Direct Care is Not the End of Empathy

If you’re currently running an insurance-based fee-for-service primary care facility, and planning to switch to direct care, you should read this op/ed from the Wall Street Journal.¬†Jerald Winakur practiced internal and geriatric medicine for 36 years and is a clinical professor of medicine at the University of Texas Health Science Center at San Antonio. His cousin Irene, a 90-year-old woman living in Queens, was recently notified that her internist was joining the concierge medicine ranks.

Winakur’s thoughts are less than enthusiastic about profit-focused decision making. But, they actually don’t contradict our own belief in Atlas MD-style of direct care. Why is that? Because concierge medicine is not the same as direct care. According to Winakur:

“What Irene learned was that her internist was converting her fee-for-service office into a ‘concierge practice.’ For a yearly retainer of $2,200 (in addition to the usual charges that would still be billed through Medicare and supplemental insurance), Irene would receive “value-added” services. These include same-day appointments, electronic access to her medical records and lab reports, shortened waiting times, and other ‘frills’ that Irene said her doctor always provided anyway.”

This type of “hybrid” practice led Winakur to question whether docs still had empathy in this day and age. He says he would never have abandoned a patient just to make more money. We agree with him there. We wouldn’t recommend any doctor do the same. The goal of transitioning to direct care is to make the services MORE AFFORDABLE but CUTTING THE RED TAPE. Something we’re concerned with is doctors marking up the cost of their “attention,” i.e. wealthier patients can see them more often, while poorer patients have to get in the back of the line, or get off the bus entirely.

We should clarify that profit-focus can lead to better outcomes, but only when coupled with certain value: that enabling care matters more than enabling profitable transactions.