Friday, September 21, 2007


The New York Times Health section (just added to "Favorite Medical Timesucks" in the lower sidebar to the right) always has some great articles, and usually there's at least one article that relates to something I've learned in class. Other times, there's an article that catches my attention because it deals with how physicians are practicing medicine today.

Almost two years ago I came across the article "For a Retainer, Lavish Care by 'Boutique Doctors.'" The article takes a look at the trend of "concierge" medicine, which, according to the Times, debuted in 1996. In this type of practice, patients pay an upfront cash fee of roughly $2,000 each year to have 24/7 access to their primary care physician via telephone, email, or same day appointments. The physicians carry a smaller patient load, allowing them to make thorough physicals, take extensive histories, and basically spend more time with the patient. When problems arise, the low patient load allows the physician to focus on the problem and coordinate patient care with specialists. It's an interesting concept. Kinda how medicine use to be. However, I can see how it only adds to the inequities in American health care.

Today, I came across this article via the Times' Health Around the Web section about a young doc named Jay Parkinson, M.D., in Brooklyn that wants to be your eDoctor (if you live in lower Manhattan, that is). That's right, he has no office! Most of your interaction will be over email, text, video conference or telephone. He'll only take you on as a patient after you complete an application on his website. Oh yeah, you must be 18 to 40 years of age and healthy -- "no old-people diseases." His focus is preventative medicine, which I think is a good thing. He's looking to take on about 1,000 patients and has a yearly cash fee of $500. It's a unique concept for a practice to say the least.

I don't begin my clinical years until next year, so I don't have any first-hand experience from the "physician" end. I have, however, had plenty of interaction with the health care system from the patient's perspective: waiting for hours in the waiting room, assistants taking vitals and drawing blood, and then spending 5 minutes with my primary care physician. I asked him, my PCP, on more than one occasion if he enjoyed his job (he was a relatively young doc and we had a good relationship) and he said he did.

I don't think I would enjoy practicing medicine in an environment where I only had 10-15 minutes with a patient. I just don't see how that's good for either patient or physician. As a patient, I could sense when my PCP was rushed -- he always seemed behind schedule, so I didn't always tell him everything that was going on or didn't ask questions when I wanted to. As a physician, I think the constant pressure of seeing as many patients as possible to keep a practice afloat would wear on me. I could see myself in a practice along the lines of "concierge" medicine, but I think I would feel wrong doing it. And I don't know what to think about young Dr. Parkinson. Hmmm....

[Update 9/23: NYT article on "Doctor Delivery." Like pizza or chinese food, a doctor's just a phone call away.]

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