Extra Care

‘Concierge’ medicine gives patients the royal treatment. Still, the service has its price — and its critics


Doctors haven’t made house calls since they wore head mirrors. But Dr. John Blanchard will make residential visits. Not in every case, mind you. But it’s part of his service as a so-called “concierge” doctor, an emerging practice model in the complicated chaos of American health care.
The Clarkston family practitioner prefers the term “innovative practice” and, in fact, he’s founder of the Society for Innovative Medical Practice Design, but concierge seems to be the colloquial term for his practice model. It’s a white flag of sorts in the rat race of corporate medicine, an opt-out that allows him to practice better medicine and his patients to get better care. It has a price, but for a certain sort of patient, it’s one they’re happy to pay.

The concierge model is this: Patients pay an annual fee — around $200 a month in Blanchard’s practice, billed quarterly — for a higher level of care. Their appointments last longer. They spend more time in conversation with their doctors, discussing not only illness, but also its prevention. They never have to wait; in fact, Blanchard boasts that the offices of Premier Private Physicians don’t even have waiting rooms, because patients arrive and are seen immediately. Patients have their doctor’s cell-phone number, and are encouraged to call whenever they have a problem, 24 hours a day.

All office visits are covered by the retainer fee. Anything else — lab work, hospitalization, and specialist referrals — is billed to a patient’s insurance, which they are required to have.

In return, Blanchard can treat his patients at a much slower pace. A typical concierge practice is limited to 300 patients. (A large-group private-practice physician might have 3,000.) He can really get to know them and their situations, the better to understand what might be affecting their health for good or ill. And he will make a lot more money than primary-care doctors in traditional practices.

Primary-care doctors — family practitioners, internists, and other general practitioners who are a patient’s first call in case of illness — are the “paupers of the profession,” Blanchard says. A good first-care doc has to know about everything from pediatrics to geriatrics, cardiology to orthopedics, but he or she will earn a fraction of what doctors do in most of those specialties. While no patient wants a doctor who’s in it only for the money, the plain fact remains that medical students are choosing primary-care specialties at lower rates than the more lucrative sub-specialties, enough that the American Medical Association sees doctor shortages looming, and is studying the issue.

Blanchard says his average patient is over 50 and well-off. They may be self-employed and self-insured, but willing to pay extra not to cool their heels for 90 minutes in a waiting room while a backed-up schedule resolves itself: “They want a doctor who works for them.”

Brian Joseph is typical. A funeral director in Warren, he has spent his career in a field that offers very specialized service at stressful times in people’s lives, and expects the same in his own.

“When someone’s mother has died at home in the middle of the night, we don’t tell them we’ll be there in the morning,” he says. “We go out right away. That’s what I want from my doctor.”

Recently divorced, the 43-year-old Joseph found himself living alone for the first time in many years, and wondered what would happen if he became too sick to leave home. “I like knowing I can pick up my phone and have a quick response,” he says. His time with Blanchard has been a revelation: “My first physical with him took four hours,” he says. “He’s explaining everything to me, laying everything out. The value you get for your money, it’s just incredible.”

Vernon Scholz agrees. A Warren engineer, he has a chronic medical condition that has so far been resistant to treatment, and, frustrated, he wanted “a medical quarterback, someone who could coordinate everything.” Blanchard will accompany patients to consultations with specialists, and Scholz loves that. “You can call him when you have a question, when it’s fresh in your mind, and he picks up the phone.”

So concierge medicine is win-win? Not for everybody, says Dr. Susan Steigerwalt, a Detroit nephrologist with a large practice composed of far poorer patients. As past president of Physicians for a National Health Program, she emphasizes that she speaks only for herself. To her, concierge medicine only puts off what she sees as the only solution to the nation’s health-care woes: a single-payer national health plan.

She’s sympathetic to the problems that led Blanchard and his patients down that path. “But the bigger problem is 49 million uninsured — people skipping their meds because they can’t afford them this month,” she says. And as for that concierge service, Steigerwalt says: “My little old ladies with uncontrolled hypertension have my cell-phone number, too.”

Derringer is a Grosse Pointe Woods-based freelancer. E-mail: editorial@hourdetroit.com.

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