Because of the frustration of coordination and big picture problems. Esp in older folks, when problems arise that may be attributed to a number of different body systems, they can’t get anyone to coordinate their care. Or in the case of someone having a problem getting a diagnosis, there is no one looking at the big picture. They get daisy-chained from specialist to specialist and no one looks at all the records and results to come to one conclusion or one approach to care.

As I understand it, an insurance-paid practitioner won’t do so because there is no reimbursement code for it. So then — that leaves the patient to his own devices, and the retainer doc fills that void.

The search for quality of care results in quantity — draining the system and moving no one forward.

Trisha Torrey
EveryPatientsAdvocate.com
About.com’s Guide to Patient Empowerment
http://patients.about.com

My understanding is medicine in the US makes up 16% of GDP or $2 trillion dollars. The next closest country, which has universal care, medicine makes up 12% of GDP.

Under a retainer system the doctor will still bill insurance, but the fees paid by patients give them a base income, allowing more time and mitigates other financial relationships.

Under a fee for service arrangement you just pay the bill. The medical provider will give you a receipt with services rendered and it is up to you to collect from any insurance you have available.

Under both of these systems the financial driver becomes the patient. With fewer patients the retainer doctor needs less staff, billing insurance becomes a secondary office function, and the focus can be on saving money, not moving patients to the next provider.

Steve Lucas

I reject the public service argument against retainer practices because of the way in which physicians are educated and trained in this country. Young people devote their best years of young adulthood to pursuing a medical educations; they work long hours (really, even 80 hours a week is pretty long!!); and go into tremendous debt to earn the priveledge to join the medical profession. I believe all AMERICANS should be good citizens and human beings and help the less-advantaged in our country; I don’t see that a doctor has an additional duty under the present system. Sure, doctors should be professional, competent, and compassionate, and when they breach professional norms of behavior and competence they should NOT be allowed to practice medicine.

1) Excellent medicine- although the evidence is scant and speculative, I’m pretty sure that retainer medicine will improve patient-physician interaction and both physician and patient satisfaction. Whether it will improve quality of medicine is a completely different question, but I am willing to concede that for those patients in a retainer practice, that is probably true. I also think that if physicians want to practice retainer medicine, let them.

But what I wanted to really comment on is db’s argument that his “support of the retainer model stems from [his] desire to see patients receive the best possible care” (For one thing, best possible care does not mean excellent care). I don’t doubt his desire. But Db argues that time is an issue. There is nothing stopping physicians from seeing less patients a day under the current model– there’s a pay cut if the physican does so, but he or she won’t be impoverished. It seems more likely that retainer medicine is driven is some part by economic incentive and satisfaction for the physician (there’s nothing wrong with that).

2) The speculation that retainer medicine will change internal medicine. I also don’t doubt that there will be a small portion of retainer practices, but I strongly doubt that it will change internal medicine unless physician and patients influence third party payers for the simple reason that not everyone can afford to have “excellent medical care”. Do you really think that the proportion of patients will pay out of pocket for medical care will be substantial enough to transform internal medicine? American have often thought of medical care as a right (or at least an entitlement), and this will not change because of a few scattered retainer practices. I’ve no doubt retainer practices will grow. I have no problem treating medical care as a privilege to pay for, just the idea that retainer medicine will impact the health care industry enough.

3)db’s continued rejection of public health is odd. How can someone who cares about the welfare of physicians (by his support of retainer medicine) and care about his patients (or at least the patients of those retainer practices) disregard the impact on patients of other physicians. The argument that retainer medicine will provide patients with better care with retainer medicine but then not care about the health of patients (who form the public) doesn’t make sense. It is exactly this disregard of externalities or political concerns that put us here (physicians lack of political activity and not sitting at the table when third payers stepped into the picture). In case you haven’t realized, health care form a large part of the GDP, and we’d be stupid to forget politics.