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Doctors Abandon Traditional Practice for Concierge Medicine, Hospital Employment

Posted on by Nu-living

For patients it’s about finding a dedicated physician whose only concern is the patient’s welfare, having no hidden agendas such as holding down costs to derive financial bonuses like the hated gatekeeper of the 1980s. For physicians is about keeping independent from the heavy hand of government run health care and being able to serve their patients needs.

The Palm Beach Post, on the growth of concierge medicine: “As health reform prepares to send another 32 million people into the already stressed health system, some say that concierge medicine is the future — where the wealthy see the best primary care doctors in a luxury setting, and everyone else makes do with clinics staffed by ‘physician extenders’ such as nurse practitioners. … More than 430 MDVIP [a concierge medicine company] doctors now practice in 31 states, seeing 138,000 patients. The growth, nearing 25 percent a year, persuaded Procter & Gamble to become 100 percent owner of MDVIP in December. Meanwhile, its concept has been copied, and some observers put the number of concierge doctors nationwide at 5,000” (Singer, 11/7).

Concierge Medicine Today: In 2009, an online media and news agency, Concierge Medicine Today, was created by entrepreneur and journalist, Michael Tetreault. Media outlets, like Concierge Medicine Today, are perceived to be more relevant and share more factual information when compared to web portals, blogs, independently owned physician web sites and group associations. Why? Because according to the Online Publishers Association, online news and media web sites provide more accurate, educational, informed, unbiased and comprehensive content. This relevance translates into a perception that brands (eg. Concierge medicine) found on media web sites are more informed, relevant, pre-screened and vetted than those found on generic physician directories randomly found on the Internet

“Concierge Medicine has a story to tell…no doubt,” said Michael Tetreault, Editor-In-Chief of Concierge Medicine Today. “That story is that these practices provide an affordable, cost effective and personal relationship with a doctor. Furthermore, I personally believe it is also a life-line to those primary care physicians across America considering alternative business structures for their practices. It [concierge medicine] is very attractive to just about any physician that wants their future in medicine to be rewarding and fulfilling in the years ahead.”

The Wall Street Journal: More physicians are choosing to work for hospitals rather than going into private practice. “The latest sign of the continued shift comes from a large Medical Group Management Association survey, which found that the share of responding practices that were hospital-owned last year hit 55%, up from 50% in 2008 and around 30% five years earlier. … The trend is tied to the needs of both doctors and hospitals, as well as to emerging changes in how insurers and government programs pay for care. Many doctors have become frustrated with the duties involved in practice ownership, including wrangling with insurers, dunning patients for their out-of-pocket fees and acquiring new technology.” Meanwhile, “[h]ospitals are also seeking to position themselves for new methods of payment, including an emerging model known as accountable-care organizations that is encouraged by the new federal health care law” (Mathews, 11/8).

Nu-Living Concierge Medicine in Action

Posted on by Nu-living

A 48 year old male patient, Mr. CS, came to see me with a complex problem which included feelings of depression, muscular twitching, weakness, fatigue and periods of memory loss. He has been a highly successful real estate business man but because of his illness, he was a risk of losing his job. He called me on a Saturday on my cell phone and related his complaints. After I heard his predicament, I logged onto my office computer from home and immediately scheduled him for a Monday appointment.

Upon his Monday visit, I was able to spend enough time examining him and formulating a diagnostic plan which was to see a neurologist as soon as possible. The wait time in my area for neurology consults is over 7 weeks. While CS was in my office, I called my neurologist colleague and pressed for an expedited appointment over the next 48 hours. I emphasized to the neurologist that I knew this man and something was definitely going on which needed rapid diagnosis and treatment. By the end of the week the patient had a diagnosis. Mr. CS had a history of multiple concussions while playing sports. His EEG revealed a form of epilepsy most likely related to multiple concussions. He was placed on anti-epilepsy medications and within two weeks he was much improved and able to work and focus.

The point of this example of Nu-Living Concierge Medicine in “real life” was the various ways the program allowed me to rapidly help CS. First, he was able to reach his personal physician by phone on a weekend. The Nuliving electronic medical record system allowed me to access my office on the weekend to schedule an appointment immediately. The limited member patients I see allowed enough time for me to thoroughly evaluate his case and to personally call and appeal to the neurologist for an expedited appointment. Finally, because I knew CS, I recognized that something very serious was occurring, an unlikely scenario in situations where patients see multiple physicians and don’t have one who really knows them.

Crisis in Primary Care

Posted on by Nu-living

Big changes are occurring in today’s healthcare environment and physicians already are finding it very difficult to practice high quality personal medical care. The adult primary care specialties of Family Practice and Internal Medicine are in grave jeopardy of becoming extinct. Years of declining insurance company and Medicare reimbursements, skyrocketing practice overhead and ever increasing red tape have led to a major shortage of primary care medical doctors as the current generation is shrinking due to physician retirement and the lack of interest on the part of young physicians to go into primary care. As a result, patients are experiencing more difficulty finding a primary care doctor, waiting longer for appointments, and visits have become shorter and rushed as doctors are forced to see more patients in an “assembly line”, impersonal fashion. Needless to say this is not good medical care for patients who need more time with their doctors.

