Readers speak out on 'boutique' medicine

Readers speak out on 'boutique' medicine

There are 20 comments on the Baltimore Sun story from Oct 29, 2008, titled Readers speak out on 'boutique' medicine. In it, Baltimore Sun reports that:

Thank you for the front-page article about concierge medicine . As a family physician who has practiced for 22 years in Maryland, I find the current state of affairs in primary care heartbreaking.

Join the discussion below, or Read more at Baltimore Sun.

Tommy

Philadelphia, PA

#1 Oct 29, 2008
I believe that boutique medicine will become the norm if universal health care is implemented. Medicare recipients have trouble finding doctors who will treat them and so will those who are covered by universal healthcare. Those with money will always find quality healthcare which will not be available to the masses under any sort of national healthcare plan.
ann

Flint, MI

#2 Oct 29, 2008
I'm surprised it has taken this long for medicine to move toward this concept. Granted it's a better choice for some doctors but maybe it's a better choice for the some patients who will be able to afford it. At this time, I cannot. My last doctor was into feng shui and astrology and would let his patients sit in dingy, cold, basement waiting room while he schmoozed with pharma reps. He was arrogant beyond belief and would insist on an 'appointment' to merely pick up a referral so he could charge the insurance company for a visit. My current doctor diagnosed a very bad ankle sprain as arthritis two years ago. After walking around on the ankle for several months and getting progressively worse I was referred for further tests and physical therapy, but, hey, I'm just fine now. This doctor is part of a large multi-doc practice and getting care requires contact with the warm, fuzzy outer office where the cubicles are decorated with angels, puppies and kittens and the staff wouldn't spit on you if you were on fire. Boutique medicine, bring it on......
CKK

Ellicott City, MD

#3 Oct 29, 2008
I don't understand the point of the retainer fee. Why don't the doctors just stop accepting insurance and simply collect the fee for service at each appointment? Many people only see their primary care doctor once or twice (if that) per year, so paying $2000 up front makes no sense. Most psych practices now dont accept insurance. The patient pays the full fee at each appointment and then submits his/her own insurance claims.
citizen17544

Columbia, MD

#4 Oct 29, 2008
what a great idea.

patients get higher level care... doctors have their income and lives back... and there are fewer places for bad doctors to hide.

of course some people would rather see everyone miserable than see someone else improve their lot, so expect lots of resistance to this...
Spike

Bethesda, MD

#5 Oct 29, 2008
The problem is patients won't get a higher level of care...it will just become the next version of a PSL, that money just gives you the right to schedule an appointment, and you'll still sit there for hours as they overbook to maximize profits at your expense as your insurance rates continue to climb because they want to be reimbursed $90 for spending 2 minutes with you and prescribing you some aspirin (also charged at $50 to your insurance).

“panem et circenses”

Since: Jun 08

East Coast USA

#6 Oct 29, 2008
I agree with Dr. Andy Lazris. Increase Medicare and insurance reimbursements to primary care physicians. Also limit the dollar amounts for awards in malpractice lawsuits.

Medical schools and nursing schools need to provide significant tuition assistance, even if public funding is neccessary.

While I don't blame doctors for going the concierge route under the present system, this does not bode well for society.
MikeWall

Chicago, IL

#7 Oct 29, 2008
I went to a wonderful doctor for many years, one who my family credited with saving my father's life. He switched to a boutique practice and none of us hesitated for even an instance finding other medical practices to go to. None of us have ever looked back. Some of the writers ask "who can blame the doctors?" My response is - I blame the greedy for their greed. I may point out a little thing called the Hippocratic oath. My current physician, I'm sure, does not make a fortune, yet he's a wonderful doctor, and a wonderful man. He got into medicine for the reasons that I thought doctors were supposed to get into medicine - to help people. It may be a cliche, and if may be impractial in this day and time, but if you wanted to get rich, why didn't you become an stockbroker? I certainly don't want any part of a doctor who whines about how hard he has to work and how much money he's not making - my attitude is - screw you - yod don't deserve to have a medical license!
XXX

