In recent years, my wife and I have done our doctoring at a Philadelphia group practice that’s a shining example of community-oriented internal medicine. Whenever we have a concern, a phone call to the practice (as opposed to an 800 number in Tulsa) connects us to a friendly and reassuring voice. If our own internist isn’t available, some other doctor in the practice— or, more likely, a physician’s assistant or a nurse— will address our issue capably and empathetically, either over the phone or in the office, either that very day or the next day at the latest. Our internist, whom I will call Dr. Debbie, was beloved by her patients for her combination of knowledge and compassion.
But about five years ago, Dr. Debbie informed me that she’d been approached to join a concierge network that charges patients an annual fee of $2,000 or more, in addition to the patient’s insurance coverage, ostensibly for easier access to their physician. Before the 21st Century, the term concierge usually connoted a hotel employee— preferably multilingual, knowledgeable, and personable— who recommends restaurants and entertainment, makes reservations, and otherwise soothes the niggling annoyances of guests from out of town. Only in the past 35 years or so— or roughly since Dr. Debbie was born— has the term been applied primarily to doctors serving well-heeled patients. As Dr. Debbie saw it, the concierge model would enable her to drastically reduce her patient load— not to mention her paperwork— so she’d have more time to devote to each patient. In such a brave new world, she and her patients would be liberated from the bureaucratic constraints imposed by insurers and government programs. She asked my opinion.
(That question itself was remarkable. How many doctors do you know who solicit feedback about their practice from their patients?)
I replied that the concierge approach might be a good idea for older doctors who want to wind down their practices without retiring altogether. But given the advances in medical technology we’re likely to see in the coming decades, a 30-something doctor like Debbie would best keep abreast of cutting-edge biotech developments by exposing herself to a large pool of diverse patients rather than a small pool of affluent patients.
‘Have a nice day!’
Dr. Debbie took my advice, at least initially. But two years later, she notified her patients that she had signed on with one of America’s largest concierge physician networks: MDVIP, based in Boca Raton, Florida, whose 1,100-plus doctors serve more than 390,000 patients. From now on, Dr. Debbie’s patients would enjoy access to her only by paying $2,000 per year ($4,000 per couple) for the privilege. Otherwise, we’d be reassigned to another physician in our group practice.
What to do? We adored Dr. Debbie, but our due diligence failed to generate similar enthusiasm for MDVIP. Its ballyhooed “Wellness Program” struck us largely as a marketing ploy designed to justify the additional $2,000 annual fee each of us would be charged to remain with Dr. Debbie.
MDVIP’s patients are given their doctor’s cell phone number and encouraged to think of their doctor as a friend they can call at any time. Its website assured us that its physicians “have time to get to know you, which studies show improve both the doctor-patient relationship and health outcomes. And since you'll see your physician — not a physician extender or one of many doctors — you'll have continuity of care, which studies have also shown lead to better outcomes.”
But MDVIP’s selling points— like an annual physical exam, emphasis on preventive medicine, and same-day or next-day access to care— were virtually identical to the benefits we already enjoyed through our group practice. MDVIP’s Wellness Program seemed especially superfluous in our case, since we already had relationships with some dozen specialists, whom we visit annually or semi-annually for precisely the sort of preventive screening advertised by MDVIP. All our visits and tests with these specialists are covered by our health insurance, contrary to MDVIP’s talking points.
As part of our due diligence, Barbara and I perused Facebook’s patient reviews about MDVIP. As you might expect, we found many favorable reviews and many negative ones. What disturbed us was MDVIP’s response to these reviews. Each favorable review received an effusive thank-you reply, followed by “Have a nice day!” But the patients’ complaints were largely ignored (with a few exceptions). We were left with the impression that MDVIP cared more about its image than about addressing patients’ concerns.
‘Don’t call me on weekends’
Ultimately, Barbara and I decided to conduct our own comparison test: She signed up with MDVIP for a year, mainly to maintain her relationship with Dr. Debbie. I declined the MDVIP program and accepted assignment to another physician with our group practice. After one year, we would compare notes, assess whether the added cost of MDVIP was justified, and decide how we’d like to proceed.
Well, more than a year has passed— during which, incidentally, MDVIP raised its annual fee to $2,200— and we recently made our decision: Barbara dropped her MDVIP relationship and switched to my own internist.
