Paying extra for better access to a doctor, often called concierge medicine, is growing in San Diego County.
Experts say the reasons range from a long-standing dissatisfaction with traditional managed care to more immediate worries about a possible doctor shortage driven by federal health reform.
While local specialists have mixed opinions on what is driving the growth, many said they believe the practice of charging a yearly membership fee in exchange for direct access to primary care doctors is on the rise.
An online directory maintained by the American Academy of Private Physicians, which listed 17 concierge specialists in 2011, today lists more than 60.
Tom Blue, chief strategy officer for the academy, said the directory can give only an approximate number for concierge doctors in a given community because none are compelled to be listed. Still, he said, concierge medicine is becoming more popular.
“We estimate that we’re seeing a 25 percent per year growth rate nationwide and, in terms of the concentration of private physicians around the country, it appears that California is the leading state,” Blue said.
Growth has come not just from single physicians deciding to change the way they practice. Major players like UC San Diego Health System and Scripps Health are also big players in the local market.
Concierge medicine is, at its most basic, a return to the age when doctors made house calls and were paid directly by the patients they treated.
These days, with instant communications and health insurance companies in the mix, things are more complicated. But the main point is the same: Families pay a subscription fee, ranging from hundreds to thousands of dollars per year, for more direct access to their doctors.
The rise of the concierge doctor at first came as a reaction to the heavily scheduled nature of modern medicine, where doctors working in large groups must see dozens of patients per day and seldom have much more than a few minutes to spend getting to know, or listen to, those they treat.
Concierge doctors are responsible for fewer patients and make up the difference by charging their fee. With most doctors, this fee gives patients much longer appointment times and direct access via cellphone, email or both. While the doctor’s attention is covered by the yearly fee, additional services like blood tests or visits to specialists are still the patient’s responsibility. Most still have health insurance, and concierge doctors have various ways of helping make sure that carriers are billed.
Pam Brar, a solo internal medicine doctor with a concierge practice on the Scripps Memorial La Jolla campus, said time and attention were the main reasons cited by patients when she first started in 2004.
But lately, she said, many of her new patients are citing the Affordable Care Act, often called Obamacare, as a reason they want to sign up. Many, she said, fear clogged waiting rooms and months waiting for an appointment when thousands of newly insured residents arrive after the first of the year.
“I would say almost all of the people I have spoken to recently, that was a concern they had,” Brar said.
Blue, the academy representative, said the trend is national.
“People have a sense that, particularly in primary care, there just aren’t enough doctors to go around. Most people are pretty concerned with solidifying their primary care relationship,” he said.
Brar said her practice has 185 patients today and is growing. She charges $2,500 per patient per year and plans to increase that to about $3,300 after leaving the Scripps La Jolla campus and moving into downtown La Jolla.
Dr. Marty Schulman, a concierge doctor in Encinitas, said he charges $800 per patient per year, and $500 for each additional family member. Unlike Brar, Schulman said he has not experienced as much Obamacare concern. Rather, he said, most people are still more motivated by the time-constrained nature of the traditional health system.
Still, he said he is not discounting the possibility that Obamacare will start his phone ringing in the new year.
While multiple studies have confirmed that there is a doctor shortage in the United States, that does not appear to be the case in primary care in San Diego County.
A list provided in July by the state medical board lists 4,097 doctors in the county in the specialties of family medicine, internal medicine and pediatrics, the three specialties generally considered primary care.
That’s far more than the 1,547 that would need to be available, according the U.S. Department of Health and Human Services, which recommends 1 primary care doctor per 2,000 residents.
But health reform, which requires most Americans to buy health insurance in 2014 or pay a penalty if they are not already covered by company policies or a government program like Medicare, will bring thousands more insured people into the market soon.
Covered California, the state’s health insurance exchange, estimated in June that 193,000 San Diego County residents will qualify to buy policies. And that number does not include thousands of additional local residents who will newly qualify for insurance under Medicare.
No one knows for sure how the local network of providers will absorb the crush of newly insured. While large networks like Scripps Health, Sharp HealthCare, Kaiser Permanente and UC San Diego Health System have all said recently that they are confident their systems can meet demand, smaller independent doctors and groups of doctors say they are not participating in exchange plans due to low levels of reimbursement offered by insurers.
Schulman, the Encinitas doctor, said he believes there is little question whether such a massive upheaval in the nationwide health care market will push some subscribers toward concierge practices.
“I think it could potentially drive some growth. I think the main question is: Is it going to drive some doctors out of regular practice and into concierge practice,” Schulman said.
