MANAGING CONFLICTS OF INTEREST – PRIMARY CARE

A family physician becomes increasingly frustrated with his medical practice. He notes that his income has decreased, relative to inflation, over the past twenty years. He also notes that the time he is able to spend with patients had decreased – now thirty minutes for new patients and about ten minutes for established patients. Two of his long-standing patients are also frustrated with his practice. They complain about the long wait to see him and the decreased time for the visit. Both of these patients suggest that the family physician consider starting a retainer or “boutique” medical practice. This type of practice would increase the physician's income by requiring patients to pay a retainer fee and would allow him to spend more time with his patients. The physician considers this change.

A Perspective from a Family Physician

Control of today's typical primary care practice has passed to third parties including Medicare, Medicaid, HMOs (health maintenance organizations), PPOs (preferred provider organizations), and employers since they, not patients, control the ever diminishing flow of funds to physicians and other providers of health care. Patients are churned, one problem at a time, with brief visits, to maximize ever shrinking third party per-visit revenue. Afterhours and hospital care is shunted to the emergency department and to hospitalists. The former financial and personal rewards of practice are now replaced by frustration and bureaucracy. As a result, primary care, the indispensable backbone of our profession, is crumbling. Concierge medicine is the rational reaction to these realities.