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Unwelcome Surprise
Andrew Wise and his partner are converting their Franconia practice to a smaller one that will require their patients to pay an annual retainer of $1,500.
(By Mark Finkenstaedt For The Washington Post)
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MDVIP requires doctors like Wohler to help each of his patients find a new primary care physician, and they don't stop seeing them until they do.
Last week about 50 patients attended an information session in Springfield hosted by Wohler and Wise, complete with a video touting the benefits of the program. Here, too, patient views were mixed. "I'm absolutely going to join," said Arthur Smith of Fairfax County. "There doesn't seem to be any drawback."
Others were more cautious.
"It makes you wonder where we're going as a health-care system," said a patient of Wise's, who identified himself only as Ray and declined to give his last name. "I understand where these doctors are coming from -- all the paperwork they have to fill out, no time with patients. . . . It can make you feel like you're really not doing your job."
Doctors and medical ethicists across the country continue to debate the trend toward concierge medicine.
In a policy statement several years ago, the American Medical Association said that while retainer contracts offer viable options for care, "they also raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care."
Even short of that, some have expressed concern about limiting access to care for poorer, sicker and nonwhite patients.
A 2005 survey of 144 retainer doctors in the Journal of General Internal Medicine found that such practices had far fewer minority and Medicaid patients than non-retainer doctors.
"This really isn't a solution to the chief problem in our health-care system, which is maldistribution," said Jay Jacobson, chief of the division of medical ethics and humanities at the University of Utah School of Medicine, who wasn't involved in the survey. "By giving more people an opportunity to opt out, they're not addressing the problem of access to health care."
Others have questioned how much impact retainer practices are having. The 1,000 or so retainer physicians, they say, are few compared with the more than 280,000 primary care physicians nationwide.
"Reasonable people can disagree about the practice, and they certainly have been a lightning rod for controversy," said G. Caleb Alexander, an assistant professor of medicine at the University of Chicago, who co-authored the Journal of General Internal Medicine study. "But it's unclear to me how viable the market is right now." ¿
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