TORONTO — Six years ago, Dr. Jon Yardney, a general internist in Wayne, Pa., was struggling to practice primary care medicine in a way that he felt offered his patients the best care.
After 25 years in practice, his patients were getting older and their medical needs were becoming more complicated. But even as they needed more time with him, Dr. Yardney was being forced to keep visits short. On a typical day, he would walk into the exam room and greet an 80-year-old woman with 10 medical problems, who was seeing five subspecialists and taking 15 medications. Sitting next to her would be her daughter, carrying a list of questions.
After spending nearly half of the 15-minute appointment on documentation, he would have time to answer just one question. He would then ask the patient to make a new appointment to address the rest of her concerns, an appointment she probably wouldn't be able to get for another 6 weeks, he said.
“I'm watching the faces of those ladies sitting there in my office, and saying to myself, 'My God, I'm failing them,'” Dr. Yardney told physicians at the annual meeting. “This is not what they signed up for. This is not what I signed up for.”
Then he saw a brochure promoting concierge-style practice. He worked with MDVIP, a national network of more than 350 primary care physicians who practice retainer-style medicine, to set up his new practice. A year later, he became an MDVIP-affiliated physician and opened his new practice with fewer than 500 patients. “Practicing this way has been a personal revelation for me,” he said.
Letting Patients Choose
For Dr. Matthew J. Killion, the move to offer retainer services was driven by patient demand. He had stopped accepting private insurance, and patients started to ask about a retainer program. He decided to try it as a voluntary pilot program, letting his patients choose to join the retainer program or stay in the regular practice.
Today, Dr. Killion's internal medicine practice in Philadelphia is still made up mainly of fee-for-service and Medicare patients, but he also sees more than 100 retainer patients—a number that's growing. He said that his own experience illustrates one way for the medical profession to achieve a larger goal: changing the primary care practice model to encourage physicians to stay in internal medicine.
Over time, Dr. Killion said he would like to expand the retainer part of the practice, and he's experimenting with offering different packages based on patient needs. For example, older patients may opt to pay a higher annual fee and get more services. “It can be very individualized,” he said in an interview.
The transition hasn't been a big money maker, Dr. Killion told attendees at the ACP meeting, but it has made a real difference in his lifestyle. Before accepting retainer patients, he saw 20-25 patients a day. Now he sees about 12 patients a day and still has time to pick up his kids from school and spend time with them.
The 'Private Medicine' Model
These experiences aren't unique, said Tom Blue, executive director of the American Academy of Private Physicians. For most physicians who transition from a traditional practice to a concierge or retainer model, frustration with the unsustainable primary care business model is the chief motivator. Others may feel that a high volume of patients is a barrier to providing high-quality care, Mr. Blue said.
“They just can't keep running faster and faster on the treadmill,” he said.
The perception of concierge or retainer medicine is that it's a luxury medical product for rich people, driven by physician greed, Mr. Blue said—but the opposite is true.
More than a decade after the first physicians began this movement, concierge medicine can mean anything from a $25 monthly fee to a $20,000 annual retainer, he said. About 3,500 U.S. physicians now practice using the concierge model, which Mr. Blue calls the “private medicine” model, meaning that the practice offers some services that are privately funded by patients.
Mr. Blue predicts that the number of “private medicine” physicians is likely to double annually for the next 3 years. He said he has seen a lot of interest from medical students and residents, who see the practice model as innovative and more sustainable.
Darin Engelhardt, who is president of MDVIP, agrees. He said the retainer practice model provides an incentive for younger physicians to consider primary care as a profession. And he thinks that retainer-style practice has helped experienced physicians stay in practice longer. Many of the physicians who join MDVIP, he said, are at a crossroads professionally and are contemplating leaving primary care altogether.