That’s no reflection on Dr. Debbie. As I see it, the concierge formula alters the expectations of doctors and patients alike, and not in a good way. Concierge patients feel free to call their doctors at any hour of day or night, and consequently concierge doctors feel compelled to set boundaries to avoid being bombarded with all those calls. One patient I know, having been diagnosed with cancer, phoned his concierge internist (not with MDVIP) to relay the grim news. “If it’s cancer,” the doctor replied, “I can’t help you.” Another concierge patient, alarmed by her difficulty in accessing the results of a recent mammogram, phoned her MDVIP doctor for assistance, or at least a few kind words. “Don’t call me on weekends unless it’s an emergency,” the doctor curtly informed her.
Private equity math
Nor did MDVIP’s “Leadership Team,” as described on its website, seem equipped to react if and when its “Wellness Program” inevitably becomes outmoded as medical technology evolves. Of its nine top managers, only one is a physician— and she’s an osteopath, not an M.D. The CEO is described as an investor and health care entrepreneur. The remaining managers specialize in communications, marketing, technology, legal issues, business development, and physician recruitment. Did I mention that, since 2014, MDVIP has been majority-owned by private equity investors?
Why would a dodgy field like health care appeal to an investment firm? Do the math. According to its website, MDVIP’s 1,100 internists serve 390,000 patients, an average of 354 patients per doctor— a fraction of the number many internists now serve. But even at that relatively relaxed rate, each doctor generates more than $700,000 in cash flow for MDVIP.
How much of that $700,000 goes to the idoctor, or how the doctor’s compensation is calculated, isn’t clear; but my cursory research suggests that a concierge internist receives a salary in the $200,000-$250,000 range, which even after other expenses still leaves plenty for the investors. And MDVIP is a relative bargain player in this field; some boutique concierge networks charge patients as much as $10,000 each for access to internists or specialists.
The bottom line: If 390,000 patients pay MDVIP $2,200 each, we’re talking about a business whose annual revenues exceed $850 million.
For the time being, concierge medicine seems like a deal that works for some doctors, patients, and investors (even if not for Barbara and me). But no business plan lasts forever. MDVIP claims that 90% of its current patients renew their membership each year. But on the inevitable day that the concierge model no longer works for doctors and patients, the investors can shift their assets elsewhere. The doctors who’ve invested many years and dollars in their medical education won’t enjoy that option.
Death of a hospital
Consider the fate of Hahnemann University Hospital, a vital Philadelphia community health resource that closed in 2019 after it was acquired by private equity investors who mistakenly believed they could apply conventional business methods to a distressed medical institution. In that case, the investment firm shrewdly hedged its risk by separating the hospital building from the hospital itself. Then the investors closed the hospital and sought bankruptcy protection from the hospital’s creditors while keeping its real estate for themselves. A sweet deal for the firm’s investors, but not for the hospital’s staff or patients.
Incidentally, when Barbara and I canceled her MDVIP membership, nobody at MDVIP inquired as to why we were quitting. My own phone calls and email messages to MDVIP’s media relations director, seeking her reactions to my observations expressed here, were not returned. We did, however, receive several messages and calls from MDVIP reminding us that we still owed $1,100 for the remaining six months of Barbara’s membership. These folks seem to have a keen grasp on their priorities.
Of course, now we Rottenbergs confront a new challenge: what to do with the $2,200 we’ll save each year by dropping MDVIP. Should we throw a party? Fly to Europe? Catch a new Broadway show every month? Donate the money to the International Rescue Committee for its work in Ukraine and Gaza? Stock up on liquor, cigars, and chorus girls?
Decisions, decisions. Maybe we need a concierge financial adviser?
Enjoy Dan Rottenberg’s new memoir, The Education of a Journalist: My Seventy Years on the Frontiers of Free Speech. You can also visit his website at www.danrottenberg.com
From reader Jeoffry B. Gordon, MD, MPH:
"Speaking as a family doc and a healthcare nerd, you got it just right. And by mentioning the Hahnemann Hospital in passing, you raised the issue of the big picture.
"Physicians tend to have smart, entrepreneurial personalities, and now that smart entrepreneurial insurance companies are not paying them well, they are eager to earn money some other way. I cannot think of a more ethically challenged model than concierge medicine, where a doc discriminates among his/her patients (or any patient) on a cash upfront basis.
"Sadly, I think financialization has captured so much of the medical care system that we are past a tipping point. COVID demonstrated that, and it will be downhill and collapse from here."
From reader Katherine Conner:
"When the doctor we both loved, and had been with for years, first talked to us about concierge medicine, we were all in agreement that, except in special cases where the accessibility of very needy patients seemed worth the extra money (assuming it actually happened), overall it appeared to be basically a profit-making model, designed to get the maximum of dollars from the rich, while depriving the less rich of many competent doctors at more reasonable prices. But, as with Dr. Debbie, our doctor was eventually lured by the siren call..."