Concierge Practice: Unjust for Patients and Doctors Alike

 

Arthur L. Caplan, PhD

Hi. I am Art Caplan at the University of Pennsylvania Center for Bioethics. Today I am going to talk to you a little bit about the growing practice of "concierge" or "boutique" medicine. What is concierge medicine? Basically, in concierge medicine you ask your patients to pay an additional fee (usually $1500-$2000 a year), and in return they receive better service. You promise that if they join the plan, you will answer their phone calls. You might give them your cell phone number. You might be in a situation in which concierge patients have more time available when they come in for an office visit, and you are going to help them wend their way through the hospital and gain access to specialists. In other words, patients are going to get more of you for the money.

What is fueling this shift toward concierge practice, particularly in primary care? It is the red tape, hassles, bureaucracy, micromanagement, and too much overhead cost that primary care providers in particular are facing in the current healthcare environment. There is just not enough time to see patients, and people feel as though they are on an assembly line. It's understandable that the idea of having patients pay more as a way of getting out of a broken system might come to the fore. A lot of people are doing this. There are probably 6000 primary care physicians alone who have shifted over to a concierge practice. To be honest, concierge medicine for the superrich has always been around. The person who has an addiction who goes off to the Betty Ford Clinic and the executive who takes a jet for an executive physical at the Mayo Clinic: These are versions of concierge or boutique medical practice. Now it's expanding into the middle class.

What is the downside, and what are the ethical worries about this growing type of practice? First, there aren't enough primary care providers around to begin with. We all know that we have too many specialists, not enough generalists, and not enough primary care providers in the United States. If you take a significant number of them out of the pool available to every patient and make them available only to people who can pay additional fees, it results in a bigger workload for the rest of the providers who are doing primary care. No matter how you look at it, if you allow providers to buy out, you are going to leave other patients with lower-quality care, and you are going to burden the remaining primary care practitioners (who don't take the concierge route) with more work.

There is also the issue that if patients aren't in a boutique or concierge practice, they are going to wind up getting lower-quality care because they might see more physician extenders. There are certainly great physician extenders -- both nurses and physician assistants -- but patients don't understand that they may be seeing someone with a bit less training and may be paying the same money or fees for someone with less qualification.

At the end of the day, we have a justice issue. Concierge practice is a business solution to what is essentially a broken system. We must find different ways of solving the problems with healthcare, other than having people pay a fee to escape the broken system. Concierge medicine is fundamentally unjust. We have to come up with a better answer. It will probably be something along the lines of what is being proposed for healthcare reform. Concierge medicine is more a symptom of a broken system than it is a solution.

Thanks for listening. I'm Art Caplan at the University of Pennsylvania.


originally published by medscape.com

 

 

Go Back

Latest Updates

21-23 Jun 2019
11th ASEAN & 8th Perak Health Congress on Primary Healthcare
Details >>


12 Aug 2018

Implementation of Data Breach Notification
Details >>

25 April 2018
Guidelines on Continuing Professional Development (CPD) for Medical Practitioners In Malaysia
Download >>

8 Mar 2018
Specialist Medical Practitioners Continuing Professional Development (CPD) Policies and Guidelines
Read >>


Recent Events

15-16 Sep 2018
2nd FPMPAM / IPH Annual Convention incorporating 1st FPMPAM Malaysian Healthcare Conference
Flyer >>

15-16 Sep 2018

1st FPMPAM Malaysian Healthcare Conference
Flyer >>

 

12 Aug 2018
Cardiothoracic Surgery & The General Practitioner
Flyer >>

 

15 April 2018
Medico-Legal Forum on "Medical Manslaughter - Aftershocks from Bawa Garba 2018".
Flyer >>

 

Date: 25 Nov 2017
Insight Into Clinical Radiology
Details

 

Date: 8 Oct 2017
Doctors' Day Celebration 2017
Details

 

Date: 16 & 17 Sep 2017
1st FPMPAM/IPH Annual Scientific Convention
Announcement || Souvenir Programme

 

Date: 8 & 9 Sep 2017
Nursing Conference 7.0 / Training Course for Clinic Personnel 9.0
Full details || Report

 

Latest Newsletter


go to newsletter section

 

Latest newsletter of Perak Medical Practitioners' Society
Click here >>

 

 

Resources / Links

Specialist Medical Practitioners Continuing Professional Development (CPD) Policies and Guidelines
Read >>

 

Joint Integrated Healthcare Committee (JIHC) Term Sheet
Click here >>

 

Joint Integrated Healthcare Committee (JIHC) Terms of Reference
Click here >>

 

National Pharmaceutical Regulatory Agency
Click here >>

 

NPRA: Reporting medicinal problems
Click here >>

 

Makluman Kontraindikasi Penggunaan Ubat Yang Mengandungi Codeine Untuk Kanak-Kanak Beumur Bawah 12 Tahun Dan Ibu Yang Menyusu Susulan Risiko Respiratory Depression
Click here >>

 

Peringatan: Langkah-Langkah Pengurangan Risiko Bagi Kesan Advers Kulit Tang Serius Susulan Penggunaan Allopurinol
Click here >>

 

VALPROATE
Guide for HCP >>
Patient Information >>
Sodium Valproate (Guide for HCP) >>

 

NDST Report 2011
Click here >>

 

Garis Panduan Pemantauan Keselamatan Produk ESAs dan Pelaporan Kesan Advers PRCA
Click here >>

 

Report On Suspected Adverse Drug Reactions
Click here >>

 

MADRAC KE 146 - Traditional Medicine found Adulterated
Read >>

BPFK website: Cancellation of Registered Traditional Products / Notified Cosmetics
Read >>


Pharmacy Services Division: List of Adulterated Products
Read >>

 

Pharmacy Services Division: Press Releases
Read >>