Friday, April 9, 2010

Concierge Medicine

One of the projects that is keeping me so busy right now is my search for real medical care.  I mean, I'm looking for a doctor who will do more than listen to me for 5 minutes and indiscriminately prescribe drugs.  (Well, ok, they discriminate a little bit.  I exaggerate when I'm angry.)

My undiagnosed pain problem seems to be coming back - either that, or I've had a broken toe for the past 3 months which sometimes makes the rest of my foot (and sometimes my elbow) hurt, too.  I could go back for PRP therapy, but I thought I'd try again for an actual diagnosis.  That means that I'll have to collect my medical records from about 7 places and find someone who will actually read them and use his mind to try to solve the problem.  Regular doctors have no time to use their minds.  (Hey, that's a bit like parenting!) 

Thanks to a suggestion from Paul Hsieh on a private list, I found out about something promising:  concierge medicine.  I knew there were doctors out there who don't take insurance, but I had assumed that they were unaffordable.  Those doctors may exist, but concierge medicine is something different.  The doctors still take your insurance, but you also pay a yearly fee for extra service.   The doctors only take a maximum of about 600 patients, instead of thousands.  The fees vary, but the ones I'm looking at charge $1,500/year.  That's only $125/month.  I can afford that! 

There is a national group called MDVIP which has standardized the cost and service levels for the member physicians.  I'm sure there are plenty of independent operators out there, too, but what you get with MDVIP is:

  • 24X7 access to your doctor

  • a real annual physical exam which covers much more than your insurance would

  • same day or next day appointments - for anything

  • appointments that last as long as necessary

  • a CD containing your medical records

  • assistance with insurance issues

  • a doctor who might even come with you to a specialist appointment or surgery

You also get a doctor who has chosen to practice real medicine instead of herding sheep through his office.  This is the biggest selling point to me.  These doctors want to use their minds!

There is another organization called the American Academy of Private Physicians from which I'm drawing referrals as well, but I'm not sure of the annual fees yet with those.  I'm going to interview at least 3 doctors and give this a shot.  Here are the questions I've come up with to ask each doctor.  If anyone has any suggestions for other questions, I'd love to hear them.

  • How many doctors in your practice and do they all participate in concierge medicine?

  • How many patients in your practice?  How long are appointments?

  • Why did you decide to practice concierge medicine and how long have you been doing it?  Has it lived up to your expectations?  How could it be even better?

  • What is your philosophy of care, if any?

  • How do you decide on specialist referrals?  Will you coordinate my care?  Will you help me get appointments?

  • What are your views on nutrition and exercise?

  • I believe in informing myself about health issues and being an active part of my own care.  What if I come in with information on a study I found on the Internet or from a book and ask you if it is valid?  If you’ve never heard of the study, will you take the time to research it and help me understand if it is scientifically valid?

  • What does “evidenced-based medicine” mean and what is your view of it?

  • What tools do you use for diagnosis?  Is trial-and-error with medication part of diagnosis?


  1. Bummer about the pain! Your quest sounds really thorough and well founded. One thought that came to my mind is fibromyalgia. I don't know if any of the other stuff fits, but it's one of the things my doc was considering for me before Iodine made such a difference.

    I hope you're feeling better soon!


  2. Thanks, Rachel. I don't think fibromyalgia is an actual condition - just the name that doctors use when they can't diagnose pain. I'd rather just call it "undiagnosed pain." I've tried all the drugs and therapies for it anyway, to no avail.

    If I can't get a diagnosis, I'm pretty sure PRP therapy will help me again. It's good to know that there is one thing that will work, even if I can't get to a root cause. Besides, PRP therapy is really cool! My own body fixes itself. Here's the link if you want to know more about it:

  3. Additional Questions:

    How many patients do you have?
    What percentage of your patients "renew" every year?
    Are you happy with that number?
    What are you doing to change that number if you're not happy with it?
    Do you vary your fee based on the age of your patient?
    Do you vary your fee based on any preexisting conditions of your patient?
    What do you think of Obama's health care plans?
    What if the law contradicts what you think is best for my care, how will you handle that situation?
    I am a hero worshiper, who are your heros and why?
    What kind of staff do you have to support you?
    What are their backgrounds/skills/areas of expertise?
    What are the key criteria you look for when you hire staff?
    How long have your staff been with you?
    My family history has issues X, Y, and Z, are these areas you have experience in? If not, how much time will you be willing to invest to get up to speed on these issues in working with me through my health care issues?
    In issue X conventional wisdom is A, but I have found B to be significantly more effective for me. What are your thoughts on breaking the "conventional wisdom"?

