Concierge Medicine: The Good, the Bad, and the Ugly

— Innovative care models should be a tool to enhance quality and equity, not further diminish it

 A photo of a man tapping on a concierge bell.
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    N. Adam Brown is a practicing emergency physician, entrepreneur, and healthcare executive. He is the founder of ABIG Health, a healthcare growth strategy firm, and a professor at the University of North Carolina's Kenan-Flagler Business School.

At the intersection of healthcare and consumerism comes concierge medicine, a trend embraced in some form by athletes such as , , and . Many pursue this form of care to achieve the highest levels of medical care -- and they pay a premium for it.

Concierge medicine is a where patients pay a flat fee for complete access to a physician. This fee often covers unlimited office and telehealth visits, direct phone access to a doctor, basic diagnostic and blood tests, and specialist referrals as necessary -- all without co-pays and additional charges.

But it's not just athletes who are embracing this trend. Tech billionaire Bryan Johnson reportedly spends on regenerative medical procedures to stay healthy and to attempt to reverse the aging process with a biological "hack" that includes some less traditional methods of therapeutic care.

This approach to care reflects a broader shift toward a consumer-driven approach in healthcare, focused on quality and personalized service, offering a distinct contrast to traditional models of care. But at whose expense?

While millions of Americans remain uninsured for routine care, the concern is that concierge medicine will further exacerbate disparities in access and quality, and place further burden on our already strained healthcare infrastructure.

The Good

Concierge medicine has emerged as a viable and expanding business model within the U.S. By 2032, the market size for concierge medicine is projected to , marking a nearly 65% increase over a decade. This model's allure lies in its unique approach to healthcare, which appeals to both patients and physicians.

For patients, this offers 24/7 access to care, with same-day or next-day appointments readily available. The range of services is comprehensive, from wound treatment, blood work, and physicals to preventative screenings -- all conveniently in-office. Patients also benefit from the absence of co-pays or deductibles for office visits, and some practices further add value by dispensing common medications directly at a discounted rate.

The model's success doesn't stop there; it has proliferated . Initially centered around primary care, such as family practice, internal medicine, and pediatrics, concierge medicine has since expanded to include over 45 secondary specialties, including addiction medicine, cardiology, dermatology, general surgery, gynecology, and oncology. This broad adoption across specialties shows the model's versatility and potential for further growth.

For physicians, this model can offer a less stressful work environment with more predictable hours. Many doctors, disillusioned by government regulations, stringent insurance mandates, and overwhelming administrative duties, find this tailored approach a refuge from professional burnout and dissatisfaction. It allows physicians to refocus on the reason they went into medicine -- providing quality care to their patients.

The Bad

Concierge medicine has carved a notable niche in the U.S. healthcare system, presenting both opportunities and challenges. While it offers enhanced access and personalized care, not all concierge medicine practices are .

Some concierge services charge relatively modest annual fees of around $150, providing benefits like extended visits and streamlined scheduling. At the high end, fees can exceed thousands of dollars, featuring luxury services and highly exclusive patient panels. For example, Equinox, a luxury fitness club based in New York City, just announced their new "" gym membership, a personalized health program, lab testing, nutrition coaching, and other benefits. But here's the catch: it's a whopping , and there's a waitlist. This creates a potential risk of a tiered healthcare system, where the quality of care one receives is directly linked to financial capability.

A highlighted that individuals enrolled in concierge medicine experienced a 30-50% increase in total health spending, yet without any noticeable improvement in mortality rates (on average). This finding prompts critical questions about the value proposition of such high spending on personalized care when it does not evidently lead to better health outcomes long-term.

It's important to recognize that concierge care does not replace the need for traditional health insurance. While routine care might be covered under a concierge plan, major medical expenses like hospitalizations and specialized treatments still require comprehensive insurance coverage. In response, some people opt for (HDHPs) to reduce their overall health premium spending and obtain coverage in case medical costs are not included in their concierge care.

The Ugly

While concierge medicine can benefit both patients and physicians, it also introduces significant challenges and potential drawbacks for the wider healthcare system.

One major concern is the impact on the availability of primary care physicians for the general population who can't afford or who don't have access to this service. As doctors shift to concierge models, which typically involve smaller patient panels, this exacerbates the of primary care clinicians. This worsening access crisis is particularly alarming against the backdrop of the who remain uninsured in the U.S.

This migration to concierge medicine also places a heavier burden on physicians remaining in traditional practices. With a thinner spread of doctors to cover an extensive patient base, they might have to shorten appointment times and increasingly depend on nurse practitioners and physician assistants (PAs). Although nurses and PAs are indispensable to the medical field, excessive reliance on them could potentially dilute the quality of care that patients receive due to their potentially more limited scope of practice. It would also place an additional burden on them.

Another issue is that the exclusive and high-cost nature of personalized medicine may skew the doctor-patient relationship, signaling that a doctor should cater to the patient's wants rather than actual medical needs. Doctors might feel compelled to prescribe unnecessary treatments or tests just to appease their clients.

Physicians must always adhere strictly to , grounded in solid medical judgment and guided by relevant professional standards, while considering cost-effectiveness. Concierge medicine must not become a marketplace where patients' whims override healthcare providers' expertise and ethics.

The Future

As concierge medicine continues to expand in the U.S., we must weigh its commercial success against the ethical questions it poses. This model has undeniably met the specific needs of both patients and doctors, yet it threatens to establish a that could exacerbate the already large disparities in healthcare access and quality.

In a consumer-driven healthcare industry, individuals who can afford concierge services are entitled to a higher level of medical care. Nonetheless, physicians carry a unique ethical responsibility that transcends typical market dynamics; they are committed to delivering the highest standard of care to all patients impartially. Deviating from this commitment risks detrimental effects on society's most vulnerable groups.

As we look toward the future, it's crucial to consider the implications of healthcare consumerism. We must question how to nurture the growth of concierge medicine without compromising equitable access to quality healthcare. Achieving this requires a delicate balance of fostering innovation and personalized care while strictly adhering to the core principles of medical ethics and social responsibility. The advancement of healthcare models like concierge medicine should be a tool to enhance the overall quality and fairness of healthcare, not further diminish it.