obtain catastrophic coverage and use my office for their health needs. I use to see 30-40 patient’s per day and started to question why I chose to be a family doctor. I didn’t get to know any of my patients or their family in 10 minute visits. I now spend 30-60 minutes with each patient and look forward to my future in medicine. If some people feel it is unethical to do this, talk to my patients.
It’s nice to love medicine again and feel like the family doctor I always wanted to be.

By: Kathleen Carlton

Kathleen Carlton — Sun, 17 Aug 2003 20:06:41 +0000

I hope physicians in my area start this concept. I am tired of the “doc in the box” type of medicine. If a doctor wants to give quality medicine and still be able to afford to pay his malpratice, go for it!!
Old fasion quality, one on one, home visits and being able to actually speak with my doctor on the phone. Oh call me crazy, I guess I will just have to pay my insurance company less and give myself better care.OOH could that be why there is such an uproar?
Think about it.

By: Bard Parker

Bard Parker — Sat, 02 Aug 2003 20:54:08 +0000

May I assume Dr.Lacsamana that you are no longer “doing” internal medicine? I haven’t posted on retainer medicine because it really can’t be applied to a surgical practice. But in speaking with my primary care friends they have had to turn their practice into a “mass production plant” because that is the only way to insure solvency of their practice, given how reimbursement has fallen. They would love to spend about a half-hour with each patient (given 20 patients over an eight hour day). But in a practice with ANY substantial percentage of medicare/medciaid it just can’t be done. I doubt an appeal to my patients if I could pay my liability insurance would be met like George Bailey’s need was met in “A Wonderful Life” .

By: CHenry

CHenry — Tue, 29 Jul 2003 01:18:35 +0000

The truth is, retainer medicine is about the money. It is about collecting the full charge at the time you deliver the service, or beforehand, in some cases. It is about not allowing a third party, the federal government, a state government, or an insurance entity get the money first, take its cut, and pay you whatever and whenever it feel like, regardless of what your costs might be. It is also about transparency, knowing beforehand that you as a patient will have to pay a fee (and not expect someone else to pay it for you) and for that fee, get a quantity of service that you expect, not a truncated facsimile of a service, necessitited by the predation of some third party.

The truth is that the third party payment system has become enormously costly in and of itself, with tremendous staffing, information, compliance, investment, profit and waste burdens added. There just isn’t enough money to pay for it all and have enough left over to buy the services themselves. Who can blame these doctors for opting out. No doubt they will soon have lots more company.

By: Bernie Simon

Bernie Simon — Tue, 29 Jul 2003 00:34:46 +0000

You don’t realize how strange this all sounds to me. A homeopathic doctor is expected to spend an hour and a half minimum on new patient intake and half an hour on follow up visits. How on earth can you take a new case in half an hour, let alone seven and a half mintues? Does the patient even have time to sit down in the chair before the interview is over?

Is this how it works?

Patient: I get a pain in my back when I stand up.

Doctor: Here’s a prescription for NSAIDs. Schedule another apointment if the pain doesn’t get better.

God help the poor patient!

By: bill reith

bill reith — Mon, 28 Jul 2003 19:30:20 +0000

Retainer medicine *can* be just for the money, and it *can* be to provide better service without losing money or working longer hours. It can even be both. What comes out the other end depends on what’s put into the mix.

By: Lisa Williams

Lisa Williams — Mon, 28 Jul 2003 16:52:40 +0000

It’s horrible, terrible, reprehensible!

Now where do I sign up?

By: R.G. Lacsamana

R.G. Lacsamana — Mon, 28 Jul 2003 13:44:48 +0000

Whatever euphemism you want to employ, boutique or concierge medicine is not going to smell as sweet as a rose.

I have heard or read all the rationalizations for this hybrid medical practice; they simply amount to crass commercialism and abandonment of all the ideals that have made medicine a unique and respected profession. I don’t deny the gradual bastardization of medical care that has taken place over the years, but
this “retainer” medical practice has leapfrogged over what I feel are the outer boundaries of what we expect physicians to do as trusted guardians of their patients.

I disagree with AMA that this is an ethical practice. Any type of practice that discriminates against those who cannot afford the fees is unethical and further perpetuates the perception that those with the financial wherewithal are entitled to a special type of medical care.
To paraphrase the late Winston Churchill, this is a matter up with which we should not put.

Time and money? Come on. This is all about money. Physicians who really care about their patients should have the time to do that, unless we care more about making more money and turn our offices into mass-production plants seeing 40 to 50 a day.
I did general Internal Medicine for 33 years, saw an average of 20 to 25 patients a day, spent enough time with all of them, and still made a decent living. Working earlier and having an efficient support staff in the office made all that possible,
not any worse than the hours we all spent during our residency days.

There is one further observation here: Patents enrolled in these “retainer” practices should not be under the delusion that they are going to receive better care.
Physicians, regardless of how many patients they see daily, should be available all the time to their patients,
and must make accomodations to decide on what to do for them under all circumstances. The extra time offered to concierge patients may be tantalizing, but it does not mean much for patients who put more value in the caring approach and type of care rendered by their personal physicians.

Somebody was mentioning that this was another type of insurance. This is another deception. This type of “insurance” does not take care of hospitalization, drugs, or other expenses unless one has traditional health insurance. That should be made clear to enrollees up front.

Although I have been a long-standing member of AMA, I do not support its stand on this issue and feel that the bill offered by Senator Bill Nelson of Florida to ban participating concierge physicians from collecting fees from Medicare is the right thing to do.

“Retainer” medicine is not about giving better care to the public; it is about changing the lifestyles of a tiny minority of physicians.