  4. Thanks, John! I have my first interview tomorrow and I'm going to update my list of questions with a few of yours.

  5. [...] Mossoff presents Concierge Medicine posted at The Little Things, saying, “Just as no rational person should depend on Social [...]

  6. I pay $2,000/yr. for a service called Swedish Premier Health in Seattle (nothing to do with Sweden.) It has been about a year since I joined. I'm not entirely satisfied, but the service is a huge improvement over 5 minute appointments and rude service. When I'm due for tests or other follow ups, I get an e-mail. The easiest way to contact my doctor is e-mail, though I can also phone. She always gets back to me quickly. The staff are friendly and helpful. I have kept my specialists, e.g. my gynecologist and my diagnostic radiologist, since I have tremendous confidence in them, but it's great to have one person co-ordinating everything who has time to sit and talk with me for as long as I need.

  7. Get aboard while you can. That way, if concierge medicine is banned, you might be grandfathered in.

  8. Maryallene, in my research I think I read about that service. Would you mind elaborating on what you don't like about the service?

    Jared, I agree with you. For what it's worth, though, the doctor I chose is pretty heavily involved in what's going on in Washington and he said that he's pretty confident that some form of "upgraded" service will continue to be available after the health care bill is enacted.

  9. Amy, first I need to make a correction. I pay $2500 a year, not $2000, which is a lot for me. Also, they do not take insurance at all, which is fine. They charge my credit card monthly, and I can cancel by giving them 30 days notice. One disappointment is that I cannot use flexible spending money to pay the cost, but this is not the fault of Premier Health. I could use an HSA if I had one, but my employer doesn't offer it.

    I have been using the service for almost a year now. I have chronic back problems, mostly under control and only rarely causing me discomfort or restricted activity any more. I did something (don't know what) late last year that caused my back to flare up rather badly. I talked to my doctor, and she referred me to a two session, four total hours back program. I thought I might need an MRI and further evaluation, and she said all that would be evaluated in the program, and they would follow up as needed. This was not the case. Everyone in the class, about a dozen, had been referred by a doctor who was treating his/her back, and there was no follow up. There was some good reminder info on good body mechanics, and some really bad info on the benefits of "proper nutrition." Overall, the class was useful, but not worth four hours of my time. Interestingly, my back healed more quickly than it ever has. I think that may be due to the paleo diet. I have not had a chance to tell Dr. James that her referral was a disappointment (I could send an e-mail, but I'd rather talk face to face.) She has been on jury duty for the past three months and only can see patients on Fridays. I am surprised that a doctor could not be excused from jury duty, especially a lengthy case. There is another doctor in the practise who I can see if I needed to, and I do like him.

    There have been a lot of good things about the service. No snotty staff, no long waits in the waiting room. Reminder e-mails about vaccinations, and tests that are due. Also, getting medical issues addressed more quickly and not having to make separate appointments for multipe issues, and knowing that I have someone to co-ordinate care if I have a complicated issue. However, for the price, I expected a little more time and personal attention.

  10. Thanks, Maryallene. I'm concerned about the quality of referrals, too. And I'm sure glad that my service costs so much less. I'm glad to hear your back got better.

  11. Another alternative is if you are looking for a clear diagnosis to a specific problem is to go to Mayo Clinic in our back yard. (less than 2 hours drive from our door) They do that all the time, and half way through the process appear to be very good. Details when we're completed.

    Added bonus, you can visit us on your trip! :)

  12. Amy and John, thanks for your list of questions! I am beginning a doctor search and I'll use many of these to help in our quest. I looked into concierge medicine in Atlanta and there are several options. However I'm mainly looking for a family physician, someone (or a practice of several docs) who will become familiar with and treat our whole family. The concierge medicine practices I've found don't do pediatrics. Is that your experience in VA?

    Anyway, thanks again!

  13. John, it sure is hard to get people to visit way up there, huh? We had the same problem in Michigan. Someday...

    Jenn, I found internists and family practitioners through MDVIP, but I only ended up interviewing two internists, neither of whom saw children under 17. I'm not sure if the family practices would have taken children, but you would think so. I actually think Sam is better off with a regular pediatrician for now because she has no medical issues and the ped we use is good about seeing her immediately when necessary. I needed an internist because I need a good diagnostician, and my understanding is that this is what internists are good at. Your situation is probably quite different.