Retainer or "concierge" physicians

Here and there, across the country, a new type of medical practice arrangement is appearing that, at its root, is founded on restoring the classic doctor-patient relationship. This new style of practice arrangement is variously called "boutique" or "concierge" or "retainer" medicine.  There are many different flavors of retainer practices, but in essence they all involve patients paying doctors directly for their services.  

That's it. Patients pay the doctors directly.

It's simple, but the change in medical dynamics is revolutionary. The doctors in retainer practices don't work any more for HMOs, or for insurance companies, or for the government - and none of those entities any longer determine their viability as practitioners.  Instead, it is the patient who is the customer, who must be kept satisfied, and who will determine the doctor's professional viability. The doctor is not only free once again to act solely as the patient's advisor and advocate, he is obligated to act in this way.

There are several varieties of retainer practices, and some are more "pure" than others. For argument's sake, the retainer practices I'm referring to collect money only from patients, and not from Medicare or insurance companies. Less pure financial arrangements, I'll stipulate, will less purely restore the physician-patient compact.  Doctors in "mixed" retainer practices are still beholden to the third party payer, and how purely they're able to advocate for their patients is still an open question.

Most "pure" retainer practitioners limit the number of patients they care for to several hundred (instead of the typical several thousand).  Patients enrolled in the practice will generally pay an annual retainer fee, and in return they get personalized, 24/ 7 access to the doctor via cell phone and e-mail, guaranteed same day or next day appointments, detailed and leisurely medical examinations, personalized education and risk modification plans, personalized coordination of all medical care, and in some cases, house calls. In my mind, it is unfortunate that these features (as desirable as they are) are the aspects of retainer medicine that the new-style practitioners and their marketers stress.  What patients really get is the one thing our healthcare system insists they not have - an advocate who places their needs above all others, and guides their care in the face of a hostile healthcare system What they get is a doctor who will make it virtually impossible for them to become victims of covert rationing.

There are still only a handful of retainer practices in the U.S., but the number of doctors showing interest in this form of practice is growing rapidly.

If you are interested in finding a retainer physician, the Useful Links page provides some resources for you.