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> If you want safe and really high quality medical care you should absolutely have a personal physician you have a personal relationship with, who understands y

> If you want safe and really high quality medical care you should absolutely have a personal physician you have a personal relationship with, who understands your lifestyle, your risk factors for side effects, and your medical needs deeply. How many Americans have that? Maybe a few dozen? A bit of a tangent: I have this here in the US, through a model called Direct Primary Care. I pay $50/mo for a single provider, unlimited visits / communication, and highly discounted labs. She makes house calls on occasion. This doctor is working solely in my interest, and has little concern of insurance, except to help me navigate that system should I need a specialist, prior authorization, etc. I do worry that it's sustainable, but I think there must by a way to scale up this practice of the general practitioner working in the interest of the patient. My previous doctor was part of a large health system, who also happens to be directly associated with the large regional insurance provider whom my employer supplied to me without another choice. Every 8 minute visit centered around insurance and billing, with my health seeming to be a distant second. It seemed every visit had to end in some kind of prescription or referral, arrived at quickly and without much discussion. It quickly became clear they were not working in my interest, and I sought other options, eventually landing on the Direct Primary Care model. Now I have full 1 hour visits, and someone who seeks to understand what is happening for me completely, not through the lens of a payer.

lmm 1y ago
> I pay $50/mo for a single provider, unlimited visits / communication, and highly discounted labs. She makes house calls on occasion. This doctor is working solely in my interest, and has little concern of insurance, except to help me navigate that system should I need a specialist, prior authorization, etc. Someone's presumably paying her more than $50/hr, which will burn through your monthly fees pretty quickly. Where's the money coming from?
- genocidicbunny 1y ago
  It works the same way that health insurance works -- most people don't need all that much care, and when time-consuming care is needed, it is often pushed to the specialists rather than the generalist. Your $50/mo payment might not seem like much, but if all you're doing is a bi-monthly checkin with them over the phone, you're really paying more like $100/visit for a 15-30 minute visit. A lot of these 'concierge medicine' services are set up to deal with mostly people who don't need all that much medical care, beyond relatively brisk access to the doctor in a few rare circumstances. Since they also don't really do much in terms of specialty care, they tend to have fewer Px who need extensive personal care.
  - onlyrealcuzzo 1y ago
    Doctors make $20k a month or more. That's 420+ patients at $50/m. Doesn't seem feasible to know them all personally and deeply. Other revenue would be needed.
    - in_cahoots 1y ago
      420 young, healthy patients probably see the doctor 2x a year at most. That's less than 20 visits a week for the doctor. And as soon as you become unhealthy you are passed along to a specialist or dropped. You're paying for the bedside manner, not the medicine.
      - sshine 1y ago
        I’m 39 and I see my doctor once a year, at most. This year I had a urinary thing. Last year and the year before that I had a rash. The year before that I didn’t go. For all of my twenties I went three times. She still remembers me just fine, asking how is my CrossFit doing. I see my wife’s doctor more often than my own because he is also our newborn son’s doctor. They both have thousands of patients. The waiting rooms mostly have elderly, parents with their newborns and obese people.
        potato3732842 1y ago
        >She still remembers me just fine, asking how is my CrossFit doing. That's because just before she walks in she reads your chart.
        collingreen 1y ago
        Which seems plenty good enough for the care op wants
        sshine 1y ago
        My chart doesn’t mention my hobbies. But yes, she does read my chart. It’s not very interesting.
- zetazzed 1y ago
  In the models I've seen, they still require and bill insurance. The monthly fee is a supplement for the doc practices.
- fluidcruft 1y ago
  You're also probably fairly healthy and not much work. Concierge care for my elderly parents with complex diseases has been quoted at $20k/year.
bongodongobob 1y ago
$50 + health insurance? I saw my PCP after my health insurance had unknowingly lapsed and a physical was ~$1k with just some basic blood work.
- jjcob 1y ago
  How people justify paying $1000 for probably less than 15 minutes of work is beyond me.
  - esseph 1y ago
    Beause people don't want to die or be uncomfortable
  - sokoloff 1y ago
    That included lab work, talking to the front desk people, the nurse who took the blood, the GP, the drivers, the janitors, the record-keepers, the lab techs, and the calibration work on equipment and who knows who else. That is way, way more than 15 minutes of work.
    - jjcob 1y ago
      I recently got a physical exam, including ultra sound, two urine samples, and bloodwork, at a private doctor in Austria and it cost 150€. You Americans are crazy. I'm not sure how a physical would be more than 15 minutes of work. Lab techs? Standard blood tests are all automated, the most complicated part is putting the stickers on the vials. Yes, someone needs to calibrate the machine, but the machine processes 1000s of samples per day. I just checked, the price for a standard blood panel at a local lab is 14€. It's really not a complicated procedure. Drivers? Janitors? What the hell are you paying those guys to justify a $1000 bill? And you really don't need to hire a driver to get a box of samples to the lab at the end of the day.
      - Der_Einzige 1y ago
