What is Concierge Medicine
Part 1 – Background – The Problems with Insurance-based Primary Care
The Problem with Standard Medicine
Have you ever worried that you can’t trust your doctor to give you the best advice, and help you make the best health decisions possible?
What if you never lost another wink of sleep over that? What if you could rest easy, knowing that you and your family were getting the full attention of your doctor’s expertise? Knowing that your doctor, unlike most, isn’t too busy to keep up with the latest medical articles, and to apply those to your health.
Let’s face it, the medical system isn’t working. Patients get an average of 23 seconds to speak before their doctor interrupts, and the average office visit lasts about 11 minutes. The New York Times suggests you have about a minute to talk. The average primary care doctor tries to take care of 2500–3000 people, and tries to see 20–30 of them every day.
There’s a reason for this insanity, and there’s a fix.
Who Does Your Doctor Work For?
From a doctor’spoint of view, the situation of standard medicine is pretty bad — burnout rates among internal medicine physicians are now 50%. Physician suicide rates are skyrocketing.
You’ve come to accept having a burned-out, inattentive, rushed, out-of-touch and out-of-date doctor
Doctors originally decided to go to medical school and specialty training in order to really help people, and they find that in reality, they don’t have time to do anything more than place band-aid after band-aid. Medicine is now being called The Most Miserable Profession.
But for you, it’s even worse. You see the annoyance of impossible paperwork, and wasting an entire morning waiting for a doctor’s appointment that was supposed to start 2 hours ago.See, the dirty secret of medicine is that your doctor isn’t really working for you. He’s a subcontractor for your insurance company.
But you don’t see the misdiagnoses (the rate is about 1 in 20), the “shoot-from-the-hip” thinking that has replaced careful consideration and research. You might not even know what good medicine is supposed to look like, because you’ve probably never seen it. You’ve come to accept having a burned-out, inattentive, rushed, out-of-touch and out-of-date doctor is “just the way it is”. Basic politeness is gone, let alone attentive modern communication, thoughtful diagnosis, or researched advice.
Just like you, your doctor realizes the problems of the system he’s in. He knows it’s wrong. And if you can get an honest opinion, he knows he’s not doing the best he can for you – he knows he could do better. If it weren’t for insurance.
See, the dirty secret of medicine is that your doctor isn’t really working for you. He’s a subcontractor for your insurance company, or your employer. As the southern saying goes, “yer workin’ fer whoever pays ya.”
How Insurance Took Over Medicine
Health insurance only became common in the 1940’s and 50’s.
Back then, the patient would see a doctor, pay, and then get reimbursed by the insurance company. The doctor had nothing to do with it. After a while, to compete with other doctors, some doctors started offering to submit the insurance claim on the patient’s behalf, so the patient wouldn’t have to pay up front.
Then, in the late 1980’s, Medicare stopped paying the “usual, customary, and reasonable fee”,Doctors get paid by the insurance company…but what happened to the agreement between the doctor and the patient? and started imposing a fee schedule (along with documentation requirements and business rules) that physicians were required to accept. All the other insurance companies followed suit.
Gradually, now that the patients’ opinions were totally out of the picture, insurance started paying less and less, and doctors started seeing more and more patients to make up the difference.
Now, of course, most physicians operate that way, and they must see crazy numbers of patients per day,If your doctor takes insurance, he’s not working for you, he’s working for your insurance…But what if you could have your doctor work on your behalf? and they must follow all the complicated and crazy rules that insurance companies come up with (Medicare, for instance, only accepts forms that are double sided and printed in red ink, or the doctor gets nothing). So, doctors get paid by insurance company, according to the contract between the doctor and the insurance (or the employer), but what happened to the agreement between the doctor and the patient?
If your doctor takes insurance, he’s not working for you, he’s working for your insurance company. But what if we could turn it all around again, go back to just being patients and doctors, without the middle men? What if you could have your doctor work on your behalf?
That question has started a revolution.
Since it’s creating in the 1990s, Concierge Medicine has risen up as a way of putting patients and doctors back on the same team, and removing third-party interests.
But before we discuss all the ins-and-outs of Concierge Medicine, let’s talk about some of the clear effects of putting insurance companies in charge, by talking about some things that most doctors get wrong.
- (a) The 18-second Rule
(b) A newer study says you now have 23 seconds before your doctor interrupts you
- USA Today – 11 minutes per visit
- NYT – Tell the Doctor All Your Problems, but Keep it under a minute
- According to Medscape – Physician Burnout Rate is now 50%
- Doctors as a profession have the second highest Suicide rate.
Newsweek – When Doctors kill themselves.
- How being a doctor became the most miserable profession.
- BMJ – Rate of Misdiagnosis in US Primary Care
- Your Doctor is a Subcontractor
- A Quiet Revolution
- Old 2001 Guidelines – ATP-III