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Citing an impersonal health care system, more patients are seeking concierge medicine

Patient Heather Doolittle lies on a table in an exam room. Dr. Alexa Fiffick puts her hands on Doolittle's head and forehead.
Ryan Loew
Ideastream Public Media
Dr. Alexa Fiffick performs osteopathic manipulative therapy on patient Heather Doolittle, of Rocky River, at Concierge Medicine of Westlake on Thursday, Oct. 19, 2023.

Heather Doolittle, of Rocky River, bounced between traditional primary care doctors and specialists for years.

She suffers from migraines, meaning she sometimes needs quick access to a doctor. So the current process of scheduling appointments — sometimes weeks or months in advance, for only a few minutes of facetime in an office with a doctor — wasn't working for her.

That's why she decided to try concierge medicine, also known as boutique medicine or direct primary care. It's a membership-based model that typically removes health insurance from the equation.

Concierge doctors charge an upfront fee in exchange for unlimited access to a variety of primary care services, like a subscription. Patients pay their doctor directly through fees.

Dr. Alexa Fiffick, who opened Concierge Medicine of Westlake in September, charges a flat rate for six months or a year, with a year costing $3,000.

"For that $3,000, you get to see me as much or as little as you want, so it's like paying for a gym membership. I'm here when you need me. I'm here when you want me. You don't always have to show up, and I'm not going to hold you to any sort of number," Fiffick said, citing a desire to craft a more personalized experience for her patients.

In addition to having access to their doctor at all times, Fiffick said her patients receive more time and comprehensive care from her. Concierge doctors often form their own private practices independent of health care system affiliations to limit their number of patients.

Fiffick, whose practice is part of the Ms. Medicine Concierge Doctors and Physicians network, noted this model allows her to dedicate time to getting to know her patients, with most visits in her office ranging from one to two hours.

"Getting a full hour or more to really start learning about someone, I think makes the big difference,” she said.

A boon for women

Fiffick said that women in particular fall through the cracks of an impersonal health care system. Care tends to weaken after maternity, meaning women enduring menopause are often overlooked, she said.

"They feel like they're being heard and their questions are being answered when they're actually with me and they're not being rushed through a visit," Fiffick explained. "So they don't go home quite so confused all the time. I think getting the care and having the conversations they need in the office is really helpful for a lot of patients."

The ease of access is why Doolittle said she became one of Fiffick's patients, who are given Fiffick's cell phone number and are guaranteed prompt responses any time of day. They can also access her via video calls and unlimited in-person visits. Appointments are guaranteed same day or next day.

"At night, if I need to call her, I can call her. With insurance, that's not going to happen. It gives her a lot more freedom to treat me the way she thinks I need to be treated rather than how insurance would determine how I need to be treated," Doolittle said.

Concierge doctors like Fiffick offer the same care patients see from a primary care doctor. Doolittle was able to receive osteopathic manipulation treatment during a recent visit to Fiffick's office, which also has a lab on site.

"One time I wanted to change my medicine and I called the office at 12 p.m. and it was at the pharmacy by 12:45," Doolittle noted.

Dr. Alexa Fiffick performs osteopathic manipulative therapy on patient Heather Doolittle, of Rocky River, at Concierge Medicine of Westlake on Thursday, Oct. 19, 2023.
Ryan Loew
Ideastream Public Media
Dr. Alexa Fiffick performs osteopathic manipulative therapy on patient Heather Doolittle, of Rocky River, at Concierge Medicine of Westlake on Thursday, Oct. 19, 2023.

Reinforcing inequities?

The concierge medicine model has been criticized for catering to people of means while leaving the less fortunate behind. Critics argue "VIP services" in health care widen socioeconomic and racial divides.

A peer-reviewed article published in the American Medical Association Journal of Ethics warned that "VIP care" exacerbates "inequity in access to health services and the maldistribution of resources in vulnerable communities."

"The very existence of VIP services allows for multiple tiers of care along racial and socioeconomic lines, thereby reinforcing patterns of racism and classism already present in the United States," authors Dr. Denisse Rojas Marquez and Dr. Hazel Lever wrote.

A 2020 NPR poll showed a little more than one in five of the top 1% highest-income adults in the U.S. participate in concierge medicine.

But Tom Campanella, healthcare executive-in-residence at Baldwin Wallace University, said concierge medicine could save money in the long run if patients are theoretically healthier from receiving more personalized and consistent care, meaning they won't be spending as much money overall on doctors' visits.

"Obviously, a healthier patient is not going to the hospital or to doctors as much, so that's going to save money in the long term as well as short term,” he said.

Marquez and Lever also noted the shortage in resources that already strain the health care system, including a shortage in primary care doctors.

"Given the shortage of primary care doctors in the United States, the influx of physicians to concierge practices effectively works to decrease the number of physicians available for the rest of the population," they wrote. "Moreover, compared to their counterparts, physicians in concierge primary care have a smaller patient load and serve fewer Black, Hispanic, or Medicaid patients."

But Campanella said that expanding the roles of primary care and concierge providers could force health care organizations like hospital systems to provide more value for their primary care physicians by paying them more to stay competitive.

"When you think about it, which specialty is the main focus to keep people healthy? It's primary care," Campanella said. "And isn't that what we're all trying to do as a country — to try to really transition to a health system instead of a sick system?"

Filling a gap in primary care

The share of primary care physicians among all doctors is about 25%, a number that has "been declining for years," according to the Kaiser Family Foundation, but Campanella thinks the rise in concierge medicine could actually compel more medical students to choose the primary care umbrella.

"All this is going to do — and it's simple economics — is give primary care docs more choices, which means they're able to match their quality of life with this particular setting that they may be in, and their pay will go up because of supply and demand," Campanella explained.

Students and professors are pleading with University Hospitals to preserve the family medicine residency program at its Cleveland campus.

Health insurers could also benefit from concierge medicine. According to Campanella, health insurance brokers, including some in Northeast Ohio, are pushing for collaborations with direct primary care practices and linking them with employers in the community.

"I think the insurance side of the business is starting to recognize the value of this. Maybe initially, they were looking at this as sort of a negative, they didn't necessarily collaborate as much. But now, I think they're recognizing that if this ultimately reduces health care costs, this will be good for them, too," Campanella said.

Fiffick said her goal is to keep patients out of emergency rooms and urgent cares to prevent co-pay costs.

"As much as people think that $3,000 is a lot of money and it's really expensive, if you have insurance that has a $5,000, $6,000 or $8,000 deductible and I can do everything in my power to limit those external expenditures, I'm going to do that," she explained.

Concierge Medicine Today, an industry publication, estimates there are now as many as 25,000 subscription-based physicians or programs globally.

According to NPR, about 1,000 direct primary care practices in 48 states serve approximately 300,000 U.S. patients. There's less known about how many patients receive care in true "concierge" practices, NPR said. It's also difficult to define the number of true concierge practices in Northeast Ohio.

But demand for concierge doctors is growing, particularly among older adults. Nearly 60% of patients seeking concierge care are Baby Boomers and 29% are Gen X, according to Concierge Medicine Today.

Doolittle, who is 47, said having easy access to a doctor who knows the ins and outs of menopause is a comfort.

"There’s a lot of different things that are going to change that I really don't know about," she said. "And so having somebody that's an expert on that and then that I can get a hold of quickly, is going to be, I think, a fantastic thing.”

Stephanie Metzger-Lawrence is a digital producer for the engaged journalism team at Ideastream Public Media.