Three years ago, Dr. Wayne Benjamin — then 67 years old — was considering retirement. He was worn out, frustrated with the daily grind of his family medicine practice and the increasing pressure to see “more and more patients in shorter and shorter” amounts of time.
Then, on a whim, he decided to attend a seminar about an alternative practice model. The event was hosted by some company called MDVIP, and it introduced Benjamin to a new way of practicing medicine — although he and many of his peers prefer to think of it as “the old way.”
It’s called concierge medicine, and it hit the spot for Benjamin. He decided to start a new practice with MDVIP, a national network of concierge doctors. Now, he says, he’s happy he didn’t retire.
The concept of concierge — also called retainer or boutique — medicine has been around for at least two decades, but it’s recently been gaining traction among both physicians and patients who crave a health care relationship that hearkens back to the days of house calls and leather doctor bags.
Under the concierge model, patients pay an annual or monthly retainer fee to the physician, who sees a fraction of the number of patients a traditional doctor would. In return, patients get much more attention, including longer, unrushed exams (often at least an hour) and same- or next-day appointments.
Concierge physicians also make themselves available by phone or email 24/7 for patients, who receive the doctor’s personal cell phone number and email address.
“Patients don’t have to call an answering service,” Benjamin said. “They get me directly.”
Previously reserved for the ultra-wealthy — and still somewhat dogged by a reputation as elitist — concierge medicine is now becoming more popular among middle-class individuals, according to several physicians and other experts.
Multiple factors are driving the trend, including the surge in high-deductible health plans, which affect consumers’ medical-spending habits.
And, as more people get health insurance — thanks to the Affordable Care Act — physicians are being stretched thin by the increased demand. For many doctors, concierge medicine provides relief from those pressures.
“[Concierge medicine] appealed to me because at my age, I thought it was a nice way to practice,” Benjamin said. “You’re not in a rush to see people, so you can take your time and enjoy the relationship with a patient.”
At many concierge practices, the retainer fee covers a core set of medical services, like annual checkups, a certain number of follow-up visits, EKG tests and other primary care benefits. But, at some practices — particularly the early ones — patients pay for each service rendered, in addition to the retainer fee.
When people think of concierge medicine, many think of the latter model. But those practices are not what’s driving the sector’s growth, according to Paul Gurny, a former Medicaid director in Maryland who now teaches the business of medicine at Johns Hopkins University.
“Physicians who say, ‘Give me $2,000 bucks a year just to have access to me, and then pay me again when I actually see you,’ that will fall by the wayside —they won’t last,” Gurny said. “That’s not a very good business model. If you’re going to charge something, you have to give something in return.”
These days, new concierge practices tend to target middle-income earners who could feasibly find room in their budgets for health care that’s billed as more personal, comprehensive and convenient, said Gene Ransom, CEO of MedChi, Maryland’s medical society.
“This isn’t just for rich people anymore,” Ransom said. “We’re seeing more and more docs looking into this as a way to practice, and now more than ever, they’re looking at the middle-income bracket.”
One reason for that, said Ransom and others, is that more health care plans now come with high deductibles. That means consumers are stuck paying thousands of dollars out-of-pocket before the insurance kicks in.
Concierge medicine can mesh well with that structure. Here’s why: Most concierge doctors do not bill insurance; patients pay the annual fee and any additional expenses in cash. Depending on the doctor and the insurance company, patients can put some of those cash expenses toward meeting the deductible.
Dr. Alexa Faraday, a concierge physician in Towson who switched to the model four years ago, said many of her patients use funds from a Health Savings Account to pay her $1,600 fee. (People who pay all at once only owe $1,520.)
But for that to work, physicians must itemize the medical services they deliver. Portions of the retainer fee that cover “membership benefits” cannot go toward the deductible or be paid for with HSA funds.
For example, Faraday’s fee includes a yearly physical plus 11 follow-up visits, an annual flu shot, EKG testing and gynecologic exams. It also includes optional house calls, “24-hour direct access” to Faraday, “unhurried appointments” and similar perks.
Parsing out which of those benefits are HSA-eligible can get tricky, so many patients don’t bother using insurance at all. As required by the ACA, they still hold other coverage for specialty care or emergencies.
Judy Funk, a 61-year-old retired accountant, had been seeing Faraday for more than a decade when the physician decided to switch to concierge. Funk went along for the ride, saying “at that point, the fee was worth it.”
“For me, concierge medicine is all about value and relationships,” Funk said. “I’m getting a lot of value for that money. It’s coordinated care, and it puts my mind at ease knowing I can reach her whenever I need to.”
Funk said her last physical took about half an hour, but that Faraday then spent “at least another hour and a half” discussing health, nutrition and other concerns.
“This attracts people who want a higher level of service,” Faraday said.
But is it affordable?
Of the more than 5,500 concierge physicians nationwide (including more than 100 in Maryland), more than half charge $135 a month ($1,620 annually) or less, according to Concierge Medicine Today, a trade publication that also has a research arm.
Though that’s the low end of the industry, those expenses would still be unaffordable for many. That’s where the criticism comes in.
“One concern is that if a large number of doctors end up in concierge, it’s going to exacerbate the physician shortage we already have,” Ransom said, because concierge physicians severely limit their patient loads.
Benjamin, the Chestertown doctor, said he used to see 1,200 patients. Now, he only has 250. Similarly, Faraday went from 1,500 patients to fewer than 200.
Furthermore, Gurny said, the rise of concierge medicine may perpetuate a two-tier health care system in which affluent individuals pay extra for better care while everyone else pays the going rate to see increasingly overburdened doctors.
But, Gurny said, the rise in demand for concierge docs might end up making the service more accessible.
“As more physicians start doing concierge, they’re going to start competing on the retainer fee, the services they offer, the access they offer,” Gurny said. “If you want patients to come to you, you’re going to have to lower your price.”