Concierge Medicine

Columnist questions ethics of "concierge doctoring."
In the New York Times (8/27) Doctor and Patient column, Pauline W. Chen, MD, discusses concierge medical practices in which patients pay a monthly or yearly retainer to guarantee "around-the-clock access to [a] doctor, appointments within 24 hours of calling, longer office visits, and...personalized attention and care coordination." Over time, "the debate about the ethics of concierge doctoring has grown more heated, with more and more physicians unabashedly lining up to take sides." For example, "an editorial in the Annals of Internal Medicine this spring...questioned not only the ethics, but also the quality of care delivered in such practices." Chen wonders "whether it is possible to practice in a way that reconciles concierge medicine with all the ethical concerns."
Tufts Medical Center uses concierge retainer fees to provide free care to impoverished patients. The New York Times (8/26, Tara Parker-Pope) "Well" blog pointed out, "Although patients often sing the praises of concierge medicine, the medical community is grappling with the ethical concerns of creating two different levels of medical care for the haves and the have-nots." But, physicians at Tufts Medical Center in Boston have come up with a practice model that benefits both wealthy and poor patients alike. Since 2004, primary-care physicians there "have offered patients the option of being part of either a traditional general medical practice or a retainer practice." The $1,800 yearly retainer fee paid by the concierge patients "is used to support the traditional general medical practice, the teaching of medical students and trainees, and free care to impoverished patients."