When the lead singer of a famed female trio got a cough on tour in Japan, Dr. Ronald Primas, a concierge doctor with celebrity clients rumored to include Ivanka Trump, Jared Kushner, D’Angelo, the late Mickey Rooney, Ludacris, Adam Sandler and Al Pacino, asked her to cough into the microphone.
“This was before the days of Skype,” says Primas, who would not comment on the identities of any of his clients but was once described as the “exclusive doctor” for the Trump Soho and Trump International hotels. “I asked her to send me an MP3 of the cough, and I immediately identified it as bronchitis.”
A few hours later, he tracked down a respected specialist in Japan and arranged an immediate and discreet appointment for his client. He says that quietly admitting well-known patients to hospitals and rehab is a major part of the job.
Such anecdotes may seem like scenes from “Lifestyles of the Rich and Famous,” but Primas says that while his patients tend to be famous artists, company owners and entrepreneurs, this kind of service is typical of most concierge practices. It’s simply the power of a model that incentivizes going the extra mile for your patients, he says.
People of means pay for the best of everything, and healthcare is no different. It’s not unusual for a VIP to retain the services of a private physician kept at the ready 24/7. But over the last two decades, the sans-insurance concierge model of healthcare, which gives the best medical attention to those who can afford to pay the most, has become a booming growth industry.
“A concierge in a hotel makes sure that you feel well taken care of and that your needs have been anticipated. That is what I think concierge medicine is trying to do,” says Dr. Michael Siegal, an early adopter of the concierge model of medicine, whose office sits on the prestigious strip of Central Park South sandwiched between the Plaza and Park Lane hotels. He declined to comment on his fees.
“It became obvious relatively soon after I started practicing that due to the large volume of patients and the expectation of those patients that the model needed to evolve,” he says. “There needed to be more reciprocity. Patients needed to feel that they were getting something special, that they were getting a quality of service that was worth paying for.”
For the majority of concierge doctors, operating this kind of practice means continuing business as usual, i.e., accepting insurance from a large pool of patients, while supplementing that pool with patients willing to pay a fee that can range from as little as $500 a year to six figures. In return, the concierge patients can see their doctor the same day or the next, with appointments that last up to two hours if necessary. Compare that to just 15 minutes, the median length of a traditional doctor visit, according to a study in the Health Services Research Journal.
The accommodations don’t end with on-demand and longer visits, however. The concierge doctor will make house calls, meet the patient at their office or even hop on a private jet to supervise medical care in another state.
While some argue that the expanding popularity of concierge medicine reeks of inequality — traditional patients with appointments, for instance, might be bumped for higher-paying “clients” — doctors and industry experts interviewed by LLNYC maintain that the model shouldn’t be so easily dismissed. They point to numerous health benefits for their patients, including fewer hospitalizations and emergency room visits, and a less exhausting environment for typically overburdened doctors, which means placing less stress on the healthcare system overall. But most important, perhaps, there is market demand.
Currently, only somewhere between 5,000 and 12,000 out of roughly 923,300 licensed physicians in the U.S. operate under a concierge model, according a report by Concierge Medicine Today, a trade journal. But that is changing fast.
At least for now, the Trump administration
looks like a boon for concierge medicine.
A 2012 survey of nearly 14,000 physicians, conducted by physician staffing firm Merritt Hawkins, found that 9.6 percent were planning to convert to concierge practices in the next one to three years.
“We’ve seen a tremendous amount of growth,” said Dr. Dean McElwain, president and COO of Castle Connolly Private Health Partners, a medical consulting company founded four years ago with John Castle and Dr. John Connolly that helps physicians convert their practices to a concierge model. “Concierge medicine affords physicians the ability to return to a much more old-fashioned style of practice where you actually had generous time to communicate with your patients and to work one-on-one with them to solve their problem and get to know them as individuals and not just a diagnosis.”
At least part of the concierge boom is driven by the toxic politics surrounding healthcare, numerous concierge doctors told LLNYC, with both patients and doctors disillusioned with the insurance model.
As Senate Republicans squabble over how much flesh they should cut from Obamacare with their Better Care Reconciliation Act of 2017, which would leave an estimated 22 million Americans without access to affordable healthcare, among other vivisections, the vociferous objections from the largest doctor and hospital groups only get louder. Having failed to pass an alternative to President Obama’s flagship legislation once already, it looks more and more likely that President Trump’s agenda will meet with disaster a second time.
“There are a lot of people who are looking at the [political] environment and the possibility that they won’t be able to see certain doctors,” said Dr. Damon Raskin, an internal medicine and addiction specialist with a concierge practice in Pacific Palisades, California, and at the rehab center Cliffside Malibu. He added a concierge model to his practice about eight years ago after noticing a rise in patient demand for a more attentive and intimate style of medicine.
And McElwain adds that, at least for now, the Trump administration looks to be a boon for the industry.
“There is only so much they can move the dial, and I think it is going to go back toward self-determination,” McElwain said of the Republican healthcare legislation. “Certainly, with this administration, there seems to be an appreciation for the utilization of health saving accounts and the ability to engage privately with your physician … It’s very multifactorial, but I think if anything, it looks like it will have a nurturing effect on what we do.”
Doctors particularly benefit under the concierge model by whittling down the number of patients they see from as many as 3,000 to as few as 200, freeing them to brush up on the latest medical research and to learn about advanced technologies.
