The nation's physician leaders, legislators, and healthcare advocates are wringing their hands over a spate of articles highlighting the ever-decreasing number of primary care physicians (PCP).
It's an issue worthy of concern. According to a recent article in JAMA, "the United States faces a shortage of primary care physicians that could exceed 40,000 by 2025." Many areas of the country already face a severe shortage of PCPs.
It is commendable that the nation's healthcare leaders are aware and concerned about the problem, but it is time to do more than just talk about what can be done. It's time for an honest dialogue about realistic and viable options. While many solutions are being discussed, most agree that what we need is a system that promotes quality care while creating a realistic option for physicians and providing affordable and accessible choices for healthcare consumers.
As with any complex problem, there is no one answer and no single solution that will address all of the challenges related to the current primary care physician shortage. However, many physicians now believe that a small but growing practice model—hybrid concierge—should be added to the discussion.
Hybrid concierge models give patients the choice of the model within a practice—concierge or traditional insurance coverage—that best meets their needs. In addition, it gives physicians the opportunity to practice medicine the way they were taught and to be fairly compensated for their commitment and service to patients.
Options for Physicians and Patients
While the concept of concierge medicine holds much promise, the current model, also known as boutique or retainer medicine, has gained its share of detractors. Primarily they that claim it:
- Costs too much for the "average" healthcare consumer
- Creates multiple tiers of care
- Exacerbates the shortage of primary care physicians
However, a hybrid practice directly addresses all these points and more. For example, in terms of cost, the average price of a hybrid option within a primary practice is $100-$150 per month for a patient. While the price will not fit all budgets, it will fit many, particularly those who value a more personal relationship with their physician.
In addition, the hybrid model includes a Comprehensive Wellness Exam. This evaluation and a series of screening tests are the cornerstone of a preventive program designed to achieve long-term health goals. Combined with other services, the actual yearly cost of a hybrid practice option is less than what most patients would pay for a standard executive physical.
As to the argument of a multi-tiered system, the majority of medicine practiced today is already multi-tiered. Patients have many healthcare needs, as well as many personal preferences. As Americans, we don't want anything single-sized; we want choices. The hybrid model provides a reasonable, accessible product that allows the consumer to select the option that makes the best sense for him or her.
However, the aspect of the hybrid model that most intrigues physicians and consumer advocates is that it enables physicians to continue to see their traditionally insured patients and to remain in government and private plans.
Under a full concierge practice, many physicians simply stop seeing patients that don't opt to join and pay the monthly fee, leaving patients to find new healthcare providers (and causing some insurers to drop those providers). In addition, they often are dismissed from plans or elect to leave government plans like Medicare.
Under the hybrid model, physicians do not have to "fire" their patients. In fact, the additional economic support enables physicians to remain in plans that they otherwise might have to leave. Physicians can move to a hybrid model when as few as 5% of their patients opt to participate.
This level allows physicians to have a more meaningful office visit with their concierge patients. In medical school, physicians learn that 80-90% of a patient's diagnosis is tied to family and social history. Yet with an average office visit of 7.5 minutes, it's difficult, if not impossible, to fully gather all of this important information.
Because physicians can see fewer patients in a day and have more time for office visits with all scheduled patients, concierge models allow physicians to return to the way they were taught to practice medicine. They can take the time to thoroughly discuss family and personal histories. There is more time to be an advisor and advocate and to help insure a complete understanding of the medical, physical, and perhaps emotional situation that a patient is dealing with.
In short, it enables an element of advocacy and education as the ability to focus on preventive measures and plans for long-term health. No matter how dedicated or committed, those are simply services most primary care physicians can no longer provide during the average routine office visit of today.
Rewarded for Excellence
In fact, it is the opportunity to get to know patients and provide more meaningful counsel and care that has many physicians so invigorated by a concierge option. Indeed, physicians that now practice a hybrid model frequently comment that they had forgotten how much they missed talking with patients and that they are much better physicians when they have the appropriate amount of time to spend with each patient.
Physicians also appreciate the fact that with a hybrid model, not only can they continue to see patients, but the compensation mechanism of a concierge model allows them to be rewarded for excellence. Quality physicians, who are committed to providing outstanding personalized care, will see their practices thrive. Those that provide sub-par service will be unable to keep and attract the patients necessary to offer a viable practice.
In essence, that is with the hybrid model is about: a combination of socially responsible medicine and a private pay system that rewards excellence and strong patient relationships.
Let the Debate Continue
The debate on both how to "fix" the nation's current healthcare system and how to attract and retain primary care physicians is far from over. As discussions continue, we need to focus on the solutions that are viable, possible, and preferable. We would all like to have the prototypical Norman Rockwell style of medicine. However, realistically no one—not government, business nor individuals—is prepared to increase payment to a level that will achieve this level of care.
The hybrid concierge model represents a viable solution—one worthy of discussion in an honest debate. It accomplishes the following:
- Introduces a private source of revenue that can help to supplement a physician's practice
- Gives patients real choices in the type of care they receive
- Enables physicians the opportunity to practice
- Strengthens the physician/patient bond
This model provides the value that both patients and physicians want. It is one that can help to attract quality and caring physicians to the practice of primary care.
Is the hybrid model the only answer? Will it solve all the problems facing the primary care system today? No. But a growing number of players in the system believe that in order to maintain a healthcare model where physicians and patients are at the center of the care paradigm, the hybrid option must be included in the discussion of solutions.
Wayne Lipton is a managing partner with Concierge Choice Physicians, a private company developing hybrid model concierge practices for physicians in 11 states—California, Arizona, New York, New Jersey, Nevada, Delaware, Virginia, Massachusetts, Texas, Maryland and Florida. For additional information, contact Lipton at wlipton@choice.md or visit www.choice.md.