I'm heartbroken that I now have to scramble and scurry about looking for another primary-care physician after my primary-care physician decided to go "boutique." I have pondered a couple things First, if I could afford to pay for this kind of retainer practice, would I? Second, what on earth happens to those who can't afford to pay for this service?

Another question comes to my mind: Doesn't boutique medicine go against what most doctors are pledged to do, help people while ensuring equal access for all? Ultimately, this type of practice leaves those of us who can't afford the yearly fee out in the cold, abandoned essentially.

Doctors claim that they are doing this because they can provide "personalized health care." I'm sure that is true to some extent; however, let's face it, the doctor gets a pretty hefty up-front annual fee, which makes me ponder about the motivation for some of these physicians.

Another point to ponder: If almost all the primary-care physicians decided to go the boutique route then access to affordable health care would be jeopardized. Dr. Jonathan Fish stated in the Nov. 13 issue, "what are the ethics behind seeing patients for seven minutes apiece?" I ask, is it ethical to patients to be abandoned by their physician, just because one can't afford the hefty annual fee? Sure, the patients kicked to the curbside are given a list of physicians one can contact. However, the bond that has already been nurtured and valued over the long-term relationship with his/her physician has been thrown to the curbside as well.

I concur with Howard County health officer Peter Beilenson's statement, "It will stratify health care and then only the real 'haves' can continue to get the best care."

Ruth Dumont

Harper's Choice

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user comments (3)

user digitlnoize says...

While I agreet that this could be a problem for access, people need to realize that the current medical system is forcing the hand of primary care doctors (PCP's). In order to make a living, PCP's who accept insurance are forced to see patients far too quickly, in order to see enough patients in a day to keep their office open. Remember, not all doctors are rolling around cash. Docs also have ~$200,000+ of medical school debt (not counting undergrad!) by the time the start practicing... Doctors do take an oath to help people, but we do not pledge to provide access to care for all human beings. Docs who switch to a "boutique" model, are simply trying to find a way to spend the proper amount of time with their patients...to give them the care and attention they deserve. If access to health care is a universal right, then I suggest that restaurants also be forced to serve food for free. After all, isn't food more basic to human survival than health care? There are 2 ways out of this mess. 1. Raise the amount that PCP's are paid for see a patient. 2. PCP's switch to a cash payment model, just like the old days. Imagine, having to pay money for a service...what a concept! I agree that many boutique practices are very expensive. At the same time, I have heard of very reasonable fees being offered. $10,000 a year is way too much. $1000 a year is more reasonable. As more physicians open boutique practices, this amount will equalize to more accurately reflect what the market can bear. However, it is still somewhat dictated by the finances of running an office, starting family, and buying a modest house...all while paying of debt and still allowing adequate time with patients. The current system makes this impossible for PCP's.

Posted 4:31 PM, 11.26.08 | Permalink

user jb9054 says...

Ms. Dumont- You have several mistaken assumptions. First, having spent 9 years of my life in medical training (after college), and two plus decades in practice, I never heard anyone in the medical profession claim that we could or should ensure equal access to all. That phrase is often used by politicians who want your vote and tax dollars to spend as they see fit. What they promise is impossible- the only equal access is no access. Just as with food, water, housing, clothing, and other necessities of life, you get what you pay for. Government can help with paying, as with food stamps, rent vouchers, etc., but the government model for health care is the VA, which offers excellent care for veterans in some places, and awful or worse care in others (yes, I'm a veteran). You have not been abandoned, any more than your previous doc would have been "abandoned" if you had decided to switch doctors on your own accord. It is illegal and unethical to abandon a patient, but what your doctor did was change his business model to one that would allow his practice to survive. He invited you to come along; it's your call whether you accept his invitation. If he actually kicked you to the curbside, as you state, you should call the police and inform the state medical board. If that is only your inflammatory way of describing him making adjustments in how he runs his practice, please consider how this attitude will affect your relationship with your physicians in the future. Up until now, you have been subsidized by your doctor- he has taken money that he has earned taking care of other patients and applied it to your care, instead of using it for his own purposes, which are every bit as legitimate as whatever you spend your personal funds on. That was feasible in the past, but every year his expenses go up, and reimbursements from insurance companies go down. Our profession has to fight hard to keep Medicare fees stable, and they are typically less than what it costs to run the office. Physicians getting away fro Medicale and insurance companies find that they can give better service at lower cost. What's wrong with that?

Posted 3:32 PM, 11.27.08 | Permalink

user dynamite says...

You know what this kind of sh** happens right? clinics ain't importing enough devices in proper prices. they only get local products which might be OK for the economy in general - but than they short in cash and that's wassup. Why don't they getting a medical monitor from Israeli "Oridion" for that matter? It is developed in Israel with offices in the US, could save lots of money and is still very effective.

Posted 7:29 AM, 01.29.09 | Permalink