Boutique medicine vs. traditional care; Is it a benefit or a pay cut? The IOM proposes more hurdles
How do you tell a concierge physician from a solo family doc? The main difference I see is that the concierge doctors have figured out how to get rich practicing medicine ["How to set up a concierge practice," Aug. 22].
Like the concierges, I too have a small practice, about 500 patients who have access to me 24/7. And I also guarantee same-day appointments where I may spend up to an hour with a patient. I respond to patient e-mail, make home visits, meet my patients in the ER, and follow them when they're hospitalized, seeing them at least twice a day. I advocate for my patients to get the best consultants and care available. Basically, I do what family doctors have been doing for years.
The difference between a concierge doctor and me is that I do not charge a retainer for these services. I accept Medicare and private insurance and see patients from all socioeconomic levelsthe elderly on fixed incomes, struggling young families, working class, and a few well to do. All are treated the same.
Yet we family doctors are lucky to earn $100,000 a year; some of the concierge doctors are poised to make over $1 million.
Aletha W. Tippett, MD
Nothing boils my pot quicker than seeing marketing materials like the ones you used to illustrate how concierge practices promote their image. The ad showed a chart comparing the multitude of diagnostic tests and procedures provided in a "premium" practice's physical exam to the modest list of tests included in a "typical" physical.
A checkup isn't a reason to order every test under the sun. As a residency director, I've spent much of the last 12 years trying to get medical students and residents to own up to the harm done by ordering tests and exams without reason. It's never cheaper, safer, more convenient, or more ethical to do this type of indiscriminate testing on a low risk patient. The comparison chart pictured is exactly the kind of marketing rubbish that slick entrepreneurs pass off as high quality medicine. It's not. It's medicine for profit. It's wrong. And it has to stop.
Richard Neill, MD
In "Staff pay policies that work," [July 25] your consultant suggests that practices should give each employee an annual compensation report detailing fringe benefits that don't show up on the W-2. This will give staffers a sense of what each benefit costs you and what it's worth to them.
However, the downside to this idea is that if the cost of a benefit decreasesa new health insurance program with lower employer costs, for examplethe employee might perceive this change as a pay cut.
Michael G. Wiethorn
After reading "The IOM targets doctors" [Sept. 5] I was very discouraged. I believe that these new evaluation and recredentialing policies will only add to the burdens that physicians face every day. Andalong with the malpractice crisisthey will help convince people that medicine is not a good career choice.
It seems to me that the recommendations proposed in the Institute of Medicine's report are an extremely expensive way to weed out a very small number of bad physicians. The big question is who's going to pay for this? I'm sure the cost will be placed on the backs of the already beleaguered rank and file physicians.
One of the core findings of the IOM study is that medical schools and residency programs fail to prepare physicians to give patients the best and safest care possible. If that's the casewhich I doubtmaybe that's where change should be implemented.
Joseph M. Yasso, DO
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Letters to the Editors. Medical Economics Nov. 7, 2003;80:10.