Agreeing to disagree has been what most of us, doctor and patient, have done since concierge, or retainer, practices first appeared in the mid-1990s. Developed as an alternative to the constraints of traditional practice, this new model allowed doctors to offer more personalized care that in turn increased patient and professional satisfaction. By decreasing the total number of patients seen in an office from well over 2,000 to as few as 500, doctors could offer longer visits, increased and immediate accessibility, personalized coordination of hospital care and, in some cases, even house calls and accompanied visits to specialists. In return for these services, patients would pay retainer fees, ranging from just under $2,000 to as much as $15,000 per year.
By 2003, according to a national survey, the number of doctors practicing concierge medicine numbered fewer than 200. And while critics raised ethical concerns about the “abandonment” of patients left without primary care physicians while their doctors downsized and the creation of a “two-tiered” system that exacerbated disparities in health care access, little was done to address those concerns. These boutique practices were a relatively rare curiosity, and practitioners were left alone.
But over the years and particularly in recent months, the debate about the ethics of concierge doctoring has grown more heated, with more and more physicians unabashedly lining up to take sides. An editorial in the Annals of Internal Medicine this spring, for example, questioned not only the ethics but also the quality of care delivered in such practices. The writer went on to urge other physicians to abandon “the neutrality with which the medical community has addressed” this issue thus far.