As many medical centers postponed elective procedures and routine examinations during the early days of the pandemic, there was one group of patients who mostly kept seeing their doctors as usual: those who are members of concierge practices.
Concierge medicine—where patients pay what amounts to a retainer fee for direct access to a doctor or doctors—has boomed during the pandemic. According to Kona Medical Consulting, which manages concierge practices, such doctors saw a 21% increase in new patient volumes nationally during 2020, adjusting for normal fluctuations.
“There was a marked increase for a number of reasons: People couldn’t get a hold of their own doctors, who were diverted to treating Covid patients. Tele-health is great, but it’s hard to get a Covid test that way,” says Thomas LaGrelius, a concierge doctor specializing in family and geriatric medicine in Torrance, Calif.
Concierge medicine, also known as direct primary care, isn’t for everyone. For one, it can be costly, and critics say it creates a two-tiered system that contributes to health inequality. It also might not make sense for younger people and those without health issues.
Yet with rising demand and interest in concierge medicine, we spoke with a number of practitioners and experts to get a better understanding of the offerings and considerations:
People age 50 or older make up the most typical client in the concierge practices, according to senior advocacy group AARP. Young patients with no outstanding health conditions may be better served in traditional practices, experts said.
Concierge practices typically don’t take Medicare and Medicaid, and the annual concierge fee wouldn’t be covered by the government programs.
When considering a concierge practice, make sure it is certified by the American Board of Internal Medicine and affiliated with a major hospital. Concierge Medicine Today trade publication estimates there are 5,000 to 20,000 concierge practices nationally, compared with 920,000 licensed doctors in the U.S.
The American College of Private Physicians also says concierge medicine may be a good fit if you have a complicated medical background and need more attention than the normal 15-minute doctor’s appointment allows. Concierge medicine may not be the right choice for a healthy 22-year-old who gets a physical once a year, LeGrelius said.
Concierge medicine requires patients to pay an annual fee that averages $2,500 to $3,000, which buys 24/7 access to their physician, same-day appointments, and unlimited visits, according to the American College of Private Physicians. Patients still need insurance for emergency room visits or specialist visits, as well as medication.
Yet advocates say concierge fees may not seem so high when compared with the average annual deductible for single, individual health insurance coverage, which eHealth says hit $4,363 in 2020, in addition to monthly premium costs.
“There is a perception that it’s a luxury product. But when you look at the out-of-pocket, insurance deductibles and co-pays and sit down and do the math, it’s rarely the expensive luxury item the stereotype suggests,” said Donovan Miske, executive director of Kona Medical Consulting in Detroit.
However, critics say, comparing health insurance deductibles to concierge fees isn’t fair because not everyone has health insurance. Concierge fees, therefore, are high compared with subsidized government health-care programs like Medicare and Medicaid, critics say.
“It’s a warped notion to have the ability to even have concierge medicine,” says Glenn Ellis, a bioethicist and visiting scholar at the National Bioethics Center at Tuskegee University. “It means being able to buy into a health-care system over and above what you already have.
“It’s about access, vaccine access, and what people are willing to pay to get access.”
Fewer Patients, More Time
Concierge practices typically have fewer patients to treat, which many doctors say allows them time to give more focused care. A concierge practice averages 300 patients total, compared with 800 to 2,300 patients in a traditional practice, according to the American College of Private Physicians.
Patients in a traditional primary care physician’s office have appointments with a median visit length of a bit more than 15 minutes, with a median of six topics being discussed, according to the National Institutes of Health. Concierge doctors, meanwhile, spend 35 minutes with patients per appointment and have four appointments a year, according to research from the University of Wisconsin.
LaGrelius said that his concierge patients have his cellphone number for round-the-clock access and that he does house calls when necessary. “Seniors were scared [during the pandemic]. They wanted more attentive care. But they didn’t want to go to big medical offices with big, crowded waiting rooms. Here, there’s no waiting room and no wait,” LaGrelius said.
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