Last Word

September 17, 2004

The country can't afford boutique medicine

An announcement in a medical journal caught my eye recently. It was advertising a conference on boutique medicine, and it went like this: "After this meeting, you, too, will learn how to enjoy being a doctor again. You, too, will know how to see fewer patients, make more money, reduce insurance hassles, and gain more personal time!"

As its name implies, a boutique practice (also known as a concierge practice) focuses on providing a select number of patients with an enhanced level of service—year-round 24/7 access, coordination of care, executive physicals, and so forth. In return, doctors receive a pre-established fee or retainer, ranging anywhere from $1,500 to $20,000 a year.

I'll admit it: such an arrangement seems pretty enticing to a family doctor like me—someone who over the last three decades has cared for patients of all economic and ethnic backgrounds but who in recent years has felt the joy of medicine slipping away in the midst of many obstacles. After all, who wouldn't like seeing two or three patients an hour, instead of six or seven? Or having 30 to 45 minutes to spend with each of them, instead of less than half that time? Or having a guaranteed annual income of more than $150,000?

Yes, I'd love to practice this kind of medicine, less frustrated and shackled by the regulatory and third-party constraints so many of us now commonly experience on a daily basis. I'd love to have whatever time I needed for my patients, so that I could go home each night feeling what I always used to feel—the pure joy of being a family doctor for all my patients and making a real difference in their lives.

Could my current patients afford this level of care? Some, I know, couldn't even come close, but enough could to make it feasible for me to start such a practice.

Unfortunately, more than 43 million uninsured people in this country can't count on even a basic level of care, much less an enhanced one. Another 30 million or so have insurance, but it's inadequate for their needs. Minorities fare especially poorly in terms of adequate healthcare, despite our often feeble efforts to redress historic disparities in service. Compared to many other industrialized countries in the world, the US gets poor marks in nearly all measures of healthcare.

Don't get me wrong: I don't begrudge boutique practitioners the money they are able to generate for themselves. This is, after all, a country that still prides itself on its free-market economy and on rewarding entrepreneurial initiative. But whatever the enticements of boutique medicine, shouldn't we repair the rather large cracks in the foundation of our medical system first? Indeed, how can we cater to an elite few before we address the social injustices that touch so many?

Richard Roberts, a past president of the American Academy of Family Physicians, said it best a few years ago: "When physicians get into boutique medicine, it's a little like saying, 'Watts is on fire, so I'll move my house to Beverly Hills.' "

For now at least, I think I'll keep my house just where it is, despite the problems.

 

Robert Pallay. Last Word: The country can't afford boutique medicine. Medical Economics Sep. 17, 2004;81:76.