Many MD’s are charging annual fees of $2,000 to $25,000. Finding a doctor you can afford and trust.
By Sally Wendkos Olds
A friend on the Upper East Side who described her long-time primary care physician as “my example of a perfect doctor” recently received a letter from her doctor explaining that due to the increasing number of her patients she was not able to provide each individual with quality time and care. Therefore she was going into a “concierge practice” and charging each family an annual fee, a move that would decrease her patient load, make it possible for her to spend more time with patients, and cover her expenses.
More and more New Yorkers are receiving letters like this, with annual fees ranging from as little as $200 per year up to $25,000 a year. The typical annual fee is about $2,000. Concierge care (also called boutique medicine; membership, retainer or platinum practice; and contract care) is relatively recent: The first such practice in the U.S. was established in 1996; between 2005 and 2010 the number of concierge physicians grew 900 percent. Over the past year the number increased 30 percent, especially in big cities.
Barbara Lovenheim, editor of NYCitywoman.com, had to make this decision when her trusted doctor of 25 years went concierge. Since Barbara and her partner considered her doctor thorough, responsive, and trustworthy—and knew that he was overworked—they decided to pay the fee (a two-for-one of $1,000 each). And since her MD accepts Medicare and other insurance for procedures and does not charge for an annual physical exam, the new fee is affordable and well-worth the improved service.
What is this improved service? Usually it’s the ability to get an appointment the same or next day, email or cell phone access to the doctor, longer face-time during visits, and extended office hours. Many of us expect this from any doctor—and sometimes we get it—but increasingly physicians feel they cannot offer these services under current reimbursement plans. As Marc Spero, a Manhattan MD, told me, “I used to be a physician—but over the last 10 to 15 years, I have become known as a ‘provider’ and my patients have become ‘healthcare consumers.’ I found myself running faster and faster, and although I had resisted switching to a concierge model because it seemed elitist and unfair, I came to recognize that by seeing fewer patients I can give them better service, the kind of care I went into medicine to offer—and this gives me the most satisfaction.”
Dr. Spero bases his annual fee on a patient’s age and he offers full- or half-scholarships to long-time patients. Some doctors ask only patients they consider “high maintenance” to pay fees. Some patients, like West Sider Joan M., whose doctor, Tina Dobsevage, MD, asked for a fee of $700 so that she “could give her patients the necessary care and time,” was able to pay less after speaking to the doctor. “I’ve been very happy with my health care,” says Joan. “Dr. Dobsevage has always given me good service and it’s still good. She’ll even come to you if you need her to. I had to leave her at one point because she didn’t take insurance, but now I’m on Medicare and she takes that and my supplemental.” Many concierge doctors take insurance, including Medicare; some still require a co-pay for each visit.
There’s also another model for medical care in Manhattan. My own doctor, Margaret D. Lewin, belongs to the Independent Doctors of New York (IDNY), an association of physicians who provide “concierge medicine without annual fees.” They don’t accept commercial health insurance plans, but otherwise they differ in their policies. Some, like Dr. Lewin, accept Medicare as, she says, “my civic duty.” However, she requires new Medicare patients to sign up for a complete physical exam (mine lasted two hours), for which they pay a one-time fee not covered by Medicare (currently $1,200).
While most long-term New Yorkers already have primary physicians, doctors move or retire, patients move or their needs change, and finding the right doctor can sometimes seem as hard as finding the right life partner. I chose my doctor based on the recommendation of a good friend who’s a health-savvy physical therapist; then I researched the doctor online.
After Marilyn Goldstein moved from Long Island to Chelsea, she asked everyone she knew for internist recommendations. Then she read a report in The Caring Times, a health-oriented newsletter of the NYC chapter of The Transition Network (an organization for women over 50), describing one TTN member’s good experience with One Medical Group (OMG), an organization of physicians that has six locations in NYC and charges an annual fee of $200. However, Marilyn didn’t feel her needs were met by the doctor assigned to her. One issue: the doctor wasn’t able to recommend specialists. “Nor did she even suggest that if the sciatica complaint I came to her with did not improve—and it did not—I could get help from specialists,” said Marilyn. “All she offered me was a painkiller.” Then, through a gym friend, Marilyn found a non-concierge internist who seemed to provide all services: She takes Medicare, does not require an annual fee, and calls her patients personally to review test results “even if they’re all okay,” smiles Marilyn. “How can you beat that?”
In contrast, West Sider Molly Sugarman is happy with the OMG practice on Fifth Avenue. She had a long get-acquainted conversation with the doctor assigned to her; she has always seen Molly within five minutes of the appointed time and has never seemed rushed. Molly can also go to doctors at other OMG offices, where her records are available electronically. Molly finds OMG patient-centered and the doctors responsive to questions and explanations of lab results. OMG also takes Medicare and other insurance and submits paperwork.
Bottom line: What should you do? If your doctor goes concierge, should you sign up? If you really like your doctor, if you want the extra level of service, and if you can afford the fee, signing up is basically a no-brainer. However, you may not feel comfortable participating in this upper level of two-tier medical care, an issue that now joins many other ethical questions about health care today in the U.S.
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EXAMINE YOUR DOCTOR
If you do want to opt into a concierge practice, you should first schedule a consultation. If you’re seeing a new doctor, you want to be sure you’ll feel comfortable and happy with the chemistry between the two of you. Whether you’re talking to a new physician or your current one, you should ask a few pointed questions, like the following:
How much is your fee, and is it per patient or per family?
What services does the fee include?
Do you take insurance and will you file claims?
Am I still responsible for a co-payment with every visit?
Do you take Medicare?
May I pay your fee in two installments, a few months apart?
What kind of service will I get if I don’t pay the new fee?
Do you offer preventive care?
Can I get same-day appointments for urgent issues?
Can I contact you by email or your cell phone with routine questions?
Will you coordinate my care if I need one or more specialists?
Do you make house calls? [Amazingly, a few concierge doctors do.]