Ethical concerns over concierge medicine


It's nothing new that doctors have to work harder these days. As insurance companies continue to cut doctor's reimbursement rates, physicians say they have to see more patients and spend less time with them. But Dr. Whitehill is even busier than normal, because a flood of patients are suddenly coming from nearby Dr. Peter Navolanic's practice.

Dr. Navolanic also was jamming his days with as many patients as possible. But he is opting out of the current system. He has just joined MDVIP, a company that helps doctors cut down on the number of patients they have to see by charging patients who already have insurance an additional monthly fee. Doctor Navolanic went from having 1,800 patients to 300. He now has much more time to spend with each one.

Yet this new way of practicing medicine is stirring up all kinds of ethical questions and is raising concerns about future problems.

"Every time I hear about it, there's this element inside me thats kind of like that's not a good thing. That is not a good thing for the community or for a practice," said Dr. Charles Whitehill, a Vallejo physician.

Dr. Whitehill says there aren't that many primary care physicians in Vallejo so the community will have a hard time absorbing the patients who can't afford fee based doctors. The fees added for this so called wealth care, also known as concierge medicine, can range from $1,000 to $20,000 a year. Ethicists are worried about what will happen to the orphaned patients.

"You actually may not be able to find a doctor - you may not be able to find a doctor who will take you into their practice as a primary care patient. That's the nature of the market place right now," said Dr. Clarence Braddock, a medical ethicist with Stanford.

But the trend seems to be moving in the direction of concierge medicine. There aren't any official numbers available of doctors turning to this practice. The American Medical Association doesn't track the number of fee-based practices and they aren't regulated. But those in the medical world say they are definitely seeing the trend. MDVIP, just one of many of these groups, has six times as many doctors now than it did when it started in 2001.

"I don't have a conflict bio-ethically or ethically over this decision - absolutely not. This is the best care that my patients will get anywhere," said Dr. Navolanic.

Dr. Navolanic says some of his low income patients have surprised him and stayed with him - even taking out second mortgages on their homes to pay for it. And in exchange for this retainer fee - he promises hour long physicals, house calls, a no-wait waiting room full of snacks and preventative measures such as screening for a variety of diseases, which he believes will keep people healthier in the long run.

"If you look at the health care savings, with this kind of care, there's no question it will pay for itself," said Dr. Navolanic.

Dr. Braddock says he can't blame patients and doctors for wanting a better system, but he thinks something will have to give, or those who can't afford it will suffer even more than they do now.

"I think what needs to happen is that the profession needs to think very carefully about how we as a profession, or maybe the legislators should regulate the growth of concierge's practice," said Dr. Braddock.

Insurance companies are pushing back, some have even dropped doctors who move into the fee based practice. But Dr. Navolanic will never go back to the old way of doing things. He says he'd rather retire than work in a healthcare system he believes is broken.

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