        Americans are so much more fat and unhealthy than aussies. That’s the primary reason why it’s so much cheaper in Australia.
decafninja 1y ago
I’ve heard of this, also known as concierge medicine right? But the figures I’ve seen quoted for such service usually begin in the four digits, sometimes five digits, annually.
- trillic 1y ago
  I've anecdotally done some research and in SoCal a true concierge medicine for what I would be looking for with a brick-and-mortar location and imaging on-site is ~$5000/yr.
  - decafninja 1y ago
    Curious what that fee covers beyond having direct access to the physician (and even there, beyond just consultations). If you needed imaging work or even procedures or surgeries - would that be extra fees?
    - genocidicbunny 1y ago
      Can't speak to the parent posters' experience, but for me, it covers a lot of imaging, routine bloodwork, cheap Rx for a lot of basic medicines (think blood pressure medications, diabetes meds.) I can get a full basic blood panel (CBC, CMP, LDH, ALT, TPT..etc) done for a few bucks instead of paying several hundred, that alone has saved me a good chunk of change over the years. One of the huge benefits for me has been that I have much simpler access to specialists. They are somehow able to punch through a lot of the scheduling bullshit for me, so when I do need to see a specialist, I am not waiting for weeks or months; Sometimes I've been able to get appointments at a specialist through them within a few days instead of the few weeks it would have been had I tried doing the same myself.
throwaway2037 1y ago
> I do worry that it's sustainable What is the maximum price that you are willing to pay?
nikkwong 1y ago
How could this possibly work out for her financially? To make 120k a year, she would have to be doing this with.. 200 patients; and I think the average GP makes a bit more than that in the US. That doesn't like a good bargain on her end.
- aiforecastthway 1y ago
  I do not think I have ever spent more than an hour per visit actually in the room with my GP. I have an annual checkup. For a while there my GP was world class and also a blood relative. 200 patients at one hour per is a bit more than a month of 9-5s. If I visited my GP once per 1.5 months I’d be paying a fuckload more than $50/mo in copayments alone, in addition to my incredible premiums. Healthcare becomes pretty affordable when you’re not paying for actuaries and other scammers.
- maxerickson 1y ago
  Not paying someone to chase insurance saves something anyway. I'm at about 1 hour per year with my GP (I guess they can be spending additional time on notes or whatever, but I don't think it's much).
  - nikkwong 1y ago
    I guess I see this as somewhat different. These people are proactively choosing to maintain a relationship with a physician for an elective $50/month. I think the type of patient who wants a type of this relationship is the type who is going to solicit more than a single appointment per year; otherwise, why not just use what the current system gives us? I could see something like this being useful for me; I'm constantly nagging my physician for different drugs I am triaging for a condition I'm dealing with. But, in that case, I wouldn't be the ideal patient for the physician. I wish this kind of thing could work, but I'm not sure how I see it working in practice, unless you move up market and charge more.
- classichasclass 1y ago
  200 patients is an extremely small panel size for the typical primary care provider in the United States. Many have several thousand.
nradov 1y ago
Studies have shown that patient satisfaction scores are highly correlated with whether the doctor writes a prescription. When patients leave with a prescription then they feel like they got their money's worth, regardless of whether they really need it.
- pasquinelli 1y ago
  a lot of actual conditions are actually treated with actual perscription drugs.
  - Der_Einzige 1y ago
    And even if it didn’t treat something now, it can treat things later For example, a lot of asymptomatic STDs get accidentally cured by people taking antibiotics for unrelated reasons. Less paternalistic countries let people buy very significant drugs over the counter. Being able to rule out that a simple infection is viral instead of bacterial is a huge boon. Doctors who want to cry about risk of superbugs (while eating McDonald’s during their break) can shove their opinion alongside side their antibiotic doused meat slurry straight down their pie hole. Every nice pain killer I get I keep for emergencies. You never know when you’ll actually hurt yourself and be very happy to have some extra Vicodin. Paternialism in medicine has been destructive for the human race and it has led to a lot of very very negative outcomes.
spacecadet 1y ago
Im sorry that has been your experience. I am too on a patient of a doctor who belongs to a "large health system/insurance system provided by my employer with no choice". I have never once discussed billing. Every visit, while short 10-15 minutes, is focused on my health and if I asked questions, can extend to 30+ or more... really depends on my questions. I have never needed an hour with a GP, maybe a specialist.
- jeremy151 1y ago
  I should clarify: the billing talk would come out when talking about options. “Let’s try X because insurance will need to see that we tried it before we try Y.” I don’t blame the provider. Navigating insurance still comes up with my direct primary care doc, but it’s not most of the visit. The real value I see is a willingness to take the whole picture into account (not just symptom -> med/specialist) and teach me about how things work and why. I have some complexity in my history for which this helps a lot. Regarding the patient load discussion elsewhere, our entire family uses this doctor, we’re in for $200/mo but if we added up the interaction time even with me (a more complicated customer) it’s maybe 5 hours a year + some text communications with the MA / prescription wrangling. Their model seems to be all about effective scaling, I hope it is worth it for them, because my experience is vastly improved.

