I lost my MD

Well, I didn’t really “lose” her. She lost me, i.e., I have been dumped. I am her ex-patient. (Ever so tempted to adapt the Monty Python dead parrot sketch here but will control myself, given the “dead” part.)

Oh, I was offered a choice. In a printed announcement*, my internist announced she and her partner were switching entirely to a “concierge practice,” which is, in a patient’s simile, like switching from the wondrous serendipity of finding low-cost European designer clothes at the late Century 21 to buying $$$$$ retail at Mad Ave European designer boutiques.

Instead of accepting insurance, in my case Medicare, this exclusive conciergerie would be charging $2000 a year for anyone under 65 and $3000 a year for those of us over, i.e., on Medicare.

I was pissed off. Not that I loved my internist — I didn’t; indeed, she’s the first physician I haven’t loved — but the concierge proclamation was dated mid-April and said I’d be bounced from the practice early June. 2022. I blinked several times. Yes, the same year.

And oh boy did I growl when I read the dismissive statement, “Tell us where to send your records.”

How egregiously unprofessional that was! Two months’ notice. And nowhere in the proclamation was what I expect a physician to offer: a list of recommended internists who would accept Medicare. Who would accept me. And my records.

I juked most of that week, insisting she give me a recommendation, which she did but in a half-assed way — and I managed to slip in as a patient to another practice before it cut off all new patients. I’m fairly sure my new internist hasn’t yet graduated from med school but I’m not concerned. My appointment is not until August; she’ll graduate at the beginning of July. Besides, thanks to one of my nieces, I have confidence in brand-new physicians, especially women. They’re exquisitely careful and often know more about recent medical developments than their elders.

While I’m angry at the way my doctor handled the switch, I don’t blame her for changing her practice to big flat fees. I’m fully aware of the way doctors have to scramble financially to practice medicine in a city like New York.

Ergo, I am hardly the only person facing this problem. A couple of days ago on Twitter, I saw two major journalists, both women, one in DC and one (I think) in NYC, talk about how difficult it was to find a physician because all the ones they contacted did not take their insurance, or any insurance.

One doctor laid out her rates, which included a $1800 initial visit fee, and went on from there.

Why are doctors doing this?, the journalists asked.

Because physicians in major cities can’t afford to practice good medicine on the fees they get from insurance companies, including Medicare and Medicaid.

In the 1990s, I learned about the costs of running a medical practice in New York. My long-time OB-GYN told me she had to leave her obstetrics practice, the part of her practice she loved. A crisp, cool woman, she was in tears when she told me. And she told me why: “It costs me $35,000 a month just to open my doors,” she said. Medical liability insurance for some specialties like obstetrics is prohibitively expensive.

Unlike most of us, I have a bit of insight into physicians’ professional lives. My sister, one niece, my brother-in-law, a first cousin (and his father, my uncle), and one of my oldest friends are current or retired MDs. So I’ve heard stories.

This may surprise you, but aside from a few horror stories about getting an insurance company’s “permission” to admit a dangerously ill patient to a hospital, none of the doctors I know have complained, certainly not about their patients. They love their profession. So I’ll have to complain for them.

In New York City, we have four or more world-class hospital centers, medical walk-in clinics virtually on every block, and lots of excellent physicians. Over the years, I’ve been a loyal patient of a number of them and have had the mild fantods when each announced his/her retirement.

But life as a patient wasn’t over. Each MD (until this last one) gave at least six months’ notice of the oncoming abandonment and, with exquisite care, gave specific instructions about how to handle our records, and a personally curated list of recommendations.

Several of my long-time doctors had themselves stopped accepting insurance. I paid them directly. Their fees seemed rational to me, given how much I relied on their expertise and time-consuming, potentially life-saving work.

I can’t afford to do that now. At the same time, physicians, like my erstwhile internist, can’t afford to practice medicine at Medicare rates. (They especially dislike Medicare “Advantage” plans; run by profit-making insurance companies, they fight with doctors over choices that only the doctor is qualified to make, and stall their payments unconscionably.)

When people, politicians, proclaim their ideas for universalizing our health care system, they don’t mention doctors. Or when they do, they treat them the way insurance companies treat them, as cogs in the medical business machine.

They shouldn’t. If we can’t find doctors who can afford to accept our insurance, we may be universally insured, but for what?


*This remarkably haphazard business was only purported to be via my physicians. Actually, the whole construct seems to be created by a company called Your Chosen Concierge Medical Provider/Program, at 100 Merrick Road, Suite 410W, Rockville Centre, NY 11570-4890 at  877-888-5565.

I’ve tried Googling but, of course, got only sales pitches for concierge practices. I assume this company is a for-profit one, and takes either a fat fee for their mismanagement or a percentage of the physicians’ annual take.


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2 Responses to I lost my MD

  1. Deborah Fein says:

    I agree 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 ie 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

    • Naomi says:

      I probably shouldn’t be saying this because you are a very close relation, but this is brilliant, Deb, and heartfelt. And I so agree about how this all came about, via big business, i.e., the voracious HMO-insurance company tsunami, and Big Pharma, who decided selling prescription medicine directly to ignorant consumers was the way to go. And now you’ve written this, I think I’ll do an addendum, quoting from the “concierge” letter about what we’ll be getting with that service. Because it is…well, I’m going to do that right now.

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