In a letter to fellow members of the AAPP, Dr. Jordan Shlain, MD recently wrote:

“I would like to take a moment to reflect on who we are, what we are doing, and why it’s so important. The American Academy of Private Physicians was founded on a simple premise: more time and better care for our patients while freeing doctors from complex payment schema and contracts by ‘third party payers.’ Simply put, we are held accountable to our patients, not to insurance companies.” …”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.”

Concierge Medicine is the complete opposite of the Patient Protection and Affordable Care Act (PPACA), which is aimed at more regulation, less personal accountability and less personalized care by physicians.  The PPACA‘s stated goal is to provide more health care for more Americans at a lower cost for the patient.  It attempts to accomplish this goal through more regulations on doctors, requiring better and more readily available medical records, and free screenings and tests to diagnose medical conditions earlier.

Concierge Medicine is an attempt to promote improved health for patients through more time involvement, better relationships between doctors and patients, and more personal responsibility for individual health.  In short CM is a return to the way medicine used to be practiced in America, before employers and insurance companies became the primary source for the payment of healthcare costs.

We have reached the current healthcare situation as a result of the wage controls which were put in place during WWII, forcing employers to offer fringe benefits, such as health insurance, to compete for good employees. The insinuation of third party payers has eroded the doctor patient relationship.  Many healthcare providers point to the disassociation of the costs and benefits of healthcare from the doctor-patient relationship as the start of the rapid spirally costs of healthcare.  The patient had no interest in cost containment, since they weren’t paying for the medical care, the doctor had no incentive to control costs because didn’t have to bill the patient directly, and the insurance company had little incentive to reduce costs because they could always increase the premiums paid by the employer.  As the delivery of healthcare became more unaccountable for all parties involved, the level of personal care decreased as costs skyrocketed.

CM is an attempt to bring back the doctor-patient relationship, both personally and financially, in order to provide better healthcare at a reasonable cost.  CM operates under the premise that better doctor-patient relationships will result in better overall health because doctors have the time to delve more deeply into their patient’s history and lifestyles and perform a better job catching health problems early.  Patients also have a vested interest in following their doctor’s recommendations because they have a greater financial responsibility for any healthcare costs that they incur.

Critics of Concierge Medicine claim that it will create a two-tiered medical system within the US, one for wealthy (or healthy) Americans who can afford the best medical care, and a second class for poorer (or unhealthier) Americans.  CM patients pay a higher fee to avoid waiting or for more time with a doctor to discuss healthcare issues.  Those who can’t (or choose not to pay extra) will have longer wait times or less face time with doctors who are overwhelmed by the number of patients they see.