Doctor’s Disorders

Among the cheery updates we received from friends and acquaintances during this holiday was an unexpected one from our primary care physician. It announced that he was affiliating with a nationwide group known as MDVIP.

If you haven’t heard of this company – and I hope you never do – it represents a trend known as “concierge medicine.” As the United States moves toward a country of haves and have-nots, this is one of the most insidious milestones.

Here’s how it works: our primary care physician is now limiting his practice to 600 patients, each of whom will contribute a flat fee for the privilege of being in that group. I haven’t heard my doctor’s fee, but from researching online and talking to others, it’s anywhere from $1,000 to $2,000 per year per person. For that fee, you are promised high levels of access, quick turnaround on requests, and, according to what I’ve read, fruit and snacks in the waiting room.

I always joked that if you’re going to choose a primary-care physician, make sure it’s one that has kids heading off to college. That way, you know he or she will always be around. I never figured on this kind of development.

Let’s get to the disclosure here. As long-time readers know, I’m married to a primary-care physician. Since she graduated from medical school, she’s been in large medical groups, small medical groups, private practice, and now – I’m proud to say – works at a local Department of Veterans Affairs clinic. She administers to those brave men and women who’ve served our country, and (except for dealing with the federal bureaucracy) loves it.

She also loves the fact that she no longer has to manage her own business, which is essentially what private practice is. Between what she referred to as “mangled health care” and Medicare reimbursements, it was difficult to make an adequate living. She once calculated that she would have had to charge $400 per hour to cover her costs and make a minimal profit.

Before you start railing about how much doctors are paid, think about whether you’re talking about specialists or primary-care physicians. There’s a big difference in compensation. That’s why doctors like ours are being seduced by companies like MDVIP.

Are we going to be part of the 600? Hell, no. If the flat fee gave us access to a network of physicians, as medical insurance does, I might consider it. But it’s only for our primary care physician. We would still have to maintain medical insurance for other specialists and hospital care. And as I understand MDVIP’s regulations, I’m not signing up with my doctor – I’m signing up with MDVIP. That means that if my doctor doesn’t get 600 of his patients to pony up, I can be reassigned to the doctor of their choice.

The annual fee is ridiculous anyway for people as healthy as we are. I see my doctor once a year. When we got the notice from our doctor, I was relieved that I’d just gotten my annual physical. I thought I had at least another year to find a new doctor. Then I ran out of Advair and it hit me – I do need to find another doctor if I want to keep my prescriptions refilled.

Clearly we have it easier than most people. We have a pretty good PPO for health insurance, and my wife already knows all the good doctors. We’ll be taken care of. We’re even okay with pay-for-play, as some doctors are beginning to request (you pay them their fee, and you deal with getting the reimbursement from your insurance company).

But as if getting medical care wasn’t hard enough already – the spread of companies like MDVIP are like a disease rather than a vaccine. This concierge business is going to reduce the number of available primary-care physicians at a time when the system needs more of them, not fewer. Already, my wife wonders why anyone would want to be a primary-care physician. You come out of medical school with staggering tuition debt, and it’s almost impossible to make a decent living.

By the time it becomes impossible to find a primary-care physician, I hope I’m dead.


About middleagecranky

The Middle-Age Cranky blog is written by baby boomer Howard Baldwin, who finds the world, while occasionally wondrous, increasingly aggravating.
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8 Responses to Doctor’s Disorders

  1. Die Tante says:

    Argh, and Happy New Year to you too. I just went through all the decisions I had to make (before Dec. 31st) whom to choose: Kaiser, AARP, or whatever (I just pay and pay [I’m considered a senior now!] and now YOUR REVELATION)!
    You once told us some time ago at a family-traditional gathering: OK, before we begin and have turkey, let’s get all the politics, religion, and all the pains and our illnesses’ topics out of the way and have a good day. Good advice!
    Anyway, I have some story about pill-pusher doctors charging me/Medicare from $160 or, after learning my lesson, to $75.- per office visit to just write a darn prescription. Next time we see each other.

  2. larry marion says:

    same thing happened to me and my wife several years ago. While we both agreed our doctor was great, i didn’t think the $$$ deal made sense. but my wife didn’t want to find another doctor, so she paid the $1,500.
    and got lots of attention, extra tests for every single issue/symptom, etc. Two years later, though, she’s begun to question the ROI of the MDVIP deal as well. the extra attention and tests weren’t worth it. also, he wasn’t there all the times she needed him, and another doc was not as helpful.
    Overall , MDVIP is great for docs, not sure it’s great for most patients. and it’s terrible for society, as you point out.

  3. David Flack says:

    Google returns 551 hits for “MDVIP Scam”. We have used Kaiser for the last 15 years and Patty and I love it. Hope you find a good GP.

  4. Jerry says:

    FWIW- Why haven’t you considered the Palo Alto Medical Foundation; we have been going there for the the past 25 years. They’ve got great Primary care as well as specialties, and they handle all the garbage with insurance companies they accept. Happy New Year. Jerry

  5. GingerR says:

    I think a lot depends on how much you go to the doctor.

    If I had an ongoing problem that required frequent visits and monitoring plus lifestyle coaching — then it might be worth it. You’d know that your doctor was spending the TIME he/she needed to spend to adjust your medications and watch the variety of other things that need watching. Hopefully they wouldn’t refer you off to a specialist so quickly and would be able to balance multiple medications in a more intelligent way.

  6. dra says:

    Hey Cranky,

    For 10 years I enjoyed practicing in an old fashioned 2 doc practice. We returned calls, had a person answer the phone and spent 90 minutes with patients for their physical exams; always interviewing them in my office before going to an exam room. Other MDs were typically seeing 25-35 patients a day, while I saw 15. Why? I was taught that 90% of diagnosis can be made by listening and I work on prevention. The only problem is that I could no longer support my family.
    I started my own annual fee practice and I believe that my time and attention, I’m on call 24/7 via cell or e-mail, is worth $130. a month. With 33% of our population expected to become diabetic due to obesity it could be a cost savings. I sponsor 15-20% of patients in my practice; mostly patients with special needs, on medicaid or complex, time intensive cases. Most concierge docs make a reasonable salary and give back.
    So you are always healthy? Then why the advair? and why so cranky? 🙂 be well.

    • Thanks for your thoughts, doc. I’m glad it’s working out for you.

      I’d be happy to pay my internist for his time, so he can make a living, but not $130/month on the off chance I might need him.

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