My doctor is leaving me. Should I follow?

August 26, 2011 8:20 AM

My doctor is leaving me. Should I follow?

My primary physician has been my guy for, oh, 30 years now. I like him. Most of all, I like the relationship we've built over three decades. Yesterday, I get a letter saying he's altering his practice to become a boutique practice. That is, now I have to pay $1600 a year membership fee in addition to usual fees for visits and everything. That gets me longer, same-day appointments, a bunch of extra testing, more of his time and yadda yadda. I can see his reasons for doing this. My question is, should I follow?

I see him maybe once a year for a physical. I have no chronic conditions. I really don't need him much but as I get older (I'm 54 now), I like the thought there's one guy overseeing my knee doc, my hand doc and whatever else kind of doc I'm going to need. And maybe I'm going to need a doctor more than I do now.

So ... has anyone jumped to one of these boutique thingies? Was it worth it? And, would I lose anything other than my relationship by just jumping to someone new?

posted by lpsguy to Health & Fitness (20 answers total)

Sounds like this is his way of ramping down business before retirement. That being said, even if many patients take him up on the offer, is $1600 really going to buy you same day availability from a doctor? What's his hourly rate?
posted by Yowser at 8:23 AM on August 26, 2011

If you can afford it I would do it in a heartbeat. This is the future of healthcare for those with sufficient income to place themselves outside of the normal insurer-provided system.
posted by dfriedman at 8:24 AM on August 26, 2011 [2 favorites]

And, would I lose anything other than my relationship by just jumping to someone new?

I have seen a lot of doctors over the years, and I'm 26. Maybe it is my insurance or where I live or god-knows-what but most of them are ... not great. If you have a doctor you genuinely like, and who does a good job, I'd say hang on.
posted by griphus at 8:25 AM on August 26, 2011

Best answer: You can't buy insurance when your house is on fire. This is an insurance policy for when you start breaking down. The only other thing to consider is that if you are 54 and your doctor is much older, he will retire and you will be looking for a new doctor likely when you are in the midst of taking 12 pills a day, have 4 different specialists, have 7 legit issues and you ache every morning just because it is the morning. Maybe it is better to find a new 30 year doctor from among the younger set.
posted by JohnnyGunn at 8:29 AM on August 26, 2011 [7 favorites]

The internist my mom had been seeing for close to 25 years just recently retired. The (younger, eager, female) doctor who took over his practice did a really good job of having an extended getting-to-know-you first checkup with all of the old patients... she caught several problems (hypothyroidism among them) that had been going unnoticed by the other doctor for years.

The doctor my mom had been seeing for so long was an excellent doctor by all accounts. I think the familiarity he had with my mom made him miss certain physical symptoms she was showing and assumed them to be caused by aging and/or weight gain than something thyroid related. But the new doctor saw everything.

So, basically, it's not the end of the world if you need to find a new doctor. I wouldn't switch to his boutique practice. There's a lot to be said for finding a doctor you're happy and comfortable with, but for $1600/year you can doctor shop and find someone new. Your doctor's going to retire eventually (and probably soon), so you'll need to find a new doctor anyway.
posted by phunniemee at 8:30 AM on August 26, 2011 [7 favorites]

Also, if you're in Chicago: I have a wonderful internist who works in the Loop. I'd be happy to pass along his info.
posted by phunniemee at 8:31 AM on August 26, 2011

Your doctor will probably sell his practice, but you can certainly ask him about his retirement plans and what he intends to do with his current patients.

You can also stick with him and, if you do not like the boutique plan, look for a new doctor while you still have one, just in case.
posted by jeather at 8:32 AM on August 26, 2011

Split the difference -- buy a year and see if it's worth the $1600. Use that year to sniff out his retirement plans and gather references to newer doctors.
posted by motsque at 8:44 AM on August 26, 2011 [1 favorite]

Best answer: I used to work the front desk in a practice like what you're describing. (Significantly higher yearly fee though!) Our patients loved it, even the ones we coun't get to come in for a check up, ever. There was some interesting manuevering to get pre-authorization from insurance companies fo rspecialist visits, because we weren't providers on any insurance plan. But the peace of mind for patients was priceless. The doctor would also make house calls to homebound clients, and of course was a great advocate at the hospital when crises came up.

Be aware that this kind of availability applies to the office staff as well. When I was hired I was told that we worked 8 to 5, "Unless a patient needs to be seen before or after office hours." Wouldn't you know, I was in the office from 7 to 7 most days, and sometimes staying later. There were always patients calling at 4 on a Friday, insisting they be seen same day for the sore throat/superating sore/ingrown toenail they'd been ignoring all week. 350 patient cap on the practice, and I left at 5 one time. (Coincidentally, it was because a hurricane was coming.)

From the ghost of bilabial past, please don't be that guy demanding to be seen at 7pm because you pay good money....
posted by bilabial at 8:46 AM on August 26, 2011 [1 favorite]

If you are 54 and healthy, and your doc's been in practice 30 years, odds are he'll retire before you really need the extra service provided by the boutique practice. Side benefit is that a boutique practice is actually worth something in the resale market; in the current conditions a regular insurance-only practice is worthless and can't be sold. So you can look forward to some kind of continuity of care, most likely.

Also worth considering: if you get really sick and start taking up a lot of his time, there's nothing stopping your doc from dumping you when the time comes to renew your boutique subscription. The idea that a boutique practice might be composed of only healthy people is called 'cherry-picking' and, not to put too fine a point on it, it is the only way to make a solo boutique practice viable. You can be sure that if you were a highly complicated patient you would never have gotten the invitation to join his boutique practice.

