Concierge Service

A few months ago, I heard about this new service that some doctors are offering. I’ve got mixed feelings about it, but here’s the basic breakdown: both doctors and patients are fed up with the current way of handling health care. Insurance companies will only pay a certain fee for the doctor’s services, and out of that fee, the doctor must take care of his staff, his practice, his malpractice insurance, and his own salary. [And, I’m using the gender-neutral “he” because 1) I was taught that in school and habits are hard to break; and 2) this is a birth blog, and all people who give birth are female, while not all doctors are, so this helps to cut down the confusion.] Because of these financial restraints on the doctor’s part, he feels coerced into accepting as many patients as possible — and probably more patients than he can reasonably see in a day. How many of us have not felt short-changed by the amount of time a doctor actually spends with us (especially in contrast with how long we had to sit in the waiting room).

So, concierge service was born. Basically, you pay for exclusive service. The doctor agrees to limit the number of patients he sees, and you agree to pay a certain fee over and above your usual payments and copays for this “VIP treatment.” The part I don’t like about it is, shouldn’t you be getting good service anyway?? Why do you have to pay extra for the minimum? The part I like about it is, it works! And it works beautifully (as long as you can afford it) — some perks that medical “concierge service” offers include that the doctor actually knows you, not just your file; you can be seen within a day or two whenever you need to come in; and your doctor can actually spend time with you, finding out about your needs and complaints and special circumstances, so that you don’t feel like you’re a widget on an assembly line; plus access to the doctor’s email and/or phone numbers.

But now, I’ve read an article which says that some obstetricians are now offering “concierge service.” [This is the complete opposite from another new-fangled solution for the problem of over-worked obstetricians — laborists.] For the low price of $15,000, pregnant women get the following from Dr. Lanalee Sam: “a fetal ultrasound photo at every visit, private birthing classes, one massage per trimester, optional home doctor visits, her private home and cell phone numbers and e-mail address, and the guarantee that she will be at the hospital for her patients’ full active labor and delivery.” (This service, as I mentioned above, is in addition to the regular fees the doctor charges.) Since so many doctors are in a group practice, it’s entirely likely that a woman can have a complete stranger attend the birth of her baby, unless she met every one of the doctors during prenatal visits. So the guarantee of your obstetrician definitely being with you for your entire labor and birth is not inconsequential. This doctor does this by accepting women based on their due dates — no more than 4 per month.

All right — I can’t help it — I’ve got to run the numbers. Four women per month, twelve months per year, and $15,000 apiece — that works out to (drum roll, please) $720,000. (Plus what she makes from her regular obstetric fees, and her gynecological practice.) I know that malpractice insurance is high for obstetricians — but is it that high? — especially attending only 48 births per year, instead of 48 births per week or per month. Although, to be fair, I will reiterate that there are other costs involved in being a doctor — the overhead of the building — rent, electricity, equipment; receptionist, nurses and other staff; and everything else down to paper clips and staplers. Also, she sometimes discounts her fee, or waives it entirely. I’m not meaning to “pick on” this doctor, but she was the only OB mentioned in this article — so I’m just using her as an example.

So, reading about this, I gotta say, “Now this is the way to go!” I mean, look at the perks — you get long prenatal visits (instead of seeing the doctor 5 minutes, 15 if you’re lucky), you feel free to call or email the doctor any time something comes up that concerns or worries you (and you actually get to talk to the doctor, and not just wait around for a day or a week for somebody in the office to finally call you back), and the doctor may even come to your home, instead of you always leaving yours. That sounds great! Oh, wait a second — I did have that! It’s called midwifery care (and I didn’t have to pay $15,000 for the privilege). Now that’s the way to go!


5 Responses

  1. I got to the end of reading this… shook my head… and then read it again.
    it isn’t a joke is it?

  2. Nope — not a joke! But not very common, either. The article said just over 1,000 doctors nationwide are doing this (and I’m thinking this is all sorts of docs, not just OBs).

  3. I agree, get a midwife and save the money!

  4. What they’re offering with “Concierge Treatment” should be the norm, but without a higher fee. In other words, every patient should have the time they need for appointments (within reason). My family physician spends and hour or 1-1/2 hours with me if needed. Communication is give and take.
    We should not have even gotten to the point that the acceptable care is to wait for 40 minutes and then see the doctor for 3-5 minutes, 30 seconds of which is yours to speak.
    This reminds me of the people who pay a higher fee at Disney and go through a tunnel and cut to the front of the line – for an extra fee. The park should allow a maximum number of people so that on any given ride your wait is no longer than 45 minutes or so. Even that is too long for me to wait to go on a 3-5 minute ride.
    The best thing people can do is to do whatever is in their power to not need a doctor, hospital or surgery. Take health into your own hands so that your time with doctors is minimal to non-existent.

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    SOMERVILLE, N.J., SEPTEMBER 8, 2008 – A new study published in the August issue of International Urogynecology Journal analyzes data of an 11-year follow up study on the safety and effectiveness of tension-free vaginal tape (TVT) as a treatment for stress urinary incontinence (SUI) in women. Researchers followed women treated with GYNECARE TVT™ Retropubic System Tension-free Support for Incontinence and found that after 11 years, 90% were objectively cured and 97% considered themselves subjectively cured or improved. This study represents the most extensive follow up for modern mid-ureethral sling operations to date.
    The three-center prospective observational cohort study led by Professor Carl G. Nilsson, Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Finland, reports on 90 women suffering from urinary stress incontinence who were treated with GYNECARE TVT. Pre-operative assessment included a 24-hour pad test, a stress test, physical examination and a visual analog scale for assessing how bothersome the condition was to each patient. Of the original cohort, 69 women were available for post-operative follow-up 11.5 years after surgery. These women were evaluated using a stress test, a pad test, the patient’s overall impression of the cure and a questionnaire administered to assess the patient’s quality of life. More than 11 years after surgery, 97% of women assessed subjectively considered themselves cured or improved and researchers determined that 90% of patients were objectively cured based on 24-hour pad tests and stress tests.
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    SUI, a condition that affects more than 13 million women in the United States, is the involuntary leakage of urine during routine activities that put pressure on the bladder or urethra, such as laughing, sneezing or coughing. It can be an embarrassing problem that women are hesitant to bring up with their doctor and as a result, only one in 12 women seeks treatment.
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