A rising number of physicians, nearly all of whom are primary care physicians, are moving toward a more pure fee-for-service (FFS) compensation system for their professional fees and simple office tests (e.g., ECG, spirometry, urinalysis), no longer accepting The Man’s insurance payments, and eschewing trends toward non-FFS compensation systems. Of course, this is the model of physician compensation that existed for the majority of America prior to 1965.
I get what’s in it for the patients who choose to afford the $1,600-3,000 annual retainer fee – same day office appointments, night-time telephone advice, and more time with the doc in the exam room (20-60 minutes rather than 6-10). I also understand the benefit for the docs – more time with patients, a simpler business model, and more time doctoring (rather than dealing with insurance companies). Some report higher incomes too – a result of fewer office staff (less overhead) and higher professional fees (including that annual retainer).
But the following questions occur to me:
1. Have we physicians, particularly primary care physicians, given up on creating those same desirable and justifiable outcomes through other means, particularly authentic payment reform?
2. Have we become a guild of independent business-men and -women, rather than a profession dedicated to public service?
3. Will Primary Care soon devolve into a caste system: Americans who can afford a main doctor (concierge practices), versus those who can’t (relegated to see a NP at Wal-Mart for straightforward and low-risk stuff, and the ER doctor-du-jour, followed by a cadre of disassociated proceduralists for all other maladies)? That is a recipe for Anarchistic Waste if ever there was one.
Give me your answer to those questions (or comments of your choosing) below.