Ethics of Retainer Medicine
From Med Rants, about retainer medicine:
I urge these authors and their ideological colleagues to look beyond the trappings. I urge them to perform a thought experiment. Why are patients increasingly willing to pay? Why are highly ethical physicians opting for this style of practice? If they are honest, they will find some truths that knee jerk opposition obscures.
Some might argue that these “highly ethical physicians” aren’t so highly ethical by practicing retainer medicine. One ethical framework would suggest if all physicians just practiced retainer medicine, there would not be nearly enough physicians to go around. In that framework, retainer medicine would be viewed as unethical.
(I also don’t really get how Dr. Centor combats the classist and racist arguments he brings up. They’re totally valid, and I can’t help but draw a parallel between retainer medicine and insurance company cherry-picking, the latter I find to be despicable in its bottom-line philosophy. By practicing retainer medicine, you are selecting out for people who can afford to pay extra, and health and SES are intrinsically linked (and also race), so you’re essentially picking out people who are already healthier. If you look at things through an equality and social justice lens, who needs a physician’s help more: the poor, smoking diabetic or the executive with an HDL of 39 who bikes 20 miles a day?) (I however absolutely agree with Dr. Centor that health care financing is a complete and total disaster in the US, but I would argue we need to fundamentally change the system–yes, with all the turmoil and terrible problems and growing pains it would cause–than work within it and continue to try piecemeal approaches we’ve been attempting since the 1970s.)
I will use this as a springboard for my rant tomorrow. I admire your idealism, but still think you are imagining that these physicians will solve classist and racist problems if they only ran a mediocre practice. More tomorrow.
[...] Graham wrote yesterday: Some might argue that these “highly ethical physicians” aren’t so highly ethical by practicing retainer medicine. One ethical framework would suggest if all physicians just practiced retainer medicine, there would not be nearly enough physicians to go around. In that framework, retainer medicine would be viewed as unethical. [...]
Graham, thanks for providing a cogent argument against concierge medicine. The blogosphere seems to be filled with MDs who believe it’s a panacea, the miracle cure for what ails our medical system. The truth is, it provides adequate medical care to a select group of individuals, and gives MDs a steady source of income (which, I’ll admit, is becoming a problem in our current system), but it leaves a huge population of underserved and UN-served people in its wake.
It’s also good to see that I’m not the only one who cringes when I see “ethical” and “concierge” mentioned in the same sentence.
Not my baliwick, but I see concierge practices as a driver of change. As you agree, healthcare financing as it exists is a disaster, moreso for primary care than anywhere else. Where is the impetus to change the system? You can bet the specialists aren’t going to volunteer to give up their slice of the pie. And Insurers/Medicare don’t seem inclined to change the rules of the game. So opting out becomes the only way for PCPs to exert pressure on the policymakers to rethink the rules. We’ll never see reform of the RVRBS till Medicare patients have widespread problems finding a physician who accepts Medicare. This is already happening, but at a low level unlikely to stimulate change. In order for this to happen, physicians need to take the hard and painful step of saying, “No, I won’t see you,” to Medicare patients. And that is basically what concierge care is.
Is it ethical? I think that’s the wrong question to ask. Will it work, and will the outcome be better than what we have now, and worth the human cost in getting there? Those are the questions that need answering…
[...] medicine, starting with piece by Dr. Centor, an internist I high respect. I fired back this piece and now Dr. Centor has responded. I must give Josh at KevinMD some credit for getting the debate [...]
[...] Shadowfax comments that perhaps the retainer medicine trend will be a driver of change, saying that in order for change to happen to health care payments and financing, “physicians need to take the hard and painful step of saying, “No, I won’t see you,” to Medicare patients. And that is basically what concierge care is.” [...]
[...] interesting discussion between DB and My Med Body on the ethics of retainer medicine — a model of primary care medicine where patients [...]