“Direct Primary Care” physicians

[iris lilies]

I’m thinking about going to one of the physicians who charge a membership fee. I just reviewed a couple of them on their websites. Coincidently they are both female and they have the same last name. One is in Hermann and one is in a suburb of St. Louis. Anyway – these fees seem very cheap to me and I’ve heard the concierge physicians were more like $2,000, $3,000, $4,000 a year.

Both of these doctors charge “$75 a month” which seems super cheap. The doctor in Hermann says she limits her practice to 600 patients. Actually that sounds like a lot to me. The one in St. Louis doesn’t give the size of her practice but she says it everyone gets her cell phone number and she returns calls the same day, she turned off her phone for one hour per family dinner time but otherwise she’s available by phone.

What do you health professionals think of a $75 a month membership fee for access to a physician? Both of them claim their typical patient visit is 30 minutes to one hour.

[Gardnr]

These docs are making $45k/month. No coding. No insurance claims. No paperwork for those. Entries in your medical record is it. Overhead for the employees who do that doesn't exist.

If you only get an annual wellness exam and have no chronic conditions, then it is more costly.

For a PCP, I think it's decent for someone who needs a doc with some regularity or frequency! $900/year for all the dr appts you might need. Ask if you will pay for blood tests, xrays etc or are those provided in the office or if those are an exclusion.

A little more research is needed.

[ApatheticNoMore]

I guess it's worth it for managing chronic known conditions maybe? It does limit one a lot to one physician and paying a lot for that physician as well. In case one has ever gone to multiple doctors trying to get a diagnosis, the limits of that are obvious (perhaps it is the limits of the HMO model too). Oh well maybe I'm the only one who seems to get symptoms noone can diagnose.

[catherine]

If I were in a place where it's ridiculous to get a doctor (I've had to wait months for a check-up), I'd consider a concierge service. Another benefit is more consultation time, instead of the 10 minutes some doctors give, because they are so overbooked and insurance capitation rates are so low. But I agree if that's 900 for one check-up a year and maybe the odd one or two things you have to go in for, that's a lot of money.

How "full service" are these PCPs? Could you take advantage of a wide range of testing, like EKGs? Another thing to consider is PCPs are largely gatekeepers and if you need a specialist, they refer out, and the specialist would not be part of the concierge plan. It's possible for specialists to diagnose and then send you back to the PCP for follow-up to maximize your use of the PCP, but that's another consideration. If you don't have any conditions that your doctor needs to follow every three months, I'm not sure it's worth it. I'm guessing it might be hard to get appointments in general in St. Louis, but Hermann?

[razz]

600 patients seems like a very small practice to me. My recently retired MD had 3,000 patients. I would go about every 10 years for a checkup etc. He called me the 'once in a blue moon' patient.
I can understand that PCP are trying to have a life and a reasonable income because 5-10 minutes appointments are frustrating for everyone. Not sure that an hour is usually needed though.

Since so many drugs and diseases require specialized knowledge for up-to-date treatments, referrals are often needed. Is this any different than seeing an MD under the usual scenario?

Not understanding the US health system coverage, what are the pros and cons of having a PCP on the basis you are considering?

[Rogar]

I am actually unfamiliar with a concierge type system, but I have had a handful of slight complications where my PCP immediately sends me to a specialist, which I assume would then cost extra. I could be tempted to try it if I visited the doctor more often and might even look into it for myself. My quick 15 minute annual physicals and occasional office visits seem cursory.

[Tybee]

I would totally try it--sounds great to me. I looked into it here but the doctor is too far away, an hour and a half drive. If I had one local, I would do it.

[rosarugosa]

DH & I have a wonderful PCP. One of his colleagues at the practice has a concierge type practice now, but Dr. H told me he doesn't really believe in the concierge model. He hasn't been taking new patients officially for years, but he took my mother and sister at my request, so he treats my whole immediate family now. I went to see him with Mom recently, and he said to me, "You have my cell phone number right? You know you can call me over the weekend any time if you need to." We are really lucky to have him.
I have also noticed that he is usually running behind schedule (they post their wait times in the office). The other MD who always runs behind is DH's second favorite in the group (he has seen him in Dr. H's absence for an acute situation). I have a half-baked theory that the MDs running behind schedule are often the better ones because they give their patients extra time when needed.

[JaneV2.0]

If I had a condition that required a lot of doctor's appointments, I'd like to simply pay for them. Barring that, I'd prefer a concierge or similar system. I hope eventually (probably not in my lifetime) our medical-industrial-insurance cabal will be replaced by something humane, affordable, and efficient.

[Teacher Terry]

I usually only go once a year to the doctor. Although I had one bad year where I went 17 times. But I have a few specialists that I also have to see once a year so wouldn’t be worth it for me.

[iris lilies]

I don’t look at it as a dollar-value-per-visit option. I see it more as a a quality experience of less management/more physician interaction, and hang the cost which in these cases doesnt seem to be that much.But yeah, costs of the in- office medical tests need to be detailed to make this decision.

[Rogar]

From my personal experience and from stories from acquaintances it's a little hard to find a good doctor who will take new patients and/or whatever insurance plan a person has. Stories are it is even harder finding a doctor who takes medicare. I'm middle of the road with my PCP. He has always given good advice but is quick with answers to questions and my comfort level with him is just ok. Doctor quality would be a big factor if I were deciding. It could be the concierge plan gets past some of those issues?

[Teacher Terry]

I love my doctor and she spends all the time you need. I only see her in the morning because she gets behind.

[Gardnr]

600 patients seems like a very small practice to me. My recently retired MD had 3,000 patients.

This is a guaranteed income of $45k/month. Why take more patients? And yes, many docs have 3000 patients on the books. Many don't come in even once /year. But with GUARANTEED income, no need to have more.

[SteveinMN]

I have a half-baked theory that the MDs running behind schedule are often the better ones because they give their patients extra time when needed.
Consider your theory fully-baked: a friend of mine is a family practitioner at a suburban clinic with a large healthcare group up here and he says he is constantly dinged at reviews for "spending too much time with patients". :(

[catherine]

Consider your theory fully-baked: a friend of mine is a family practitioner at a suburban clinic with a large healthcare group up here and he says he is constantly dinged at reviews for "spending too much time with patients". :(

I agree. I LOVE our doctor--DH utilizes him far more than I do, but he spends a lot of time reviewing, talking, advising and even scolding, and engaging in good old-fashioned small talk. We don't love sitting and waiting our turn, but we know we wait because the people he's seeing are getting the same attention we know we're going to get when he finally gets around to seeing us.

[rosarugosa]

Consider your theory fully-baked: a friend of mine is a family practitioner at a suburban clinic with a large healthcare group up here and he says he is constantly dinged at reviews for "spending too much time with patients". :(

Thanks for corroborating, Steve!