Dr. Nancy Gade: Concierge medicine is a step in the right direction

Picture this: You receive a letter from your doctor thanking you for your loyalty. But, she says, you’ll need to pay $1,500 a year if you still want to be her patient.

The arrangement, one that’s gaining popularity, is called concierge medicine. In return for an annual retainer, you get extra time and 24-hour phone access to your doctor, without an insurance company butting in. Concierge medicine is a way to cut out insurance companies and reduce workload, proponents say.

Existing patients are faced with the question: Is it worth it?

“It’s absolutely, totally worth it,” says Mickey Austin of Weston. “It was almost a non-decision.”

For Austin, it was a sure bet. She’d known her doctor, Dr. Nancy Gade of Wilton, for years. When Austin herniated two discs in her back, Gade at first recommended surgery. But due to family history (Austin’s dad died during a routine operation), Gade recommended a non-surgical treatment called decompression therapy.

“I never had the surgery and I’m healed,” Austin says. “It took a long time, but it worked.”

The lesson? Tailored primary care cuts down on costly procedures, reduces caseloads and shrinks administrative overhead. In short, it cuts out the middle man and it seems to be one way of addressing our current health care crisis.

Concierge medicine didn’t begin altruistically. It arose by offering luxury services at luxury fees. But now doctors say they’re fed up with insurance companies that favor quantity over quality and whose requirements end up undermining complex issues like unhealthy lifestyles and psycho-social problems.

“Maybe the biggest luxury is saying, ‘Is there anything else?’” says Dr. James Slater of New Canaan, who has been practicing concierge medicine for about five years.

“You just don’t have that luxury in a conventional practice,” he says.

Concierge medicine is a growing trend in Connecticut. Washington, D.C.’s Government Accountability Office found no such doctors in Connecticut in 2005. Now there are “several dozen,” mostly in Fairfield County, according to the Connecticut State Medical Society. With 7,500 doctors, this isn’t statistically significant. But the trend may prove worrying for hospitals and other medical facilities: Many report difficulty recruiting new physicians. Less insurance-taking primary care physicians could lead to even less time and attention for patients unable to pay a yearly retainer.

“I had a hard time with this right from the get-go,” says Dr. Michael Bergman of Hamden. “It’s elitist.”

Frustration drove Bergman to try anyway. He’s a supporter of Canada’s single-payer health care system. For him, getting out from underneath conventional insurance was in essence a vote of no-confidence for the American system. Others like Nancy Gade, Mickey Austin’s doc, believe the retainer model is impractical for everyday patient care.

For covering every little cut and cold, I don’t think it makes sense,” she says.

Yet she says retainers might be a step in the right direction. Instead of paying insurance providers for blanket coverage, cancer patients, say, could pay oncologists directly. Healthy people, meanwhile, could pay for routine check-ups out of pocket or simply go without. The result would be an increasingly stratified distribution of health care, Gade says, with the haves choosing preventive care and the have-nots taking their chances.

It could mean a more efficient allotment of resources, since those who take more would pay more.

It could also mean the poorest among us going without preventive care.