MICHEL MARTIN, HOST:
There's a shortage of primary care doctors across the country and long wait times for appointments. Some doctors are overhauling their practices to adapt. But Karen Brown with New England Public Media reports they could be making the shortage even worse.
KAREN BROWN, BYLINE: Michele Andrews had been happy with her doctor in western Massachusetts for about 10 years. She did notice it was harder to get an appointment, but she was not prepared for the letter that arrived last summer.
MICHELE ANDREWS: Writing to inform of this exciting change they'll be making, and as of September 1, they're switching to concierge membership practice.
BROWN: Concierge medicine is where a doctor charges a yearly or monthly membership fee to their patients who are still paying insurance, copays and deductibles. In exchange, the doctor has fewer patients overall, so it's easier to get more timely and longer appointments. According to one trade magazine, there are about 12,000 concierge practices in the country.
ANDREWS: Second paragraph tells me the yearly fee for joining will be a thousand dollars per year for existing patients.
BROWN: And some practices charge as much as $50,000 a year. Andrews and her husband were given three months to pay or leave the practice. They left.
ANDREWS: I'm insulted and I'm offended. I would never, never expect to have to pay more out of my pocket to get the kind of care that I should be getting with my insurance premiums.
BROWN: Another patient, Patty Healey, got the same letter but had a different reaction.
PATTY HEALY: I didn't question it.
BROWN: As a retired nurse herself, Healey knew she'd have a heck of a time finding a new doctor.
HEALY: And it might be to my benefit, because maybe I'll get earlier appointments.
BROWN: This is the conundrum of concierge medicine. The quality of care may go up for those who pay.
MICHAEL DILL: But that means fewer people have access. So each time any physician makes that switch, it exacerbates the shortage.
BROWN: Michael Dill is with the Association of American Medical Colleges. He says the impact of concierge care is worse in rural areas.
DILL: Even one or two make that switch, you're going to feel it.
BROWN: But Dr. Shayne Taylor says that's not the fault nor the responsibility of doctors like her.
SHAYNE TAYLOR: We cannot spend so much time seeing so many patients and documenting in such a way to get an extra $17 from the insurance company.
BROWN: Taylor recently opened a direct care practice in Northampton, Massachusetts. Direct care is a version of concierge that bypasses insurance altogether. Taylor set membership at $225 per month. While traditional practices might have up to 2,000 patients per doctor, Taylor now caps her patient load at 300.
TAYLOR: We get a lot of pushback, because people are saying, oh, this is elitist, and this is only going to be accessible to people that have money. But ultimately, the numbers don't work.
BROWN: Some of the pushback on the membership model comes from other physicians. Dr. Paul Carlan runs Valley Medical Group in Western Mass. They're more stretched than ever. One reason is they're absorbing some of the patients who have lost their doctor to concierge medicine.
PAUL CARLAN: We all contribute through our tax dollars which fund these training programs.
BROWN: Carlan is referring to the fact that the federal government pays the salaries of doctors during their residency training after medical school.
CARLAN: And so we should be worried when folks are making decisions about how to practice that reduce their capacity to deliver that good back to the public.
BROWN: Michele Andrews, the patient who did not follow her doctor into concierge care, eventually found a new doctor. But she's still angry at the system and at concierge doctors.
ANDREWS: You're not fighting the system. This is a work-around the system.
BROWN: But for Dr. Shayne Taylor, she says it was either the membership model or leaving medicine, and serving only 300 patients is still better than serving zero.
For NPR News, I'm Karen Brown in Northampton, Massachusetts.
(SOUNDBITE OF PLACEBO SONG, "BURGER QUEEN") Transcript provided by NPR, Copyright NPR.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
