Concierge Medicine Today (CMT) posted an article announcing the opening of a hybrid concierge medicine practice in Texas. Dr. Connie Casad is the first gynecologist in the nation to provide the hybrid concierge model for enhanced gynecologic procedures. She too is convinced in the merits of our emerging business model, saying, “Like a lot of my patients, I struggled with issues related to my health and well-being as I aged. I felt like the current healthcare model didn’t provide a system that could provide patients with what they wanted and needed. I conducted considerable research and I believe that the concierge model gives the best option possible for my patients who want to take charge of their health and who are interested in prevention and wellness.”
According to the CMT article, patients can pay a modest fee, about the same amount as a daily latte from a local coffee shop. Then these “concierge” patients get comprehensive preventative care, priority scheduling, experience a shorter wait time, and get “direct” access to Dr. Casad via phone and email, as well as other benefits. We are holding true to our opinion that this is a dangerous line to toe. For the patients who are opting for the insurance-free model, that’s an absolute win. But Dr. Casad is admitting to giving priority to people paying an additional subscription. If every one of her patients had unlimited disposable income, it would be likely that they would all choose the superior method. However, not every one can afford it, creating an environment of have and have-nots. Besides this, she’s still tangled in the insurance headache, willingly, meaning that her time is not entirely free to spend with her patients, which is to both parties’ detriment.
We want to be forthcoming and say we love where Dr. Casad is headed. And we see the inherent flaw, which is that not everyone can afford the subscription, which puts some of her patients skating by on employer provided insurance on the rocks. This is a delicate issue and tough to rectify. One thing we can agree on though is that more doctors in the field who are practicing concierge medicine WOULD be beneficial. In fact, the competition could lower the market price, and lead to healthcare that working middleclass families could reasonably afford.
Here’s a related fact worth highlighting: CMT says that the OB/GYN concierge medicine specialty is likely to succeed. It turns out many American women are receiving primary care from a gynecologist. They opt for with route because they’ve figured out that many tests actually overlap. OBGYNs have a reputation for being thorough, and it’s suggested that women find this valuable. In another article by CMT, Dr. Ira Mickelson of a Detroit, MI practice says “the majority of his patients use him as their primary care doctor,” adding that “if we’re going to be good physicians we need to be aware of that and take care of all of their needs.” Dr. Mickelson suggests that because the trend is pushing toward women using OB/GYNs for primary care, some med schools are putting emphasis on this new, expanded role. This is interesting, assuming there’s some solid evidence to prove it. If true, then the next goal for us should be to get concierge medicine in front of students as a viable way to practice. There’s only one way to overcome the reality of patient influx post-Obamacare. Education needs to become a priority or the doctors on hand might not be able to see all the patients demanding care. Ironically, we could end up in the same theoretical fiasco we’re in now, with doctors scrambling to keep up with the overwhelming demands of their job.
Scott MacStravic, PhD, published a paper regarding secondary concierge specialties. He said that the initial concierge practices were all in primary care specialties like family practice, internal medicine, and pediatrics. Now secondary specialties are emerging, 45+ by his count, including ‘addiction medicine,’ cardiology, dermatology, general surgery, gynecology, and oncology. He adds, “These specialty practices usually offer the same immediate access, longer appointments, and a proactive health focus as primary care concierge practices. Some also offer home visits. Specialists usually limit their practices to a smaller number of patients–150-300 compared to the more typical 500-600 patients for primary–and they more often deal with patients who already have a chronic condition to be treated.” This reads exactly as we’d expect. Though the question remains, is Dr. Casad offering an exemplary model of concierge medicine if she’s seeing the same amount of patients as before? And what happens if all her patients opt into concierge medicine? Intuitively it seems like it might not work, that she’d be spread too thin offering quality care, additional access via phone and email. But the reality is that if all her patients paid cash, she’d never spend another minute dealing with ruthless insurance third-party billers. That time would then be put to better use, like treating her actual patients.
We’re curious what you think: Can a doctor like Dr. Casad successfully transition their full roster to concierge medicine, and offer better care? You know that we believe in it. And if a doctor’s transition to the model causes concern over “left-behind” patients, why not direct energy towards educating more doctors. That’s a solution that seems to be left off the table in most of our dialogues.