The rise and further rise of concierge medicine

“The important thing,” counsels the fashion designer Diane von Furstenberg, “is to take your time and not get stressed,” but tell that to US physicians. Many of them think they have been pushed to see too many patients, which they have to do to make up for stagnant reimbursements. They are fearing yet more stress in January, when health insurance exchanges under the Affordable Care Act unleash millions of new patients seeking a doctor’s care. And from the patient’s standpoint, there are fears that as more people seek the doctor’s time, it will be harder to get the attention they need.

Looking for a way out, unhappy physicians have been switching to direct pay or “concierge” care, an alternative practice model that deals with the doctor’s concern about heavy workload and the patient’s interest in better access to care. Such practices charge patients a regular fee, making it possible for physicians to cut back their panels to only a fraction of what they used to be. Appointments are longer and the physician can delve more deeply into each patient’s case. Patients are also allowed to phone or email their doctors, a benefit not covered by most health insurance.

This approach can be traced back two decades, when concierge physicians began charging wealthy businessmen as much as $15 000 (£9000; €11 000) a year to cover exclusive health services, such as a health spa and 24 hour cell phone access to the physician. Now it has evolved into direct pay, a stripped down version with a fee as low as $600 a year. Experiencing steady growth in the past few years, some 5000 US …