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A doctor writes about why his patients come to him, even though he doesn't accept payments from insurers.
I sympathize with the sentiments expressed by William M. Gilikson, MD in his letter (“Changes in Medicine Lead to Retirement Decision,” May 10, 2014) in which he mentions many of the encumbrances and frustrations which caused him to retire from practice.
However, I would like to offer an alternative practice model which I have been implementing successfully for the past 29 years in my private family practice in San Diego, California, which even in this crazy age still allows me to love practicing as a family physician.
My wife and I received our medical training in South Africa, and emigrated to the U.S. in 1981. We did some additional training in the U.S. to obtain the required licensure and in 1985 opened our practice in San Diego together.
Within the first year of opening our office we realized that it made no sense for anybody other than our patients to decide how much our services were worth. We therefore decided to not participate in any insurance arrangements at all (including preferred provider organizations, Medicare and everything else), and requested full payment from all our patients at the time of service.
When our patients left our office having paid the bill in full, they had a very simple question they needed to answer. “Did I get value for the price I paid, or not?” If they felt they did, they would return again. If not, they would not return and we would have been out of business many years ago. They have been returning for 29 years.
All our patients have insurance, but our fees are significantly higher than any insurance allowables, and the superbill which we give patients to submit themselves permits the patient to receive whatever their insurance may decide to pay. We do not get involved in this decision.
We do not intend to EVER use electronic health records, and we are not board certified, so the concepts of “recertification,” “meaningful use,” “medical home,” “Obamacare,” etc. have no place nor meaning in our lives or practice.
We are not a concierge practice in that we don’t ask for any retainer, nor do we limit the number of patients we are prepared to accept. We will see anybody, any time.
Since all of our patients have insurance, they all have many other doctors they could choose to see and pay them much less than they pay us.
So why do they choose us? To quote Dr. Gilkison, “All they care about is having a physician who cares about them, responds to their needs, answers their questions, and gets them well (when possible).”
The tragedy is that such simple, time-honored qualities have become the exception rather than the rule.
Neil Berkowitz, MD
San Diego, California