Thank you for the front-page article about concierge medicine ("For a little more, the doctor will see you now," Oct. 26).
As a family physician who has practiced for 22 years in Maryland, I find the current state of affairs in primary care heartbreaking.
Reimbursement rates for physicians are down, red tape is up and there is plenty of dissatisfaction all around.
I have seen my income drop by almost half. However, I still love being a family doctor.
I still accept Medicare and Medicaid patients. I occasionally still do house calls. My patients bring me great joy. But I could not be in primary care today if I were still paying off my school loans or raising a family.
Young doctors now seek to go into specialties with better reimbursement rates, and older doctors are looking to retire or move to situations like the concierge medicine practice the article describes.
If we want to have more primary-care doctors, we need to improve reimbursement rates in Maryland.
Doctors' fees are set by the insurance companies, which refuse to negotiate with small private practices like mine. We cannot charge anything extra and still participate in the plans.
In response to the charge that concierge medicine is immoral, I contend that physicians are just looking for ways to keep their doors open.
I do not want to become a concierge doctor and lose my low-income patients. But I do need some relief.
Maryland is running out of time.
Dr. Linda A. Walsh, Jarrettsville
I am one of the thousands of Howard County residents impacted by Charter Internal Medicine's move to a "boutique" practice, and I am not happy about it.
I prefer to pay as I go.
Boutique medicine is, by its very nature, unfair and divisive, and it will weaken the relationship between primary-care providers and the community at large.
Hal Holzman, Columbia
I am a physician who cares for geriatric patients in Catonsville, and I was pleased to read the article about the growth of boutique medicine practices.
I see several new patients a week who cannot afford their newly converted boutique doctors, and I always tell them the same thing: I don't blame their doctors at all.
As internists, we are among the lowest-paid doctors (making one-third the salary of many specialists) and are asked to provide comprehensive personal care to all of our patients about a broad range of medical and psychological issues in shrinking bits of time.
Between phone calls and paperwork, finding time for patient care and other reimbursable services becomes more difficult. This, combined with cuts in Medicare reimbursement rates for primary-care doctors, pushes more and more physicians to the boutique track.
The solution is simple: Medicare needs to increase primary-care reimbursements while reducing reimbursements for high-paid specialty services, and medical schools need to provide tuition assistance for students who pursue primary care.
But unless such simple steps are taken, few medical students will become internists and existing internists will flock to boutique practices and leave most patients struggling to find a good doctor.
Who can blame the doctors?
Dr. Andy Lazris, Ellicott City
Regarding the boutique physician service noted in Sunday's Baltimore Sun, this appears to me to be just financial snobbery.
I recall an old country song title that very succinctly sums up the theme of this article: "If You've Got the Money, Honey, I've Got the Time."
Ruth Fried, Owings Mills