United States

#8 Oct 29, 2008
My doctor just went MDVIP. Of the $1500 yearly fee, MDVIP gets one-third. The doctors whittle their practice down to 500 of the wealthier patients. They say they want to stress preventive care. The doctors have more spare time and more money, and in a way, who can blame them. That's capitalism! Capitalism means, if you have more money, your life is worth more than a person's with less money. So what if I can't afford the best doctor, already I can't afford the best lawyer, or the best car, or the best school, or even the best food. Fortunately, every rich person dies too, no matter how much they have. Eventually, we're all equally dead!
Billy - Ellicott City

Rockville, MD

#9 Oct 29, 2008
I like the idea of boutique practices. They don't threaten me as a consumer; but give me another option, which I like. They only problem is that they don't cover hospital stays, other specialty physicians, or prescriptions. So I'd have to keep my current insurance in addition to paying the flat yearly fee.

If these boutiques really wanted to grow, they'd offer coverage for all services and prescriptions. I'd join it b/c it is worth the premium for the additional level of service provided and b/c I could drop my work provided Blue Cross/Blue Shield.
XXX

United States

#10 Oct 29, 2008
Billy - Ellicott City wrote:
I like the idea of boutique practices. They don't threaten me as a consumer; but give me another option, which I like. They only problem is that they don't cover hospital stays, other specialty physicians, or prescriptions. So I'd have to keep my current insurance in addition to paying the flat yearly fee.
If these boutiques really wanted to grow, they'd offer coverage for all services and prescriptions. I'd join it b/c it is worth the premium for the additional level of service provided and b/c I could drop my work provided Blue Cross/Blue Shield.
Sir, better keep that health insurance. That $1500 only buys you access and a pager number. If you go to the doctor with a bad pain in the stomach your doctor might send you out to get some x-rays, or blood work, or an MRI, the costs of which are NOT covered by that $1500, but by your health insurance company. That $1500 does not get you any perscriptions either. Only faster access and more personalized service.
Billy - Ellicott City

Rockville, MD

#11 Oct 29, 2008
XXX: Thanks...If your actually bothered to read what I wrote, you wouldn't have responded. 1) read 2)respond if necessary.
sandy

Halethorpe, MD

#12 Nov 1, 2008
i totally understand what new doctors face financially. but it is so unethical to have to charge a fee to long time , elderly patients who very often have limited funds. of course the issue will only get worse in years to come, therefore something has to be done financially to help with educating the future doctors. i realize it is a snowball effect with our decades of inflation. yet i would like to believe there are still some ppl who go into medicine for the ethical reasons and can make do like the rest of us...maybe they dont need the luxurious vacations or the mcmansions etc. i realize the issue is complex but something must be worked on to solve it.
sandy

Halethorpe, MD

#13 Nov 1, 2008
loved your reply....lol
XXX wrote:
My doctor just went MDVIP. Of the $1500 yearly fee, MDVIP gets one-third. The doctors whittle their practice down to 500 of the wealthier patients. They say they want to stress preventive care. The doctors have more spare time and more money, and in a way, who can blame them. That's capitalism! Capitalism means, if you have more money, your life is worth more than a person's with less money. So what if I can't afford the best doctor, already I can't afford the best lawyer, or the best car, or the best school, or even the best food. Fortunately, every rich person dies too, no matter how much they have. Eventually, we're all equally dead!
Robin Hood

Hancock, MD

#14 Nov 1, 2008
Sorry but you are wrong.

I suggest you travel sometime outside of the United States and ask or experience a couple of national health care systems like the French, Swiss, or German (example), or read about how National Health care systems actually work in reality (not on the EIB network or in some Heritage Foundation spin article).

In most, the best doctors work for the National System because generally pays better than most doctors can earn in private practice (some doctors work in both).

Under a national system doctors don't have to have malpractice insurance...the government takes care of that.

