Regulation & Legislation
Imagine your sister is a respected physician with a network of colleagues in various specialties. She can get you in to see acclaimed physicians at leading institutions across the nation. And she responds immediately to calls or texts, even rushing to your side during middle-of-the-night emergencies.
Such is the appeal of concierge medicine, a boutique approach to health care that has found a receptive audience in recent years as patients have sought personalized attention in the crowded and sometimes daunting world of medicine. The pandemic appears to be raising interest in concierge service to a new level, with providers reporting especially high demand over the past 18 months.
It’s not hard to understand why. Aside from the obvious physical toll that COVID-19 has exacted on those who have been infected, there’s been a wrenching emotional impact that can extend even to those who haven’t been directly affected. Patients want some assurance of high-quality — and prompt — care.
“COVID made everybody feel alone,” says Dr. Howard Maron, who co-founded concierge provider MD2 in 1996. “It also uncovered their sense of medical isolation, because they realized most of their doctors were unavailable.”
And as the pandemic has done with other aspects of life, it’s caused a reassessment of priorities and a back-to-the-basics emphasis on well-being.
“I think people now realize that their health is their most valuable asset, not their stock portfolio,” says Dr. Jordan Shlain, founder of Private Medical, which is based in San Francisco and has additional practices in Los Angeles, New York and Silicon Valley.
The goal of concierge health care is to do away with crowded waiting rooms, appointment backlogs and rotating casts of providers. A single physician coordinates all patient care and may even attend other doctor visits to support patients, ask questions and serve as a liaison. Clients can text, email or call 24 hours a day, seven days a week, and be seen immediately.
“When you don’t know something, you’re anxious, and the longer it takes you to get the answer, your anxiety just grows,” says Shlain. “The magic of a great doctor is responsiveness, but also anticipating what can happen next, their follow-up and follow-through.”
This kind of immediate and personal care comes at a price, of course. Most concierge-type services don’t accept Medicare or private insurance, which clients still need for specialized care, hospital stays and treatments that aren’t covered by their concierge membership. An annual MD2 membership for a family of four costs between $40,000 and $50,000, depending on the children’s ages. At Private Medical, Shlain says, the annual fee is in the low six figures for a family.
In his previous role at a large university hospital, Dr. Peter Lefevre saw 25 to 30 patients a day. Physicals typically took 20 to 30 minutes, and routine follow-ups 10 to 15 minutes. “You’re really sprinting,” he recalls.
He now works in the Santa Monica office of MD2. The company name — MD Squared — is a play on the fact that each office has only two physicians. Each doctor attends to 50 families. MD2 is based in Bellevue, Washington, and has additional offices in Austin, Texas; Beverly Hills, California; Boston; Chicago; Dallas; the District of Columbia/McLean, Virginia; Menlo Park, California; Morristown, New Jersey; New York; Portland, Oregon; San Francisco; and Seattle.
Lefevre sees two or three patients a day, routinely spending an hour on office visits and approximately three hours on physicals. He spends the rest of his time researching patients’ illnesses, coordinating their care and speaking with specialists and others to whom he’s referring patients. He has the time to get to know patients and their concerns.
“If there is that kind of bond where you know that doctor would do everything within their power for you, you’ve accomplished something that 90% of people can’t accomplish. The traditional practice model doesn’t allow that level of devotion to materialize, really,” Dr. Maron says.
At MD2, a monthly retainer covers all primary care services performed within the office, including complete physical exams, lab tests, genetic testing, X-rays, certain acute medications and membership to a worldwide medical jet evacuation service.
The services are similar at Private Medical, where each physician sees only 100 patients. Clients receive personalized Medical Annual Reports with blueprints for appointments, tests and procedures to be completed in the coming year. Both companies are able to coordinate care even when patients travel internationally.
The onset of the coronavirus highlighted the advantages of concierge care, both medically and logistically.
“This practice is ideally suited for the pandemic because you’re not sitting in a waiting room,” Lefevre says. “The risk of exposure is really low. More than a few patients followed me from [his previous job] because they had really high concerns about that, because of underlying diseases or they’re immunocompromised.”
Concierge physicians visit patients at their homes, offices or wherever is convenient for the clients. Private Medical has administered COVID-19 tests in the practice’s parking lots.
Some concierge providers say they have rushed to expand their businesses, given the increased demand. MD2, for example, has opened new offices in response, even in markets where it already has an office nearby. At Private Medical, Shlain reports, “we have a waiting list almost everywhere,” despite amping up hiring.