Many feel American healthcare is a broken system: Patients are forced to wait days or weeks for care, insurance premiums are sky high, and continuity of care is almost impossible to manage between referrals and specialists. Doctors are burnt out by bureaucratic concerns and red tape, and frustrated that they cannot provide the care they think their patients deserve.
As a solution some people are turning to concierge medicine, also known as direct primary care (DPC). DPC practices require a monthly or annual fee (on top of insurance required for hospitalizations or specialty referrals) in exchange for direct physician access. Members are granted perks like same-day appointments, longer and more thorough exams, and round-the-clock access via telephone or email to their medical provider.
For anyone who has spent hours in an impersonal lobby waiting for a 15-minute, harried appointment, this undoubtedly sounds incredible, but there are some drawbacks. Concierge medicine is not cheap, and as such it is not practical for everyone. Here are the pros and cons to opting into direct primary care.
The Pros of Concierge Medicine:
Having direct access to your physician for longer appointment times can make a big difference in the quality of healthcare you receive. Think about it this way: according to a report done by the University of Wisconsin, doctors are required to treat as many patients as possible in 15 minute time frames, regardless of the reason for the appointment. So a healthy 30-year-old seeking treatment for their seasonal allergies gets the same amount of time as a 72-year-old who is on nine medications for chronic and developing health issues. Those with concierge care are able to spend about 35 minutes per visit, and average three more visits per year than the typical patient, according to the report.
With concierge care, not only is it easier to get an appointment, but patients typically have time to discuss all of their concerns. On the flip side, a concierge doctor can devote more time and energy to understanding each patient’s medical history, making it easier to put all the factors together for the all-important bigger picture. (Our bodies are highly intricate machines; not one part functions in an isolated system. When doctors are forced to only consider one symptom or complaint, diagnoses can be missed.)
Research is limited regarding whether concierge medicine provides better health outcomes, due to the newness of the practice. The one reality that has emerged is an overall higher satisfaction rate, for both patients and the doctors involved.
The Potential Cons of Concierge Medicine:
The most glaring issue with concierge medicine is the cost. Doctors are able to bring in more revenue per patient thanks to the monthly or annual membership fees, which is what allows them the freedom to give each patient more time and personal attention. However, not everyone can afford the membership fees, let alone the additional costs that they are likely to accrue.
Concierge membership is not a complete substitute for health insurance. Most DPCs will take care of day-to-day health issues like medication management and routine blood work, but patients still need insurance to see a specialist or if they are hospitalized for any reason. Some practices bill your insurance on top of your monthly fee for reimbursement, and there are often other out-of-pocket costs. An additional challenge is that DPCs are often picky about which insurance carriers they work with and many don’t accept Medicaid or TriCare. In addition, because DPCs are considered outside the scope of state insurance regulations, patients have reduced consumer protection should something go awry.
Concierge medicine also raises a social concern. If this becomes standard practice, it could draw all the “good” doctors away from those who can’t afford to pay for membership. The argument is similar to the one around School Choice — if you let the affluent design the systems, those without will suffer.
The Bottom Line:
If you have the money, paying to have access to concierge medicine could be an obvious choice. Additionally, those who have a chronic medical condition that requires frequent primary care doctor visits, or who have a high-deductible health plan, could benefit from signing up with a DPC, as the monthly fee would end up being cost-effective in the long run. The only way to really know is to do a thorough assessment of your budget and retirement financial plans to see if concierge medicine would be right for you.