Alternative Primary Care: Retainer, Concierge, Boutique and Spa

There’s a movement underway among primary care physicians to shift their sources of income, and it could have a profound effect on how we patients view our relationships with our doctors, not to mention our outcomes when it comes to medical problems.

If you remember the Marcus Welby days, or if you’re old enough to remember when the doctor made house calls (raise your hand! yes! there are a few of you out there!) then you’ll appreciate this movement toward taking back their own practices. As a business owner myself, I can’t say as I blame them.

Who do these doctors expect is going to pay them? Patients! Go figure.

Wait! (you might say) Patients pay them now! So what’s different?

In fact, most patients don’t pay their doctors directly. Instead, patients pay for insurance or medicare, and the doctors bill, then get paid, by the insurance companies or medicare. We patients might pay a co-pay, or a smaller percentage of the total bill, but rarely the whole thing.

Also consider this: When doctors send those bills to our insurance companies or medicare, they don’t get paid what they charge. Instead, they get paid what the insurance company wants to pay them. (Picture it this way: when your car needs repair, and the bill comes to $500, you tell the mechanic that yes, you understand the bill is $500, but you will pay him only $350 — take it or leave it.) Plus, doctors employ services or extra staff, just to take care of billing all those third-party payors. Meaning, it costs them extra for the insult.

A number of terms have popped up to describe direct-from-patient-to-the-doctor pay models. “Retainer” or “concierge” medicine, “boutique practices”, “medical spas” — the idea is that a patient pays a set amount in a year, and that gives the patient total 24/7 access to his doctor, often in ways there is limited access now. For example, retainer doctors may provide email access, may accompany a patient to a specialist, and may even make house calls. Everything “old” is new again!

Practices such as family medicine, internists, OB-GYNs, pediatricians and geriatricians are moving to this model. Others may follow suit. And my guess is, if you see a naturopath, then direct-pay-for-service is what you’re used to anyway, although the retainer idea might be new.

I have mixed feelings, but as you know, I’m always a champion of pro-patient programs, and this does seem to be one. In fact, it’s a boon to everyone involved, including the doctors. The only players on the short end of the retainer stick are the health insurance companies, and — well — frankly, who cares?

There are still considerations for patients that don’t get addressed in this model. It can be expensive. I’ve heard amounts ranging from $1,500 to $10,000 annually. And remember, that’s just for primary care. While I’m a firm believer in the idea of primary care doctor as the maestro of the medical care symphony, there are so many problems that must be addressed by other doctors, or in alternate facilities, that will not be paid for in that retainer — so — the patient will have to pay for those services separately. Or, the patient will pay the retainer IN ADDITION TO insurance premiums and co-pays for specialists and other services.

Further, I wonder what percentage of patients can actually afford this boutique-type primary care service? Now, I’m not the person who will tell you that since ALL people can’t afford it, then NONE should have access to it — no way. BUT, it’s a consideration because it does further separate the haves from have-nots. It makes me uncomfortable, at least.

There are a number of resources for patients who want to learn more about retainer services and which doctors are now using this system. Here’s a list of articles that may interest you:

Maryland Business Gazette: On Call – for a Fee and No More Assembly Line Medicine

Seattle Times: Concierge Medicine, An Affordable Option

Connecticut Post: Put Your Doctor on Retainer

What I have not been able to find is a list of doctors who have shifted their practices to this model. I can’t find local lists or state or national lists. If you know of any — will you let me know?

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2 thoughts on “Alternative Primary Care: Retainer, Concierge, Boutique and Spa”

  1. Equal access to healthcare is perhaps most similar in importance as is equal access to education. Why is there not the same concern over private education. We all know that private education is available to those who value it and can afford it but we don’t concern ourselves as much with this social discrepency.

  2. It’s a good question, BobbyG. But there are major differences between the traditional American approach to providing an education vs the traditional American approach to providing healthcare.

    We’ve relied on employers to provide healthcare coverage.
    Should we be asking employers to provide education, too? Some do — but certainly not at the basic levels of teaching reading and writing.

    Healthcare has never been set up as an entitlement like public education. I wonder if that means we value education over healthcare?

    Will universal healthcare, if it ever really comes about, be parallel to a public education?

    As I said — you asked a good question, or at least made a thought provoking statement.

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Trisha Torrey
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