Many people spend more than $1,500 a year on their hair, on cigarettes, on their pets' veterinary bills - even on their daily Starbucks coffee. Are these kinds of expenses more important than a modest annual fee that guarantees immediate access to an unhurried, focused and attentive physician who has the time and energy to enjoy doing his job well?
Let's first get past the pejorative terms "concierge" and "boutique" as descriptors of this new medical model. It is simply not true that retainer medical practices cater only to the rich and elite. Most patients in my practice are people of modest incomes - small-business employees, retirees and the like. It has been recently argued that doctors like me, who have chosen to decrease their practice sizes and charge an annual retainer fee, constitute a "menace" and are in some way harming our communities. I would counter that patients under the care of overly busy, discouraged and distracted internists seeing 30-plus individuals a day at an average of eight minutes of true face-to-face clinical time are the folks being harmed.
The disturbing fact that only 2 percent of current U.S. medical students plan a career in primary care is not surprising, given the fact that they leave their training with enormous debt, have not been inspired by happy role models in internal medicine and family practice, and watch their peers pursue easier and more lucrative specialties. However, it is simply wishful, uninformed thinking to suggest that the solution to the problem is for Medicare and the private health insurance industry to increase compensation to primary care physicians.
Experts predict that as the American population rapidly ages in the next two decades, Medicare funding will fail drastically to keep pace with the exponential increase in U.S. medical expenses. Private health insurers follow Medicare's lead and reimbursement rates. Struggling with soaring practice expenses, decreasing revenues and huge practice panels, primary care physicians are overwhelmed and demoralized.
I believe that I provide a valuable service to my patients by being immediately accessible and spending the necessary time to practice medicine carefully and thoughtfully. Physicians like me who practice retainer-style medicine do so not to make a lot of money; we do so to save our professional lives from burnout and early retirement.
Finally, if the federal government wants to bail out the crumbling U.S. health care system as zealously as it is saving the financial industry, I have a simple suggestion: Give every adult U.S. citizen a yearly $1,500 tax credit to cover his or her primary care physician's annual retainer fee. Then you'd see medical students flocking to primary care again, and all patients receiving the high-quality medical care they deserve.