Wellness

[esmerelda]

@pitdakotaDoctors who "have turned their practices over to either hospital based groups or some other enterprise specializing in managing physician practices" are no longer "private practice."  By private practice I mean those who work for themselves and are not dictated to by a hospital-based or any other group.

[esmerelda]

---

@reiki604 wrote:

---

@esmerelda wrote:

Insurance companies dictate how much time is spent with a patient?  Are you sure?  

It may be true that some doctors limit their time and that may be because they are part of a multi-physician practice and are required to see a certain number of patients each day/week/month/quarter to generate a certain amount of revenue for the practice.  Like a lawyer and "billable" hours for a law firm.

Doctors in private practice...I don't think they have that limitation.

These doctors going "concierge"...are they with other doctors or do they practice alone? 

eta...I think this concierge "trend" started after the passage of the ACA.  Coincidence?

---

According to a quick google search and wikipedia, it seems that concierge medicine has been en vogue since before 2004. Way before the now gutted ACA.  Of course more physcians are going that way as insurance reimbursement decreases. The fear is that we are heading to a tiered health care system where those who can afford to privately pay will get better care than those with insurance. 

---

@reiki604Guess I was wrong about the timing.  I hadn't heard about it until the ACA.

If those who can afford to privately pay get better care than those with insurance, that's squarely on the doctor, ins't it?  Hopefully people become doctors to help people, not to become wealthy.

And let's please not go to education expenses.  They don't choose the field blindly.

[granddi]

I'm sorry if my posts seem unsympathic to issues of doctors student debts, insurance paper work, general working conditions and all the other stuff. 

I think we can all agree that something is very wrong that we have the smartest-best doctors in the world and a really scr*wed up medical delivery system.

I am sympathic that we have smart-dedicated public school teachers that have to accept low wages, poor insurance, run down classrooms, lack of classroom supplies and over crowded classes.

I am sympathic that we have dedicated military persons and first responders who have very dangerous jobs. These men and women have low pay for important jobs.

Regarding student loans for physicians: there are programs for loan forgiveness if the doc agrees to work in an underseved area of the country for a period of time. Many rural hospitals have such programs. 

[esmerelda]

@granddiAt least you are sympathetic re teachers and schools.  I am not.

[Nuttmeg]

---

@Trinity11 wrote:

Speaking of concierge medicine. We received from Cigna something called MDLIVE. Register and have access to a board certified primary care doctor and pediatricians on line. I may just try it....it is apparently included in our insurance. You can text, go online or call MDLIVE.

---

The BCBS plan where I worked had this  type of  service for active employees or retired not on Medicare. 

[Nuttmeg]

---

@Abrowneyegirl wrote:
Reading the responses here has shown that there is a lot of depth to this topic.
It is not just private concierge practices cropping up (which seem to be more white glove service based)
But
Self pay practices are also making a big entrance into the field of medicine. Doctors can offer traditional care and simply opt out of insurance, charge what they want and let the patients deal with fighting with insurance companies. Instead of the doctors eating the short-term the patients will pay.

A health care provider told me, only the better, highly competent doctors will move to these new models. The less than average will stay part of the insurance industry mill. They get paid regardless of quality of care in that model.

---

I disagree with your last Paragraph. I saw my kidney doctor today. She is a smart woman who thinks on her feet. She is in a group practice and just gets $75. She deserves more.  

[esmerelda]

---

@Nuttmeg wrote:

---

@Abrowneyegirl wrote:
Reading the responses here has shown that there is a lot of depth to this topic.
It is not just private concierge practices cropping up (which seem to be more white glove service based)
But
Self pay practices are also making a big entrance into the field of medicine. Doctors can offer traditional care and simply opt out of insurance, charge what they want and let the patients deal with fighting with insurance companies. Instead of the doctors eating the short-term the patients will pay.

A health care provider told me, only the better, highly competent doctors will move to these new models. The less than average will stay part of the insurance industry mill. They get paid regardless of quality of care in that model.

---

I disagree with your last Paragraph. I saw my kidney doctor today. She is a smart woman who thinks on her feet. She is in a group practice and just gets $75. She deserves more.  

---

@Nuttmeg So you’re sending her a check?

[sfnative]

@Abrowneyegirl 

@Drythe

In 2009, we received a letter announcing that our brilliant Internist had made the decision to convert his practice to a Concierge practice.  He went on to explain what that meant, why he had felt the need to do so and welcomed all of his patients to attend one of three meetings scheduled, so that we could all listen to his presentation and that of a facilitation company with which he had contracted, ask questions and be offered the chance to sign up.  He further indicated that he was going to keep his practice limited to X number of patients.

We both attended.  The meeting we chose was standing room only.  After the presentation, I signed up.  Why?  Because this Internist was not only intelligent, brilliant, but also kind.  He listened.  And, I was a medically complex patient.  (Many physicians want nothing to do with me; or, they'll pick and choose what they will treat.)  Physicians with those qualities are extremely rare.

My husband chose not to sign up and went for nearly 2 years without a physician.

Unfortunately, as were were all wrapping up our second year with him in his concierge practice, when he passed away quite suddenly, after being diagnosed with a rapidly advancing cancer.  I still miss him.

However, now that I'm retired, I know that I would not be able to afford the concierge yearly fee.  However, unlike what Drythe so blatantly and wrongfully stated, because not ALL concierge practices are the same, my Internist required an annual fee, only.  Period.  His staff billed my BlueX/Blue Shield.  There were no charges heaped one upon the other.  No bogus tests, etc.

I hate it when people make lofty statements or generalize, when, indeed, they don't know what they're talking about.

[Abrowneyegirl]

@sfnative 

Well said.  I am very sorry to hear about the loss of your trusted doctor.

My doctor is the same type of caring professional person as you had.  She moved to a Concierge practice so she could limit the amount of patients she cares for and cares for us well.

Initial and annual visits are HOURS not minutes.  Question or concern call or text the doctor or one of her very competent RNs and have an answer quickly if not immediately.

No surprising her practice filled up immediately and has a wait list.

You are correct many make unfair and unfounded assumptions without first hand knowledge.  

[Jaspersmom]

I did not read through the six pages of posts, so I don't know if this has been mentioned.  The root of the problem is the profit margin of the insurance companies.  Many years ago when they became corporations beholden to shareholders, everything changed.  Check out the profits of the largest insurance providers and you'll understand it's not the doctors' greed, but their need to survive.  It's out of control and unfortunately Congress will not even try to address the problem.  They are either beholden to the insurance companies or are well invested in them and are making a ton of money from those investments.