The Sunday Baltimore Sun featured a story about “concierge” medicine and a Maryland trend of primary care docs charging premium membership fees on the order of $4000 or more for patients to be part of their practice. The reason? One doc was quoted in the article:

“Primary-care doctors are seeing 30 to 40 patients a day – that’s too many,” said Dr. Harry A. Oken, who has been with Charter Internal Medicine for more than 20 years. “It’s not about the money. It’s about having the time to spend with your patients to keep them healthy.”

With a shortage of primary care docs already existing in this country, the fact that some of them will now be isolating themselves inside these so-called “boutiques” of medicine is troubling to some. For example, Art Caplan has said it’s a clear sign of a broken primary care system. Yet, the AMA has said that the practice is not inherently bad, unless the practice means that differential care is provided by concierge medicine.

In any case, these positions would both seem to raise relevant questions about the development of this trend. The fact that primary care physicians feel the need to change their practices to restricted-access, members-only places more like country clubs than doctors offices suggest that these doctors are feeling too overwhelmed with the demands of their profession and that perhaps more primary care physicians must be trained. If that is difficult to do, primary care as a career path must be incentivized for doctors-in-training and the practice of primary care must be made different not the horrible 30 to 40 patient a day experience described in the Baltimore Sun.

Moreover, doctors must understand the ethics of providing primary care–and whether they treat 2 or 22 patients a day they all must receive the same quality of care. Regardless of whether one paid a $20 co-pay or a $20,000 concierge membership fee to see them.

Summer Johnson, PhD