A 2007 Primary Care Survey conducted by Merritt Hawkins found huge majority of Family Practice and Internal Medicine doctors believed that a severe shortage of primary care doctors will develop in 5-10 years because of lowered reimbursement and administrative hassles.

I, Medical Concierge Doctor

Posted on by Nu-living

Hello friends, my name is Dr. Alan Terlinsky and I am presently converting my long-established medical practice in Arlington Virginia into a concierge or membership type of private practice. Essentially I am making this decision in order to continue practicing the only type of medicine I have known… excellent medicine!

The Road to Being a Concierge Doctor

I attended Georgetown University School of Medicine where I completed my medical residency and fellowship in diseases of the kidney (Nephrology). I became certified by the American Board of Internal Medicine and certified in my subspecialty of Nephrology.  Along the way, in order to remain broadly engaged in general medicine and to support my young family, I moonlighted in emergency rooms and a US Army primary care clinic. I learned how to bridge the gap between super specialization, treating very complicated and extremely ill renal dialysis and transplant patients, as well as caring for patients with common medical conditions such as colds, coughs and skin rashes.

Guess what? The super specialization was easy compared to the broad knowledge I had to obtain to be a complete physician by practicing and mastering general medicine. Immediately after going into practice I began to alternate my continuing medical education courses between specialty areas and primary care. One meeting it was renal, endocrinology, cardiology, the next it was asthma, skin moles and low back pain. I choose to take courses completely out of my specialty of Nephrology such as in Rheumatology to remain diversely trained.

I can remember being at the annual meeting of the American Rheumatology Association. When my fellow attendees found out I was a Nephrologist, they asked me “why the heck are you at this meeting? Why not just worry about the kidney?“  I responded that I felt specialists were doctors who continue learn more and more about less and less and one day they woke up and knew NOTHING! They are “leaf “ doctors, knowing only about a much narrowed area as opposed to “root’ doctors who look for the basis of medical problems. I preferred to be both a leaf doctor (Nephrologist) and a root doctor (Generalist).

It was my goal to learn as much as I could about the developments in medicine and to teach what I had learned to younger doctors. I have had teaching appointments at two medical schools Georgetown University and George Washington University for my entire career, I have lectured to my peers and I have given many “Grand Rounds“ at my hospital. I did this and continue to do this to keep sharp and always up to date.

The Necessity of Time

While being informed and broadly updated in both Nephrology and General Internal Medicine was the key to having the skill sets for providing excellent medical care, another factor determined whether superior care actually was achieved. The factor was TIME! Yes, spending the time to obtain a detailed history and physical exam on a patient was absolutely required. The most brilliant physician will not provide proper care, particularly with complicated patients, if for any reason they cannot devote the time for proper evaluation, analysis and communication in treating patients.

It is very time consuming to carefully question patients about their symptoms and to assess the significance of their responses. The patient with chest pain could have anything from heartburn, to a pulled muscle or a serious life threatening heart problem. Patients always don’t provide clinical information in perfect, easy to interpret fashion. Some patients don’t understand what they are being asked. Others may have self diagnosed beliefs or wishes about the symptoms they have and will provide misleading information. Often patients will omit important information which will only be obtained by a careful and detailed interview.

Patients also need to be properly examined. They need to be placed in gowns and a systematic approach taken. Blood pressure and vital signs need to be recorded and all this takes time. How can a patient be screen for skin cancer if they don’t take their clothes off?  A single high blood pressure reading does not mean the patient has hypertension. The reading needs to be taken a few times and again it takes time.

Over the course of my career, I have avoided any situation which compelled me to skimp on time with patients. Factory assembly line clinics or capitated HMOs demanding doctors see “x” number of patients per hour was, and never will be, my style. Excellent medical care breaks down under those circumstances. Sadly, the economic and governmental forces of the past 25 years have demanded that physicians take less time with patients. As we will, see, today doctors are to the point that if they don’t drastically increase patient volume during office hours they will not survive economically.

This has resulted in the 5 minute visit, the maximum of one complaint per office visit, the increased “outsourcing” of patients to specialists by referring anything which may be time consuming to treat. This is all because doctors have been so squeezed by insurance company reimbursement and governmental program reimbursement like Medicare that they are actually losing money when they take the time needed for proper patient care. The result is deteriorating, inefficient care which fails to provide what patients need.

My Choice

Instead of going that direction, I have chosen the concierge medicine model which preserves the ability of a doctor to provide the best care to patients. This is because concierge medicine does not penalize the doctor for taking the time necessary to properly.

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