Concierge medicine: Does paying for total access to a doctor get you better care?

It’s 3 a.m. on a Sunday. You’re feverish. You’ve been coughing for days and nights. You’ve got a throbbing headache and can’t take it one more minute. You touch speed dial on your phone, and your doctor answers. In less than an hour, they’re at your house, give you an injection of antibiotics for a quick-start recovery, and leave an oral antibiotic and cough elixir. Your doctor will be back in a day or two to check on you. How do you get that kind of service? It’s called concierge medicine, and you’ll pay a premium for it.

Concierge medicine is a membership-based healthcare model in which patients pay a flat fee for complete access to a physician. This fee often covers unlimited visits to the office, at home, and using telehealth. It usually includes basic diagnostic tools such as imaging and blood tests, and specialist referrals, as necessary. Wealthy athletes like Lebron James and Tom Brady embrace this type of care.

This approach to care is a shift toward a consumer-driven healthcare market focused on personalized service. Cost and service vary from extremely limited, such as $150 annually, in which the only concierge service is expedited scheduling, to $2 million annually for very personalized services.

The positives

Concierge medicine is expanding across the United States. By 2032, the market size for concierge medicine is projected to increase by 65%, reaching almost $11 billion annually.

Patients are drawn to the 24/7 access to care, with same-day or next-day appointments readily available. The services can be comprehensive, from wound treatment, blood work, physicals, and whatever the physician and patients negotiate. Supporters say that patients benefit from the absence of co-pays or deductibles, and some practices dispense common medications at a discount. It’s hard to get excited about that, though, when your base cost for the services is astronomical.

The model is proliferating across specialties. Initially centered around primary care, such as family practice, internal medicine, and pediatrics, concierge medicine has since expanded to include more than 45 secondary specialties and subspecialties, including addiction medicine, cardiology, dermatology, general surgery, gynecology, and oncology.

This practice model may be less stressful for physicians, with more predictable hours. There are fewer government regulations and insurance mandates and usually less paperwork. Some physicians find that it is a refuge from professional burnout and dissatisfaction, allowing them to focus on the reason they went into medicine – to provide quality care to patients.

The negatives

A recent study reports that individuals enrolled in concierge medicine experienced a 30 to 50% increase in total health spending, with no discernable improvement in mortality rates. This finding prompts criticism about the value of such expensive personalized care which has not proved to lead to better health long-term.

Concierge care does not replace the need for the traditional models of healthcare and health insurance. Routine care may be covered under a concierge contract, but the greatest medical expenses still require comprehensive insurance coverage. These include hospitalizations, some diagnostic tests, treatments, consultant fees and more. In response, some people with concierge care also purchase high-deductible health plans (HDHPs) to reduce their overall health spending for higher ticket medical costs.

While concierge medicine can benefit both patients and physicians, it also introduces significant challenges and potential drawbacks for the traditional healthcare system.

A major drawback of concierge medicine is its impact on the availability of primary care physicians for the public. Concierge physicians usually cover far fewer patients, placing a greater burden on physicians still in traditional practices. This could create a need for briefer appointment times and the need for more providers (physician assistants, nurse practitioners) of limited scope. They would also experience the burden of caring for more patients.

Another issue is that the exclusive, high-cost concierge could distort the patient-doctor relationship. The doctor is expected to cater to the patient’s demands, which could mean prescribing unnecessary diagnostic tests, treatments, and drugs.

Concierge medicine must not allow patients’ whims to supersede the standards of care and ethics to which providers must adhere. The advancement of healthcare models like concierge medicine should be a tool to enhance the overall quality and fairness of healthcare, not further diminish it.