Also, under a national system, the emphasis is on preventative, prenatal, pediatric, and primary care; also there are not critical chronic shortages of ob gyns, family practitioners, generalists, radiologists, nurses, etc. like we have here.

In Europe, it is the GPs, family practitioners, and generalists who are paid the highest salaries. About a half-million per year (while American GPs earn about $160,000 per year) which is more than even most American specialists earn.

In the USA, where supply and demand rules, it is orthopedic surgeons, cardiologists, anesthesiologists, plastic surgeons, and cancer specialists who make the highest salaries. Notice most of them are there to treat the end result of poor health not to prevent poor health.

Also, specialists make even more money in isolated areas like Montana and Northern Maine where it is hard to attract doctors. Again supply and demand.

Family practitioners come in at the bottom at $150,000 per year. Under a market-driven system, we are simply not producing enough preventative care and primary care doctors and nurses and therefore we wait until our deteriorates and we have to see a cardiologist, orthopedist, or oncologist by which time it is either too late or it is going to cost and arm and/or a leg.
Tommy wrote:
I believe that boutique medicine will become the norm if universal health care is implemented. Medicare recipients have trouble finding doctors who will treat them and so will those who are covered by universal healthcare. Those with money will always find quality healthcare which will not be available to the masses under any sort of national healthcare plan.
Billy - Ellicott City

Rockville, MD

#15 Nov 6, 2008
Great. Now I can get my health care from a government bureaucrat who happens to be a Dr. Also "great" is that under National health care Dr.s don't need malpractice insurance because "the government takes care of that" - I couldn't sleep at night knowing 1) a goverment employee is my Dr. and 2) I have to sue the Federal Goverment in case of malpractice!
NHSUK

Lake Station, IN

#16 Nov 10, 2008
Billy - Ellicott City wrote:
Great. Now I can get my health care from a government bureaucrat who happens to be a Dr. Also "great" is that under National health care Dr.s don't need malpractice insurance because "the government takes care of that" - I couldn't sleep at night knowing 1) a goverment employee is my Dr. and 2) I have to sue the Federal Goverment in case of malpractice!
Currently in the US, I worked for some 15 years in the British NHS. What's wrong with a Dr being employed by the government? They still want a job and status. If they foul up, they lose these. They can also be charged with negligence.

I can't comment on suing the US government. In Britain, a suite against the state is just as likely to succeed as one against any other organisation/individual.
Billy - Ellicott City

Rockville, MD

#17 Nov 12, 2008
NHSUK wrote:
<quoted text>
Currently in the US, I worked for some 15 years in the British NHS. What's wrong with a Dr being employed by the government? They still want a job and status. If they foul up, they lose these. They can also be charged with negligence.
I can't comment on suing the US government. In Britain, a suite against the state is just as likely to succeed as one against any other organisation/individual.
Thanks for helping me make my point.
Boutiquedocsoon

Wausau, WI

#18 Nov 16, 2008
I'm a senior resident in Family medicine that intends to do this from day one. So far, I know two places where I could start this off from day one and I am excited about it.

Some of the comments here makes me wonder if people think we should even be allowed to make money. These are the same type of people that always blame everybody else if something happens to them.

Another job option I have got is working as fitness-trainer in a high-scale gym. I only have to work ten-hours 4 days/week and no call, pager or weekends.

US politicians and insurance companies have destroyed primary care and it always astonishes me how they have succeeded in putting the blame upon doctors instead. You guys want people to work for free?! Go to medical school yourself!!
Dedicated

United States

#20 Jan 9, 2009
Boutiquedocsoon wrote:
I'm a senior resident in Family medicine that intends to do this from day one.
Good luck - without prior experience and a large practice to whittle down, you won't get patient 1 to pay $2500 out of pocket to get more time with you and your pager #. People shell out these fees to hang on to a doctor they have built a relationship with.

You sound like you don't want to work very hard. How many physicians do you know who work 9-5? or 40 hour weeks? I think YOU chose the wrong profession.
BUB

Newington, CT

#21 Jan 10, 2009
I sell my own medicine does anybody need something

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