“This is practicing medicine the way it should always have been practiced,” Raskin says, noting that his well-heeled concierge patients can be more demanding, since “they are paying extra for extra service.”
“This is the way medicine was done in the 1960s and 1970s, where you had time to see patients. It allows me to not only find out about an illness, but to talk about prevention. If a concierge client comes in with a cold, that takes five minutes, but I’ll make a 30-minute slot and find out how things are in their marriage and at work. It’s not just about treating the cold, it’s about treating the whole person,” he said.
And it looks as though the scales will continue to tip in private medicine’s favor as the shortage of physicians in the U.S. increases, burdening doctors with more patients than ever before.
A 2016 report by the Association of American Medical Colleges estimated that by 2025 there will be a shortfall of 14,900 to 35,600 primary care physicians and 37,400 and 60,300 specialists in the U.S. Meanwhile, wait times for patients have skyrocketed.
McElwain explains that the No. 1 reason he sees doctors converting their practices to purely private or partially concierge is because of the stress brought on by seeing too many patients. It could be argued that physicians are trimming their patient rosters when we need them the most, but with fewer patients to treat and more money on offer, it is hard to blame them.
“Especially for primary care physicians, unless they are part of a large group or owned by a hospital, it’s very challenging out there,” said John Connolly, president and CEO of Castle Connolly Medical and publisher of “America’s Top Doctors,” a consumer guide ranking healthcare professionals. “They don’t have the negotiating power that a large group or a hospital does. They are constantly getting squeezed.”
Doctors have seen their bargaining power and insurance reimbursements dwindle even as costs of labor and technology rise. Pity them or not, across the nation, relatively well-compensated doctors are feeling the pinch.
The solution for some is to abandon ship and focus solely on concierge or extremely rich patients.
“Just as a virtual velvet rope has risen between the wealthiest Americans and everyone else on airplanes, cruise ships and amusement parks, widening inequality is also transforming how health care is delivered,” the New York Times noted in a recent exposé about niche private medical doctors commanding annual fees as high as $80,000 from a small numbers of elite patients.
But treating your patients like clients does come with hazards. For one, you have to keep your clients coming back and ponying up, year after year. If they don’t like your service, they’ll move on, so it literally pays to keep your patients happy. And freed from much of the administrative oversight MDs experience in traditional practices, scenarios arise where bonafide medical advice goes right out the window.
“Doctors do not want to see their patients in pain, and they know that they will go elsewhere. So if you have someone who is very insecure about their practice, or needs that celebrity client, then they give them what they want,” says Dr. Constance Scharff, a colleague of Raskin at Cliffside Malibu.
Scharff described one such example. “A mother goes into a doctor’s office. Her child is sick. Her child has a virus. But she demands antibiotics because she believes that the doctor needs to do something. So the doctor may give it, because they say, ‘Well, it isn’t going to help the situation but it isn’t gonna hurt it.’ You see that kind of practice with a lot of physicians.”
Raskin adds that you just have to look at what happened to Michael Jackson or Prince to see that certain doctors may do unscrupulous things for celebrity private clients.
“It is really common,” Raskin says, referring to doctors who either intentionally or unintentionally overprescribe addictive drugs to the rich and famous. “A lot of times, celebrities get the worst medical care, and that’s because even doctors get star-struck. They want these people in their practices. They want these people to like them. These celebrities surround themselves with people who say ‘yes’ to them, and if they find someone who says ‘no,’ they move on. They are very entitled.”
The recent deaths of major celebrities who were under the care of private physicians, and the fact that it can look very much like the logical conclusion of a healthcare system stacked in favor of the rich, have given concierge medicine a “brand identity issue,” according to Michael Tetreault, the editor-in-chief of Concierge Medicine Today.
Nevertheless, Tetreault said that the “velvet rope” metaphor gets it all wrong. Instead he compares concierge medicine to Netflix.
“We are all used to subscriptions. We all have Amazon Prime and Netflix, and like Netflix or Amazon subscriptions,” he said, “you’ll find doctors out there with monthly subscriptions that seem incredibly affordable or geared for a certain audience. The more you pay, the more your get.”
McElwain echoed that sentiment, arguing that concierge medicine isn’t really different from choosing to purchase private health insurance in a country with socialized medicine. It’s an option, not an impetus.
“The clinical services stay the same for both traditional and concierge patients,“ McElwain says, “Convenience and amenities are the differentials. Whether you drive a product from GM or you drive a Maybach, you are going to get to the same destination — maybe it’s more appropriate to say a BMW.”
Equitable or unfair, for the patients who choose to sign up with a concierge practice, the ability to skip the appointment line and call their doctor’s cell phone day or night isn’t really about elitism. In fact, concierge service is, in a somewhat unexpected way, a rejection of the “medical industrial complex” we’ve built in the U.S. and a return to the kind of personalized medicine everyone once enjoyed — this time at a far higher cost.
“This kind of innovative medicine is for C-suite executives and craft brewers. It’s for people who say, ‘I want the best healthcare in the world from one of the best doctors in the world, and there is a value to that,’ Tetreault says, with an air of triumphant make-healthcare-great-again-ism. “It’s an innovation that takes us back to how healthcare used to be delivered. You can have a family doctor again. No longer is it about what kind of insurance Opie has. It’s taking us back to an Andy Griffith style of healthcare.”