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.