Food for thought.
posted by Protocols of the Elders of Sockpuppetry at 8:52 AM on August 26, 2011 [2 favorites]

Protocols, we had some very, very sick patients. They were never kicked out. Many of them were super sick when the doctor struck out on his own with the boutique practice.

Additionally, this doctor had several patients who could not pay! Usually he got them from being on call at the hospital.

So. what you're suggesting doesn't hold up with what I've seen in person, though as I said, the fees were higher.
posted by bilabial at 9:17 AM on August 26, 2011

That doesn't seem like a bad deal for the money, which amounts to $133 a month. If you have the money, and care.

But I think the people who mention that this doctor is likely close to retirement and you are going to need a new doc eventually are right.
posted by gjc at 9:33 AM on August 26, 2011

Best answer: I say not worth it. You don't see him often at this point. I'd start a relationship with anoter doctor to see you through the next 30 years. I mean, assuming he wasn't fresh out med school when you first started seeing him, he likely will retire before you reach the end of your life.

I say see a nice new younger doctor to keep up your constancy of care for the next 30 years plus. But to get it, you have to build it again. But I think the goal is good...and this will be far cheaper.
posted by inturnaround at 9:46 AM on August 26, 2011

If you see him once a year, use the next year (and $1600) to find a new doctor. If you don't find one, then sign up with him again.
posted by blue_beetle at 10:09 AM on August 26, 2011 [1 favorite]

I'm kinda amazed that so many think this is a good idea, honestly. Seems like a way for the doctor to get around the pre-agreed upon rates for insurance coverages and get himself extra money for retirement in return for what he says is more premium care--which would bother me about what kind of care I'd been getting all along until now.

I don't see how he can guarantee the same-day appointments and all the rest when he has no idea yet how many patients are going to take him up on the offer, either.

But really, it's your call. If you think it is worth paying $1600 more a year to have this doctor until he retires, and you can afford it, go ahead. I just think, personally, it's a rip-off.
posted by misha at 10:58 AM on August 26, 2011 [4 favorites]

A good doctor is hard to find. I finally found an excellent doctor, and it only took about 10 years.

I don't think a doctor here in Canada could legally do something like what your doctor is doing, but if he WERE to, I would pay it.
posted by smitt at 11:06 AM on August 26, 2011

Another viewpoint: I go to a much cheaper hybrid concierge practice here in San Francisco (One Medical), and it's been worth the $100 annual fee. The advantages for me at that price are that the practice is fully EHR integrated, I can book appointments online, the front desk is extremely helpful, and the physicians see fewer patients per day, so they have more time allotted if I have a problem that requires more than just writing a scrip. They've done a lot of administrative work for me interfacing with pharmacies and insurance that might otherwise have been annoying hold time on the phone chasing stuff down... like when a prescription I had written in Atlanta ran out, and they got a staff doc to write a new one for me and fax it to the pharmacy within the next two hours, then called me back to let me know it'd gotten through. Or when I had a UTI, and they had a doctor call me back and diagnose it over the phone so that I could have same-day antibiotics. Also they have far more same day or next day appointments than my previous physicians' offices. These are all things that *were* standard practice, but have been increasingly going to the wayside in primary care in the US, because of the pressure on reimbursement for anything that's not a test or a procedure. I'd have to think carefully about the $1800 price point compared to the $100 I'm paying, but I do think there's some worth in some of these new models.
posted by deludingmyself at 12:20 PM on August 26, 2011

Best answer: I would say that the first thing you might wanna do is talk to your doctor or the people in the office. See if you can get around this fee by simply saying "I've been with Dr. ....for 30 years now. I love him and he's always been great to me. But finances are tough. I'd love to stay with you guys, but is there any way you can wave this fee because of all the business and loyalty I've shown him over the years?" All they can do is say no. But I would hope that they make some exceptions for long time clients such as yourself. In any business, raising prices to loyal customers is often the wrong move to make. Raising prices on new customers is different. But nothing beats repeat business. And unless your doctor is in huge demand...trust me they don't wanna lose your business. That being said, if they don't waive the fee or give you a huge discount I would definitely find a new doctor. I know it sucks but this is a rip off. At least I think so. Especially if you have health insurance. And if your health insurance is pretty good then you have a whole choice of doctors. Hope this helps.
posted by ljs30 at 12:30 PM on August 26, 2011

Best answer: Write him a straightforward letter, in which you:

1. Thank him for his services over the years, and express your appreciation for the relationship you've built together;

2. Express understanding of and appreciation for what he's trying to accomplish with this change;

3. Express regret that you do not feel you have the ability to pay the yearly fee, although you are exploring your options;

4. Politely ask him whether he will consider waiving/discounting the rate in order to retain you as a patient, and if not, does he have anyone still operating a more traditional practice that he would recommend for you given what he knows about you and your medical history;

5. Wish him the best in his endeavor, reiterating that while you will regret it if you must move on to another doctor, you truly do wish him success in what he's trying to accomplish.

At maximum, this is a five-paragraph letter, although the paragraphs should be brief, and if you can make it shorter, even better.
posted by davejay at 12:30 PM on August 26, 2011

What is your insurance situation?

Can you afford this? It seems like kind of a lot to me.
posted by jenfullmoon at 1:14 PM on August 26, 2011