In two weeks, McLean internist Dr. David J. Jones will be taking a giant occupational leap.
“As of April 1, I will no longer be accepting medical insurance,” he said. “That’s it.”
Jones is one of a growing number of doctors who are becoming increasingly frustrated with what they say is an inefficient primary care health system, and who are moving away from the traditional health care model into what is called “concierge medicine.”
Also known as “boutique medicine”, “retainer-based medicine” or “innovative medical practice design,” concierge medicine physicians charge their patients a one-time annual membership fee which is paid out-of-pocket instead of billing insurance companies for individual visits. Currently, the annual fee for patients in Jones’ Principal Medical Group is $2,000 for an individual and $3,000 for a couple.
“This fee enables doctors to limit the number of patients they see on a daily basis, allowing for a level of personalized care for patients often not possible in a traditional practice,” he said. “The average primary care physician has a typical roster of between 3,500 to 5,000 patients. On average, Americans spend 23 minutes in their doctor’s waiting rooms and only 19 minutes with the doctors themselves.”
There were about 4,400 concierge medicine physicians in the U.S.in 2012, a 25 percent increase from 2011, according to information from the American Academy of Private Physicians. Averaging roughly 350 patients per concierge doctor, the academy estimates there are probably nearly 2 million million Americans currently under the care of a concierge medicine physician today.
Jones argued that with physicians struggling to keep up with unmanageable patient bases, increasingly bureaucratic reimbursement issues and labor-intensive administrative chores, many don’t have the time to truly get to know their patients and treat them as individuals.
“And justifiably, patients are becoming increasingly frustrated with the impersonal service and time spent waiting, rather than their doctors actually working on preventing and caring for them,” he said. “On the other hand, with only 350 or so ‘membership’ patients, I can spend 30 minutes to an hour with each one, and get to really know each person as an individual. My patients can also call me anytime, after hours, weekends, while I’m on vacation, if they need a prescription refill, whatever.”
According to Dr. David Fein, an internist who in late 2012 opened a branch of the Princeton Longevity Center in Fairfax, current health care reform is only adding to an already overtaxed medical system.
Like Jones, Fein does not participate in any insurance plans.
“With health care reform, uninsured patients will no longer use emergency rooms as their primary care and instead will begin to flood the offices of primary care physicians, who will see vastly increased numbers of patients,” Fein said. “But reimbursement rates will also be less, so physicians will need to see more patients to remain where they were before financially.”
Fein said that as traditional primary care physicians see higher numbers of patients, the average time that most physicians will be able to spend with each patient — currently estimated by Jones to be 19 minutes nationwide — could shrink to less than five minutes.
“What I’m doing now is just what doctors used to do years ago,” Jones said. “Charging patients a fee for medical services and leaving everyone else out of the equation. I think you may soon see many physicians returning to that model.”
Jones has written a 25-page e-book on the subject, titled “Achieving Individualized Healthcare through Concierge Medicine,” in which he outlines the concept and its advantages. “It is not an advertisement for me or my practice,” he said. “It just explains more about the general concept.”
The e-book can be downloaded for free from iTunes, or at Amazon.com for a 99-cent download fee.