retired Doc clued me in to this article – Health Matters.

Today, Dr. Knope handles all the routine medical care for Mr. Haralson and his wife, Betty, and tracks the couple’s general health and fitness. Together, they pay him $10,000 a year, and think it’s money well spent. "All you need is one crisis and a good outcome and you know it’s worthwhile," says Mr. Haralson, age 71, who exercises regularly, still practices law and still eats chocolate cake.

The kind of "concierge medicine" that Dr. Knope practices is gaining popularity across the U.S., particularly among older Americans with complex medical needs. The concept started in Seattle in 1996 with mostly wealthy patients and has since spread to people of more modest means. Annual fees range from $500 to $15,000. Doctors limit the number of patients they see and give them highly personalized attention, including detailed annual physicals, preventive care, same-day appointments and a promise to return their calls quickly, 24/7.

Although there is no precise count, Thomas W. LaGrelius, a Torrance, Calif., geriatrician and president of the Society for Innovative Medical Practice Design, a professional society for concierge physicians, estimates that as many as 5,000 doctors and one million patients are involved in concierge care.

Many physicians and others have attacked this solution on ethical grounds.  They argue that retainer physicians should be seeing larger volumes of patients.  They make the assumption that volume trumps quality.

Retainer medicine has grown steadily over the 7 year life of this blog.  It continues to grow because some patients willingly pay for quality – using the broader understanding of quality which includes increased physician patient interaction.  Many patients want to pay for time and access.  These practices allow that, and otherwise patients cannot pay to have physician access.

Regular readers know that I believe time is essential to good medical care.  Consider this quote

Scheduling only one or two patients an hour also gives doctors time to discuss personal issues like sleep problems and stress. "Very often a patient’s…chronic headaches [are] related to a daughter’s divorce or a son-in-law’s bankruptcy," says Bernard Kaminetsky, medical director of MDVIP. "If you don’t have time to talk, you don’t find that out."

Those who want to promote better primary care would do well to study the successes of this model.  While seemingly expensive, perhaps having an excellent internist devote adequate time saves money downstream.  That hypothesis is not outrageous. 

Related posts:

1. Retainer medicine – from 7 years ago
2. I disagree with @DrVal – retainer medicine is the answer
3. In which I continue my debate with Dr Val
4. A provocative response on retainer medicine
5. Are retainer practices the model for PCMH?

Related posts brought to you by Yet Another Related Posts Plugin.