The last time you called your doctor's office, how long did you have to wait for a reply? How long do you usually have to wait to get an appointment or wait for a prescription to be called in? When you get to the office, how long do you spend in the waiting room and how much time does the doctor spend with you?

Did you get all your questions answered? How many seconds do you have in the beginning of your appointment to explain your symptoms before you are interrupted? Do the nurses and doctors seem to be more interested in their computers or their charts than they are to you?

If your experiences are like most people, your answers to these questions are not very flattering to the medical profession and to the health care system in general. Most doctors don't really want their practices to be like this, but they don't have much choice. They have to have a high volume of patients in order to make ends meet financially. The high volume makes the clinic a very busy place and most patients don't feel like they get much attention.

In 1996 in Seattle, a doctor named Howard Moran thought there should be a better way to do this. He pioneered the concept of having a lower volume practice with highly attentive medical care provided as a service for patients in return for a retainer fee, much like many attorneys or accountants use. This fee may be in addition to, or in lieu of, the regular office fees that are billed to insurance companies. This concept allows the practice to remain financially solvent while providing better, more attentive medical service to its low volume of patients (usually keeping the patient count down to about one tenth of the number in a typical traditional primary care practice).

Unfortunately, health insurance companies currently don't pay for this type of service, so that means the patients have to pay this out of pocket, but if the service is good, it may be worth it. Patients who join these practices are encouraged to keep their usual insurance which they will need for visits to other specialists, laboratory testing, radiological testing and/or hospital services if needed.

Many concierge practices offer same or next day appointments, no long waits for appointments or prescription refills, direct access to your personal physician day or night, house calls if necessary, continuing care if hospitalized, complete physical examinations, audiometry screening, cardiovascular and cancer risk screening, more attention to preventive care, unrushed appointments, all questions answered, family meetings if needed, coordination of care with specialists, provision of personal health records on CDs or flash drives, etc., etc.

Depending on the type and number of services that are provided, the flat retainer fee can vary widely from one area to the next ranging from $100 to $20,000/ year, most probably averaging around $1500-3000/year. There were only a few hundred of these physicians a few years ago, but there are over 5000 of them now all over the country. Many of them, but not all, are listed at the main website for the Society for Innovative Medical Practice Design - www.simpd.org. Patients may be able to find a concierge physician in their area on this site.

There has been some controversy surrounding some of these practices because some authorities feel the growth of concierge medicine will lead to a 2-tiered medical system in this country - one for the wealthy and one for the not-so-wealthy. Also, with the current shortage of primary care physicians (PCPs), with increasing numbers of concierge practices, the number of PCPs available for traditional offices will be even smaller, and access to care for patients served by those practices will suffer. On the other hand, more medical students may become interested in primary care if opportunities in concierge medicine are available to them when they finish their residencies.

Some of these practices have come under fire from insurance companies who say that concierge physicians are basically providing an insurance plan for their patients without having an insurance license to do so. The practices must therefore be legally and financially structured in such a way that avoids this criticism.

Overall, the concept of concierge medicine provides a good alternative to the currently unsatisfying traditional model of medical practice. The fee may seem high to some, but in most instances, it probably isn't much higher than the cost of the local cable or telephone bill, or about the same as what a family would spend eating out at a restaurant once a week.



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