IT TAKES TIME TO HEAL [Business, North Carolina]
By Martin, Edward | |
Proquest LLC |
She drives 20 minutes from downtown
More local artwork. She climbs onto an exam table covered in fresh linen.
A few years later, Tribble will sell her business, retiring at 50, then re-emerges chief of events planning for the 2012
Practicing medicine this way is but a sliver of
To get that, patients pay a premium. In
In 2003,
Rushing through patients and appointments can result in burned-out doctors and be reflected in mistakes, missed diagnoses and even subtler ways. "Research shows that when doctors prescribe antibiotics for sore throats, it's typically inappropriate," says
This is what private practice has become for many primary-care physicians, and why, its proponents say, concierge medicine is gaining popularity. It is a weekday afternoon in the office of a 62-year-old internist in a traditional practice. Pacing in a hallway, he scans records of a patient with a racking cough, nausea and dizziness and finds he had prescribed the antibiotic cefuroxime axetil two weeks before. He opens the door to a room dominated by a worn exam table sheathed in tear-off paper, its gray walls bearing vivid posters of intestines and inner ears. "Projection of heart valves and auscultation points on anterior thorax," one reads. Above it all hangs a faded portrait of
At Signature, Silverman's day is little like that. It includes two physical exams, from an hour to an hour and a half each, followed by a consultation with a new patient for an hour, interspersed with several sick-patient visits - a sore throat entails a 30-minute examination - and several follow-up visits. Patients are guaranteed same- or next-day appointments, and if they become sick or injured after hours, their calls will be answered by him or one of the practice's other three doctors. Recently, an executive boarding a plane for an eight-hour business flight discovered she had forgotten an important medication. "We took it from them," practice manager
In
"This kind of practice has extended my career, improved my health, I think it has probably extended my life," he says. If so, there's evidence concierge medicine might be having a similar effect on patients. In 2008, an independent study of 500 MDVIP doctors - the VIP nominally stands for value in prevention, though it's obviously a marketing double entendre - showed only 119 per 1,000 of their patients were hospitalized each year. That's about half the rate of traditional practices, despite MDVIP patients frequently having chronic or multiple medical problems. The numbers are no fluke.
On a recent Saturday morning,
week later, with no emergency-room visit, he is back to normal.
Carroll, who with wife Vivian has a family membership that costs them upward of
His doctor almost certainly was frustrated too. A recent study by the
If Carroll was sick of conventional medical practices, he had company. Many of the doctors who've switched feel the same way.
A
Paradoxically, the stampede might be driving up costs. One reason is that primary care providers often refer patients to specialists because they don't have time to diagnose them. In the South, specialists averaged
The treadmill can hamper care quality in unexpected ways. Physicians say patients in conventional settings are surprisingly considerate, reluctant to ask important questions if doctors seem harried. "Just about every patient that comes to see me has a relationship with a great doctor they think the world of," Silverman says. "But he's been slowly crushed over the last 10 years. They say, 'Look, he's getting killed, and I'm going to get killed.' "
Switching to retainer-based medicine is not, however, without financial, ethical and professional challenges. Lee, "frustrated with a high-volume practice" in which he treated as many as 30 patients a day, joined MDVIP in
Lipton, Perry and
Queens University of
Overhead costs at a retainer-based practice might be double or more those of bare-bones clinics. Signature patients, for example, get freshly laundered, blue terry-cloth robes and gowns, snacks and beverages - when they don't interfere with treatment - and other pampering. Each of the four doctors has a nurse, the practice has its own radiology technician for in-house X-rays and labs for routine tests, and there's a referral coordinator for specialists and procedures such as mammographies and colonoscopies, plus positions unknown in conventional practices, such as a patient-relations specialist who does tours for prospective members.
About 75% of revenue comes from membership fees, and though practice officials decline to discuss details, that could top
As a trend, though, retainer medicine is less than tranquil. The nation's second-largest physicians' group behind the
Its practitioners, however, say its elitist image is undeserved, and criticism that it's a step in the wrong direction, limiting access when patient numbers are soaring and there's a shortage of doctors, is a misdiagnosis. Same for accusations that it creates a two-tier health-care system, one for the rich and another for those who aren't. "People who say that obviously aren't paying attention to what's going on in medicine right now," Silverman says. "We live in a four-tier system, even without talking about concierge medicine. At the bottom you've got
Lee says the impact of private medicine on health-care access is exaggerated, overlooking the fact that humane schedules entice more like him to postpone retirement and attracts more medical students into primary-care medicine. "They're smart," he says. "They know they don't want to work as hard, the long hours. Only 3-to-4% at Chapel Hill plan to go into primary care, but I have students rotate through here and, after, they all say they'd consider it." Concierge medicine, though, will ultimately stand on the strength of its consumers.
Miserable and shaky,
If concierge medicine is the future of health care, Tribble says, it might be because it's a throwback to the past. "What they're doing is practicing the kind of medicine we knew in the '50s and '60s."
Copyright: | (c) 2012 Business-North Carolina |
Wordcount: | 2819 |
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