Contract Medicine – The Future of Medicine

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As a patient that has had excellentmedical insurance for most of my adult life, why would I support oradvocate for another type of medicine. Quite simply – the currentmedical system is broken and with the government taking more powerand intruding further into our lives every day, it is headed for thefinancial breaking point. Doctors in private practice relying oninsurance and Medicare payments are finding it very uneconomical tostay in practice and live on the increasing cuts in payments, paystaff to submit insurance and Medicare claims, and meet the needs ofthe patients. Hospitals are seizing the opportunity to buy out thesefailing practices or hiring the doctors away from them, therebyincreasing their monopoly.
The more exclusive the hospitalsbecome, the higher the costs of patient care becomes. The hospitalsare reimbursed for the recoding of simple procedures to complicatedprocedures. Does the doctor benefit, seldom, but the administrationgets higher and higher salaries and bonuses. This is why we need thedoctors and their preventive medicine, which is possible undercontract medicine regardless of type - boutique, concierge, retainer,and direct care. These caring doctors practicing preventive medicinewill decrease the probability of increases in chronic illnesses anddiseases.
The current president of the AmericanAcademy of Private Physicians (AAPP), Gary M. Price, M.D., F.A.C.P.,has some excellent points at the bottom of the front page of the AAPP website. How long it will remain up is in doubt, but it is wellworth the time to read it. I am quoting two paragraphs - “Directpractice restores the doctor-patient relationship to the lofty levelit enjoyed before being constrained and degraded by government andinsurance. We work only for our patients. We give them uncompromisingcare in an unhurried, respectful setting. Because we care, thephysician becomes a trusted friend. And in direct practice we behavelike any other free market: we listen to our customers and respond totheir needs. Which is why we have evolved many variations of ourmodel to serve every type of community and every income level.”
It is followed by a statement by Dr.Jordan L. Shlain, MD, San Francisco, CA - Internal Medicine. Hispoint is well stated here - “We arebuilding the wellness model of the future and actively critiquing thecircular illness-model. The common denominator that sets us apart isour desire to listen longer, ask more questions, and take the time towork through a complex problem in the spirit of healthy living andlongevity.”
Dr. Price lists contract medicine thisway - “In the late 1990s a new movementwas born in Seattle, Washington and Fort Myers, Florida. Creativephysicians dissatisfied with the status quo opted out of theinsurance-based medical system to invent a better way to care fortheir patients. This movementcame to be known as Direct, Concierge, Boutique or Private medicine.” Thelast sentence is different than “boutique, concierge, retainer, anddirect care” and does create some confusion as “direct” and“private” medicine are often seen as being the same. Directprimary care (DPC) may be a preferable term to direct or direct care. They are all private medicine and as a group should be consideredcontract medicine. All of the terms can be considered “retainermedicine”. Many doctors prefer the term “retainer” to boutiqueor concierge and that is the reason in my previous blog I listed thewide range of fees these doctors may charge.
Will there be aconsensus about the terms? This is very doubtful, as many doctors donot like the terms “boutique” or “concierge”. They considerthese terms elitist and while the fees may vary, they cannot acceptthe connotation that these terms may imply. This is a reason thatthe last sentence in the first quote from Dr. Price - Whichis why we have evolved many variations of our model to serve everytype of community and every income level” isso important as they are covering all aspects of contract medicine.
Back to why thisis the future of medicine. Dr. Price states most of it very well andI quote, “Direct practice restoresthe doctor-patient relationship to the lofty level it enjoyed beforebeing constrained and degraded by government and insurance. We workonly for our patients. We give them uncompromising care in anunhurried, respectful setting. Because we care, the physician becomesa trusted friend.” This may notcover all situations; however, it does spell out the importance ofrestoring the doctor/patient relationship, putting the patient firstand emphasizing preventive medicine instead of waiting for theillness or disease and treating these. This puts “human” back inthe equation and makes the doctor and the patient be in tune witheach other because the time restraints are removed and the doctor hastime to be thorough.
From the AAPP website, clicking on “TheThird Era of Medicine” button will bring you to one of thebetter discussions of the medical mess we are currently experiencing,or click on this link. I found the discussion about type 2 diabetesvery informative and on target. Scroll down the page to “Trappedin the Oscillating Structure of the Second Era”, and thendown some more to “To preserve the first era paradigm, thesystem refuses to embrace three key realities:”1. Diabetes is in fact an escalatingprogression of systemic destruction set in motion by awell-understood clinical imbalance; 2. The imbalance and the resulting damagecan be economically detected and measured very early in itsprogression; and 3. The destructive sequence can beinexpensively halted and reversed when addressed early in itsprogression.This is a polite way of saying that ourcurrent doctors are so constrained that they will not attempt adiabetes diagnosis until the conditions have reached a level thatrequires medication. Yes, there are a few conscientious doctors thatdo diagnosis prediabetes, but do not usually do much further becausethey have no support system and if medication is required, insurancewill not pay for anything. Our broken healthcare system comes tomind.
If the AAPP can state things like this,then they will be working for patients, which is more than I can sayfor the American Diabetes Association. Whether you consider contractmedicine or not, the “The Third Era of Medicine” is veryinteresting and explains what the future of medicine may become. Dr.Price says. “Today, even medical schoolsare including direct practice in their curricula.” Ifpotential medical students will acquaint themselves with the AAPPsite and a few other sites like this one and this one, they mightdecide that medicine is for them. These potential doctors may be theones to give real preventive medicine the goal of actually helpingpatients and preventing the development of some chronic diseases.
Of the many doctors that are wishing toretire – if they could, it is sad that they do not look to contractmedicine for some enjoyment until they can retire. It is even sadderthat many of these doctors will never fit in contract medicine forseveral reasons. Many are overly attached to the current system andare unable to rethink their situation to be able to work in contractmedicine. Others have overvalued their worth and will not work incontract medicine because they cannot accept value in the Internet orusing telemedicine. Still other doctors have become so ingrained inthe quick appointments that having half an hour or longerappointments scares the dickens out of them, plus they cannot operatein the preventive medicine arena. To these doctors I will only say –retire, medicine may be better off without you.
Yes, I am an advocate for contractmedicine and believe this may be a major part of the solution to ourcurrent broken medical system. Dr. Jordan Shlain is correct when hesays, “The common denominator that sets usapart is our desire to listen longer, ask more questions, and takethe time to work through a complex problem in the spirit of healthyliving and longevity.” This ideais further restated in much of the AAPP website. Take time toexplore the AAPP website. Just remember that some of it is formembers only and not accessible to the general public, but it isbetter than many professional medical websites. Transparency is aterm they do understand.