This is what a New York Times reader asked the Times ethicist a few days ago:
“Should I Feel Bad About Joining a Concierge Medical Practice? I can afford the membership fee, but I’m torn about the ethics of being part of this growing trend.”
Regarding “concierge” medical practices, this woman asked a pointless question, and got a lengthy dissertation on ethics by columnist Kwame Anthony Appiah. Which also was way off the point but Appiah, a professor of philosophy, isn’t a medical, science or business journalist who should have more and sharper things to say about “concierge” medicine.
Back in 2022, I was thrust abruptly into a personal experience with “concierge” medicine when my own internist went all “concierge.” I wrote about it and am linking my pieces, below.
There’s a lot to say about physicians who go “concierge,” and none of it is good.
But the best expert opinion was my sister’s. We call her Doctor Deb. She is a nephrologist in New Jersey and has grown fighting mad about the state of medical care in the U.S. Here’s what she wrote about it:
I agree [with me, about “concierge” practice] except to paint a slightly more jaundiced insiders view. VERY FEW of these concierge physicians deserve concierge fees. Too many are greedy mediocre physicians who always valued their income and lifestyle over commitment to delivering best care to their patients. I know of ophthalmologists and neurosurgeons who have reaped incomes in the millions of dollars each year. This is often way above paying the rent and malpractice costs. Many of my highly esteemed peers have been delivering what’s now labeled “concierge care” for years.
We were not facing economic hardship. We understood that the great satisfaction which comes from the best practice of medicine is sometimes worth more than dollars and cents. Most of our incomes were more than sufficient without “extorting” extra fees. Those who practice with caring are the physicians whom I hold in highest esteem. They are the many who went into medicine for all the right reasons: the honor of providing comfort and saving lives.
I do not mean to underplay the higher and higher costs of obtaining a medical education and those of staying in practice. These are mounting concerns for all of us. Economics are resulting in terrifying shortages of primary care physicians and some critical specialists who are perceived by medical students as working too hard for insufficient incomes. That is an entire other subject, i.e, training medical students in a “9-5” model of care.
Physicians missed the boat when they allowed themselves to be prostituted by big business. This completely deranged construct of the “business of medicine” which accepts profiting from others’ misfortune as perfectly fine, is what is destroying healthcare today.
Physicians should have understood that WE are the necessary foundation of high-quality care and should have unionized years ago. We should have demanded our rightful place at the head of the table to structure healthcare delivery and negotiate fair fees. We failed to do so due to many disparate goals and some unscrupulous greedy physicians there, too. To now make unwitting ill patients suffer in some game of musical chairs to reclaim power and an upper class CEO lifestyle is unconscionable and unprofessional.
Beware of this VIP con. This is extortion plain and simple in a world where physicians understand there’s a dreadful shortage of true professionals going into primary care and patients have no control over any of this mess.
The links to my own take-down of this subject:
Help! I Lost My MD, or How I Was Introduced to “Concierge Medicine”
What does “concierge” medicine claim it offers us patients for the exorbitant annual fee? And why the claim is devious and disingenuous, sort of like TV ads for many drugs.
“Concierge” medicine, the last sales pitch. (Or was it?)
It wasn’t.
I want to emphasize that this “business model” called “concierge” medicine was not developed by your physician. I’ll say it again: the letters and pitches I received were from a company, i.e., a profit-making company. So call this insidious thing what it is: a capitalistic con job, a sales pitch for a “product.”
The initial con is upon our physicians, the ones who are foolishly flattered by the slimey business pitch. I’m going to guess that these companies’ first approach to the physician says something about “for a small percentage of your newly high earnings.”
What?! You don’t think these companies are embracing physicians’ incomes out of generosity and kindness and concern for patients’ well-being, do you?
I agree [with me, about “concierge” practice] except to paint a slightly more jaundiced insiders view. VERY FEW of these concierge physicians deserve concierge fees. Too many are greedy mediocre physicians who always valued their income and lifestyle over commitment to delivering best care to their patients. I know of ophthalmologists and neurosurgeons who have reaped incomes in the millions of dollars each year. This is often way above paying the rent and malpractice costs. Many of my highly esteemed peers have been delivering what’s now labeled “concierge care” for years.
We were not facing economic hardship. We understood that the great satisfaction which comes from the best practice of medicine is sometimes worth more than dollars and cents. Most of our incomes were more than sufficient without “extorting” extra fees. Those who practice with caring are the physicians whom I hold in highest esteem. They are the many who went into medicine for all the right reasons: the honor of providing comfort and saving lives.
I do not mean to underplay the higher and higher costs of obtaining a medical education and those of staying in practice. These are mounting concerns for all of us. Economics are resulting in terrifying shortages of primary care physicians and some critical specialists who are perceived by medical students as working too hard for insufficient incomes. That is an entire other subject, i.e, training medical students in a “9-5” model of care.
Physicians missed the boat when they allowed themselves to be prostituted by big business. This completely deranged construct of the “business of medicine” which accepts profiting from others’ misfortune as perfectly fine, is what is destroying healthcare today.
Physicians should have understood that WE are the necessary foundation of high-quality care and should have unionized years ago. We should have demanded our rightful place at the head of the table to structure healthcare delivery and negotiate fair fees. We failed to do so due to many disparate goals and some unscrupulous greedy physicians there, too. To now make unwitting ill patients suffer in some game of musical chairs to reclaim power and an upper class CEO lifestyle is unconscionable and unprofessional.
Beware of this VIP con. This is extortion plain and simple in a world where physicians understand there’s a dreadful shortage of true professionals going into primary care and patients have no control over any of this mess.