I'm not a fan of the concierge model as it leaves a lot of patients out in the cold. The ones who are willing and able to pay the fee whether it be $200 or $500 or more get good care, but the rest are left having to find a new PCP in an environment where doing so is harder than ever. ...
Primary care is dying and nobody really seems to care or want to do anything about it.
I actually have thought about both of these. When we moved to a new state 6 months ago we knew no one. I knew it was challenging to find new doctors knowing nothing and new that it was hard to get that first appointment. So DH and I decided to go with an MDVIP practice which is $1800 a year for each of us. This is honestly expensive for us and not an easy cost to choose to pay. But, we can do it although I would rather spend that money on other things. For many people it is not an option at all. It does bother me.
I also think the existing primary care model has problems. Someone mentioned preferring to use specialists for most things. I sort of agree. For years I saw my primary care doctor maybe once a year or less. For a lot of what they did an urgent care would have been fine. A year or so ago, it was a weekend and I absolutely knew I had a urinary tract infection. It made no sense to wait to see the PCP so I just went to an urgent care.
Primary care doctors were mostly useful to get referrals to specialists. Not so much the referral as I am on Medicare and don't need one. But, to get a recommendation.
At that time of my life paying $1800 for MDVIP would have been totally wasteful.
I've had MDVIP since August and, yes, you can tell the difference. The big thing is the time. I had an initial visit with my new PCP and it lasted over an hour. I had an issue that we weren't sure what was going on and he ran several tests, referred me for an ultrasound, called me to discuss the results. They initially referred me to a specialist practice. I couldn't get an appointment for 6 months! When I called back to the PCP's secretary she called around and found me an appointment elsewhere in 3 months.
They do all vaccines (except Covid) there in the practice. They are set up to do my Prolia injections (before I had to go to a specialist). They have an annual physical. They do run some non-standard tests (some heart stuff from Cleveland Clinic). They also do stuff that usually isn't done but can potentially identify problems. There is a 2 hour visit to go over the results. Since Medicare doesn't do physicals at all this is a true benefit that I could not get without paying out of pocket for it. It was far more detailed than any other physical I had done when I was on regular insurance.
Now the physical is certainly worth some actual money since Medicare doesn't cover them. But that isn't why I pay the $1800.
Having moved to a new locale the immediate benefit was being able to see someone right then rather than waiting months for an initial appointment and being able to quickly get specialist recommendations. But, that reduces in importance now that we are here and have specialists we have found.
So not sure if we will continue the $1800 for each of us. The big benefit of the concierge practice is the time the doctor spends with you. Also, just the knowing that if you have something you want to ask about or need to see him you can get a response quickly. It was made clear it was OK to contact on nights and weekends. And since I am paying $1800 for the privilege I am more willing to call if needed.
The reality is that the insurance system is such that primary care doctors have to schedule way too many patients to be able to have hour or 2 hours long visits with patients. Most visits of course won't be that long with my current doctor but the point is that they can be.
I have sympathy to the primary care physicians. They are asked to do a lot but don't get the reimbursements that say my interventional cardiologist gets. My current doctor put out a video on why he switched to the concierge model and basically it was to be able to be a physician and to spend the time he needs to do that. It is bad, of course, that this isn't available to all doctors and all patients and that it comes down to money. But, I have to deal with reality as it is.
For this reason I am not sure the primary practice model works well. Urgent care for the stuff like my urinary tract infection works well. And, for someone who only sees specialists they don't need the primary care doctor. t years ago I didn't need one. But, as I've gotten older I have started to have more of those chronic problems and I need someone who does know everything and can see the big picture and help direct me. When I see my cardiologist he doesn't really want to talk much about other parts of the body and so on. What I really want is I guess someone who is compensated like a specialist but tries to coordinate everything. And, for now, that means paying for concierge in my situation.
I honestly don’t know what PCP is for. I have a cardiologist, dermatologist and urologist I like and will always prefer going directly to a specialist than talking to a PCP. No wonder they’re a dying breed.