Michelle Andrews was witnessing her internal specialist in Northhampton, Massachusetts, a small city to the west of Boston, for about 10 years. She was happy with care, although she started noticing that she was It becomes more difficult For an appointment.
Andrews said, “You were calling while you were talking about weeks to a month.”
This is not surprising, as many investigative studies in the workplace show that the supply of primary care doctors has decreased much less than demand, especially in rural areas such as West Massachusetts. But Andrews is still not ready for the message that arrived last summer from her doctor, Christine Baker, in Pioneer Valley Medicine.
“We are writing to inform you of an exciting change we will do in our internal medicine practice,” I read the message. “As of September 1, 2024, we will turn into a concrete membership.”
Concierrge Medicine is a commercial model in which the doctor imposes fees on patients monthly or annual membership fees – even as patients continue to pay insurance premiums, stickers, and discounts. In exchange for membership fee, doctors limit the number of patients.
Many doctors who have changed said that it solved some of the pressures they faced in primary care, such as the presence of a very large number of patients who see them in a very short time.
Andrews was ground when I got the message. She said: “The second paragraph tells me that the annual fees for joining will be $ 1,000 annually for current patients. It will be $ 1500 for new patients.”
Although the numbers are not tracked anywhere, the Conciege Medicine magazine is estimated today that there 7000 to 22000 Construction doctors in the United States organic fees range from $ 1,000 to $ 50,000 a year.
Critics say that concrete medicine only helps patients who have additional money to spend on health care, while reducing the provision of traditional primary care practices in society. It can particularly affect rural societies that already suffer from a lack of primary care options.
Andrews and her husband had three months to join, pay the fees, or leave this practice. They left.
Andrews said, “I am insulting and I am insulting.” “I will never expect, I never have to pay more pocket to get a kind of care that I have to get with my insurance premiums.”
Baker, the former doctor of Andrews, said that less than half of her patients chose to stay – the patient’s burden has shrunk from 1700 to about 800, which she considers more manageable. Baker said she was so timing that she had thought about retirement.
“I knew that some people would be very dissatisfied. I knew that some would like it,” she said. “I understood why you did this.”
Another patient in Baker’s practice said she did not think about leaving.
“I knew that I had to pay,” Healy said. As a retired nurse, Haley knew the shortage of primary care, and she was convinced that if she left, she would have a great difficulty in finding a new doctor. Healy was open to the idea that she might like the concierge model.
She said: “It may be my interest, because perhaps I will get previous dates and perhaps I will be able to spend a longer period of time in talking about my fears.”
This is the puzzle of concierge medicine, according to Michael Del, Director of Manpower Studies at American Medical Colleges Association. Del said that the quality of care may rise for those who can pay the fees. “But this means that fewer people have the right to reach,” he said. “So every time any doctor does this switch, it exacerbates the shortage.”
Estimates of his association The United States will face a shortage of 20200 to 40,400 primary care doctors During the next decade.
State analysis I found that the percentage of the population in West Massachusetts, who said they had a preliminary care provider was less than many other areas in the state.
Dell said the effect of conservative care is worse in rural areas, which often faces a doctor’s shortage. “If one or two perform this switch, you will feel it,” Del said.
Rebecca Star, an internal specialist in aging care, recently started practicing the concierge in Northhampton.
For many years, I consulted with a medical group whose patients got only 15 minutes with an initial care doctor, “This was hardly enough to review medicines, and much less than that of chronic cases management,” she said.
When a curtain opened Her special medical practiceShe wanted to provide longer dates – but she still achieves sufficient revenues to make the work work.
Star said: “I felt a little torn,” Star said. Although her dream is to provide high -quality care in a small practice, I should do so in a way that I must charge the shipping of people, as well as the insurance that pays it. “
Star said that her fees are $ 3600 annually, and the patient’s burden will be loaded on 200, much less than 1000 or even 2000 patients who have some doctors. But it still has not reached itself.
“There are definitely there are some people who like to join and cannot join because they have a limited income,” said Star.
Many doctors who switch to concierge medicine say that the membership model is the only way to obtain a kind of personal relationship with patients who attracted them to the profession in the first place.
“It is a way to practice self -preservation in this field, both patients and doctors are punished.” practice Providing “Direct Primary Care” in Northampton. The initial care model is similar to the care of the concierge in that it includes imposing repeated fees for patients, however Direct care Insurance companies completely overcome.
Taylor patients, who were crowned 300, paid $ 225 per month for basic primary care visits-and they must have healthy insurance to cover care such as X-rays and medicines, which are not provided by their practice. But Taylor does not accept insurance for any of its services, which provides its administrative costs.
“We get a lot of retreat because people say,” Oh, this is elitist, and this will be within the reach of people who have money, “Taylor said.
But she said that the traditional primary care model does not work. “We cannot spend much time seeing many patients and documenting this way to get an additional $ 17 from the insurance company.”
While a lot of decline in the membership model comes from patients and politics experts, some resistance comes from doctors.
Paul KarelanThe primary care doctor who runs Valley Medical Group In the west of Massachusetts, his practice said more than ever. One of the reasons is that the group clinics absorb some of the patients who lost their doctor in concrete medicine.
“We all contribute through our tax dollars, which funds these training programs,” Carlan said.
“Thus, to some extent, people who practice health care in our country are a public interest,” Carlan said. “We must be concerned when people make decisions about how to train in ways to reduce their ability to present this good to the public.”
But Taylor, who has direct initial care, said it is not fair for doctors to demand the task of reforming the dysfunctional health care system.
Taylor said: “Either we do something like this, or resign,” Taylor said.
This article of partnership includes Public media in New Englandand NPRAnd KFF Health News.