October 11, 2012
Contract Medicine – The Future of Medicine
As a patient that has had excellent medical insurance for most of my adult life, why would I support or advocate for another type of medicine. Quite simply – the current medical system is broken and with the government taking more power and intruding further into our lives every day, it is headed for the financial breaking point. Doctors in private practice relying on insurance and Medicare payments are finding it very uneconomical to stay in practice and live on the increasing cuts in payments, pay staff to submit insurance and Medicare claims, and meet the needs of the patients. Hospitals are seizing the opportunity to buy out these failing practices or hiring the doctors away from them, thereby increasing their monopoly.
The more exclusive the hospitals become, the higher the costs of patient care becomes. The hospitals are reimbursed for the recoding of simple procedures to complicated procedures. Does the doctor benefit, seldom, but the administration gets higher and higher salaries and bonuses. This is why we need the doctors and their preventive medicine, which is possible under contract medicine regardless of type - boutique, concierge, retainer, and direct care. These caring doctors practicing preventive medicine will decrease the probability of increases in chronic illnesses and diseases.
The current president of the American Academy of Private Physicians (AAPP), Gary M. Price, M.D., F.A.C.P., has some excellent points at the bottom of the front page of the AAPP website (sorry, this link is now broken - I suspect they rearranged site and removed some material). How long it will remain up is in doubt, but it is well worth the time to read it. I am quoting two paragraphs - “Direct practice restores the doctor-patient relationship to the lofty level it enjoyed before being constrained and degraded by government and insurance. We work only for our patients. We give them uncompromising care in an unhurried, respectful setting. Because we care, the physician becomes a trusted friend. And in direct practice we behave like any other free market: we listen to our customers and respond to their needs. Which is why we have evolved many variations of our model to serve every type of community and every income level.”
It is followed by a statement by Dr. Jordan L. Shlain, MD, San Francisco, CA - Internal Medicine. His point is well stated here - “We are building the wellness model of the future and actively critiquing the circular illness-model. The common denominator that sets us apart is our desire to listen longer, ask more questions, and take the time to work through a complex problem in the spirit of healthy living and longevity.”
Dr. Price lists contract medicine this way - “In the late 1990s a new movement was born in Seattle, Washington and Fort Myers, Florida. Creative physicians dissatisfied with the status quo opted out of the insurance-based medical system to invent a better way to care for their patients. This movement came to be known as Direct, Concierge, Boutique or Private medicine.” The last sentence is different than “boutique, concierge, retainer, and direct care” and does create some confusion as “direct” and “private” medicine are often seen as being the same. Direct primary care (DPC) may be a preferable term to direct or direct care. They are all private medicine and as a group should be considered contract medicine. All of the terms can be considered “retainer medicine”. Many doctors prefer the term “retainer” to boutique or concierge and that is the reason in my previous blog I listed the wide range of fees these doctors may charge.
Will there be a consensus about the terms? This is very doubtful, as many doctors do not like the terms “boutique” or “concierge”. They consider these terms elitist and while the fees may vary, they cannot accept the connotation that these terms may imply. This is a reason that the last sentence in the first quote from Dr. Price - Which is why we have evolved many variations of our model to serve every type of community and every income level” is so important as they are covering all aspects of contract medicine.
Back to why this is the future of medicine. Dr. Price states most of it very well and I quote, “Direct practice restores the doctor-patient relationship to the lofty level it enjoyed before being constrained and degraded by government and insurance. We work only for our patients. We give them uncompromising care in an unhurried, respectful setting. Because we care, the physician becomes a trusted friend.” This may not cover all situations; however, it does spell out the importance of restoring the doctor/patient relationship, putting the patient first and emphasizing preventive medicine instead of waiting for the illness or disease and treating these. This puts “human” back in the equation and makes the doctor and the patient be in tune with each other because the time restraints are removed and the doctor has time to be thorough.
From the AAPP website, clicking on “The Third Era of Medicine” button will bring you to one of the better discussions of the medical mess we are currently experiencing, or click on this link. I found the discussion about type 2 diabetes very informative and on target. Scroll down the page to “Trapped in the Oscillating Structure of the Second Era”, and then down some more to “To preserve the first era paradigm, the system refuses to embrace three key realities:”
1. Diabetes is in fact an escalating progression of systemic destruction set in motion by a well-understood clinical imbalance;
2. The imbalance and the resulting damage can be economically detected and measured very early in its progression; and
3. The destructive sequence can be inexpensively halted and reversed when addressed early in its progression.
This is a polite way of saying that our current doctors are so constrained that they will not attempt a diabetes diagnosis until the conditions have reached a level that requires medication. Yes, there are a few conscientious doctors that do diagnosis prediabetes, but do not usually do much further because they have no support system and if medication is required, insurance will not pay for anything. Our broken healthcare system comes to mind.
If the AAPP can state things like this, then they will be working for patients, which is more than I can say for the American Diabetes Association. Whether you consider contract medicine or not, the “The Third Era of Medicine” is very interesting and explains what the future of medicine may become. Dr. Price says. “Today, even medical schools are including direct practice in their curricula.” If potential medical students will acquaint themselves with the AAPP site and a few other sites like this one and this one, they might decide that medicine is for them. These potential doctors may be the ones to give real preventive medicine the goal of actually helping patients and preventing the development of some chronic diseases.
Of the many doctors that are wishing to retire – if they could, it is sad that they do not look to contract medicine for some enjoyment until they can retire. It is even sadder that many of these doctors will never fit in contract medicine for several reasons. Many are overly attached to the current system and are unable to rethink their situation to be able to work in contract medicine. Others have overvalued their worth and will not work in contract medicine because they cannot accept value in the Internet or using telemedicine. Still other doctors have become so ingrained in the quick appointments that having half an hour or longer appointments scares the dickens out of them, plus they cannot operate in the preventive medicine arena. To these doctors I will only say – retire, medicine may be better off without you.
Yes, I am an advocate for contract medicine and believe this may be a major part of the solution to our current broken medical system. Dr. Jordan Shlain is correct when he says, “The common denominator that sets us apart is our desire to listen longer, ask more questions, and take the time to work through a complex problem in the spirit of healthy living and longevity.” This idea is further restated in much of the AAPP website. Take time to explore the AAPP website. Just remember that some of it is for members only and not accessible to the general public, but it is better than many professional medical websites. Transparency is a term they do understand.