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Everybody knows what happens when items are scarce: prices go up. If you need any evidence, try to get tickets to Hamilton or, after the show is over, hail an Uber driver. Now, surge pricing has hit medicine in the form of concierge medicine, also called “retainer medicine.” Patients contract with a medical practice to gain ready access by paying a monthly fee. No lines, no waiting.

What are the costs? It depends somewhat upon on where you’re located. For example:

– The New York Times reports an annual co-pay of $40,000 (…/economy/high-end-medical-care.html). That’s on the high end, but some rare urban practices (in New York City, San Francisco, and Los Angeles, for example) can command an annual family fee of $100,000 and up.

– In most of the country, annual fees range from $1,200 to $1,800, with 80% of practices in the range of $1,200 to $3,000 per year. Patients expect to be greeted by their name at the front desk, wait 5 minutes or less and spend 30 to 60 minutes with the physician. Physicians spend about an hour a day answering emails, 60% work 8 to 10 hours a day, 50% see as few as ten patients per day, and 53% report having between 200 and 500 total patients. (See

– In 2015, the Journal Gazette ran an article (…/New-approach-to-care-4339506) about Dr. David Li ( ), whose practice charges about $69 per month.

– Another concierge practice, Direct Clinic (, has opened on Getz Rd. It is staffed by a nurse practitioner, Amy Howard, family practice physician, Baerbel Stumpf, and internal medicine physician, Heidi Lang. (See…/new-membership-based-healthcare-facility…/)

What are some commonly asked questions about concierge medicine–and what are the pros and cons?

– Is it true that this favors the wealthy? Not really. The local cost of $69 per month is less than 30 days of cigarettes or fancy coffee.

– Do you still need insurance? Yes. Local programs offer primary care visits, and insurance will be needed for hospitals and specialists. However, with careful buying one may be able to combine a major medical policy with concierge care and a health savings plan. The choice will be different for every family.

– Won’t this exacerbate the shortage of primary care physicians? In our current system, payment favors specialty care–and that’s mainly what discourages medical students from primary care practice. This has led to more care being provided by nurse practitioners and physician assistants. Concierge physicians say they still do their share of charity care and will practice for more years because their practice is more sustainable and enjoyable.

– Is concierge practice ethical? Each system of practice brings with it a conflict of interest and other temptations. When part of an HMO or under contract with a large clinic or hospital, a physician may be incentivized by the number of patients seen or share in a pool of profits based on cutting costs, a total of code values, or perhaps even rationing of care. Medical ethics for all systems of care insist that a physician put the interest of patients first and foremost. Concierge physicians must charge money to “keep the doors open,” but their allegiance is only to their patients.

– Will difficult access to care promote the growth of concierge care? Yes.