The United States has a shortage of physicians. The problem will grow worse over the next few decades as Baby Boomers age and doctors from the Baby Boom generation retire and become patients themselves. A survey conducted by physician recruiter Merritt-Hawkins found the average time to see a family physician was three weeks in 2022. The actual waiting times vary by region and by specialty.
The wait time for a family medicine appointment in Portland, Oregon was 121 days in 2022, and five months for an OB/GYN slot in Boston. The wait time to see a cardiologist in New York City was 206 days and 241 days for an orthopedic surgery evaluation in San Diego.
There are no easy solutions to ease the physician shortage. If doctors agreed to work 12-hour days, seven days a week that would about double the capacity. Of course that’s not going to happen. Or doctors could cut down the length of each visit from 10-15 minutes to 5-7 minutes. I doubt that would really work well either. But what if you could pay to jump to the head of the line? Or pay extra to make the line much shorter? That is possible, if not controversial. The Kaiser Family Foundation (KFF) Health News wrote about such a case in Massachusetts.
Michele Andrews had been seeing her internist in Northampton, Massachusetts, a small city two hours west of Boston, for about 10 years. She was happy with the care, though she started to notice it was becoming harder to get an appointment.
“You’d call and you’re talking about weeks to a month,” Andrews said.
Then Andrews got a letter in the mail from her doctor:
“We are writing to inform you of an exciting change we will be making in our Internal Medicine Practice,” the letter read. “As of September 1st, 2024, we will be switching to Concierge Membership Practice.”
If Andrews wanted to continue seeing her doctor, she would have to cough up $1,000 a year. Presumable, quicker response times would also come with longer appointments, and concierge care. More from KFF Health News.
Concierge medicine is a business model in which a doctor charges patients a monthly or annual membership fee — even as the patients continue paying insurance premiums, copays, and deductibles. In exchange for the membership fee, doctors limit their number of patients.
Critics say concierge medicine helps only patients who have extra money to spend on health care, while shrinking the supply of more traditional primary care practices in a community. It can particularly affect rural communities already experiencing a shortage of primary care options.
Andrews’ doctor reported that just under half of her patients decided to pay the fee. Her patient roster dropped to 800 patients, down from 1,700. With half the caseload it is much easier to get an appointment and physician visits can last longer.
Concierge medicine is, by definition, an exclusive service. There are a variety of business models. For example, $1,000 a year is only about $85 a month. That is actually rather cheap for concierge medicine. The going rate in my area is double that amount from what I’ve seen, or about $150 a month. The higher the fee, the smaller the patient roster and better the service. At least that’s how it is supposed to work. Concierge medical practices that charge more tend to have more attentive care with same day appointments and even telephone consultations. Although averages tell us little about individual practices, some concierge physicians limit their practices to only 300 patients but charge members thousands of dollars per year. Some concierge physicians bill insurance for the services insurance will reimburse, while others consider complimentary office visits part of the fee. Some concierge physicians charge patients nominal fees for office visits and services. Concierge medical practices vary, with some doctors adopting a hybrid approach. There are also concierge practices specializing in the care of specific conditions like menopause and hormone preplacement.
A distinction should be made between concierge medical practices and a related service known as direct primary care (DPC). Concierge medical practices tend to be high-end custom services, while DPC attempts to be more approachable. I’ve heard DPC described as how physicians want to practice medicine; knowing their patients by name, knowing their patients’ health status and not rushed during appointments.
Whether you call it concierge medicine or direct primary care, in either case you are paying for better access to a physician. These types of practice arrangements will become more common as doctors rebel against the 30-patient per day quota many of their employers demand.
Read more at KFF Health News: In Rural Massachusetts, Patients and Physicians Weigh Trade-Offs of Concierge Medicine
Would expansion or elimination of internship match quotas result in more doctors ultimately starting private practice? Or are the business skills needed for private practice becoming a lost art?
In some years the number of medical school graduates who don’t match exceeds 10,000. Finding a way for those who will never match to train to later practice would help. Expanding residencies, or even creating a program like nurse practitioners use would boost access to care.