Concierge Medicine: The New Club Med

A few weeks ago, my wife Susan received a letter from her longtime primary care physician. Concerned that her large practice made it difficult for her to give patients the attention and care they deserve, this doctor proudly announced that she was converting to a smaller but more personalized practice, and invited Susan to apply. If Susan acts now, and is among the first 600 patients to scrape together the new $1,500 annual membership fee, she can enjoy continued access to her beloved doctor; otherwise, she'll have to find a new one.

Welcome to the new Club Med.

Susan's doctor has chosen to affiliate with MDVIP, a company in the growing field of "concierge medicine" or "boutique medicine". In the MDVIP business model, each doctor limits the practice to a 600-patient maximum, each of whom pays $1,500 per year. Of that $900,000 annual "dues" coming in to the doctor, MDVIP keeps a third for help with administration, marketing, and research, leaving the doctor with a guaranteed annual income of $600,000 and no cumbersome insurance paperwork. For the patient, that $1,500/year has to come out of pocket - your insurance doesn't pay for it - although MDVIP says you can use your pre-tax Flexible Spending Account, if your employer lets you set one up.

MDVIP is experiencing a growth spurt. In 2006 they had about 100 doctors; the number now is 350. While Susan's doctor is one of only 5 MDVIP franchisees in Pennsylvania, neighboring New Jersey has 9, New York has 13, and California has 51. This growth may accelerate even more now that consumer products company Procter & Gamble has completed its buyout of MDVIP. No word yet on whether this corporate partnership means your MDVIP doctor will be advising you on the health benefits of P&G products such as Prilosec.

There are other concierge medicine "clubs" with even higher annual fees than MDVIP. MD2 charges over $10,000/year for the privilege of being one of only 50 families in your doctor's practice. Concierge Medicine/LA has a sliding scale fee based on age, from $1,750/year to $10,000/year, in return for the type of annual physical they say the U.S. President receives.

This gets to the core of what should be the starting point for any national debate on health care: what do we, as a nation, believe about the type of healthcare people should receive? Is health care a right, where all people deserve the type of comprehensive exams and easy access that the U.S. President or a corporate CEO receives? Or is health care a privilege, where such boutique-level services are rationed according to one's ability to pay?

Susan will be looking for another doctor, since this $1,500/year Club Med fee doesn't fit within our family budget. Meanwhile, our oldest daughter is only able to remain on my employer-provided health insurance as long as she's a full-time student. Once Kate finishes college, she'll have to find her own insurance, provided she doesn't get denied because her asthma is deemed to be a pre-existing condition. Welcome to the world of those priced out of these concierge clubs - the world of steerage medicine.