lmm 1y ago

> I pay $50/mo for a single provider, unlimited visits / communication, and highly discounted labs. She makes house calls on occasion. This doctor is working solely in my interest, and has little concern of insurance, except to help me navigate that system should I need a specialist, prior authorization, etc. Someone's presumably paying her more than $50/hr, which will burn through your monthly fees pretty quickly. Where's the money coming from?

genocidicbunny 1y ago
It works the same way that health insurance works -- most people don't need all that much care, and when time-consuming care is needed, it is often pushed to the specialists rather than the generalist. Your $50/mo payment might not seem like much, but if all you're doing is a bi-monthly checkin with them over the phone, you're really paying more like $100/visit for a 15-30 minute visit. A lot of these 'concierge medicine' services are set up to deal with mostly people who don't need all that much medical care, beyond relatively brisk access to the doctor in a few rare circumstances. Since they also don't really do much in terms of specialty care, they tend to have fewer Px who need extensive personal care.
- onlyrealcuzzo 1y ago
  Doctors make $20k a month or more. That's 420+ patients at $50/m. Doesn't seem feasible to know them all personally and deeply. Other revenue would be needed.
  - in_cahoots 1y ago
    420 young, healthy patients probably see the doctor 2x a year at most. That's less than 20 visits a week for the doctor. And as soon as you become unhealthy you are passed along to a specialist or dropped. You're paying for the bedside manner, not the medicine.
    - sshine 1y ago
      I’m 39 and I see my doctor once a year, at most. This year I had a urinary thing. Last year and the year before that I had a rash. The year before that I didn’t go. For all of my twenties I went three times. She still remembers me just fine, asking how is my CrossFit doing. I see my wife’s doctor more often than my own because he is also our newborn son’s doctor. They both have thousands of patients. The waiting rooms mostly have elderly, parents with their newborns and obese people.
      - potato3732842 1y ago
        >She still remembers me just fine, asking how is my CrossFit doing. That's because just before she walks in she reads your chart.
        collingreen 1y ago
        Which seems plenty good enough for the care op wants
        sshine 1y ago
        My chart doesn’t mention my hobbies. But yes, she does read my chart. It’s not very interesting.
zetazzed 1y ago
In the models I've seen, they still require and bill insurance. The monthly fee is a supplement for the doc practices.
fluidcruft 1y ago
You're also probably fairly healthy and not much work. Concierge care for my elderly parents with complex diseases has been quoted at $20k/year.

bongodongobob 1y ago

$50 + health insurance? I saw my PCP after my health insurance had unknowingly lapsed and a physical was ~$1k with just some basic blood work.

jjcob 1y ago
How people justify paying $1000 for probably less than 15 minutes of work is beyond me.
- esseph 1y ago
  Beause people don't want to die or be uncomfortable
- sokoloff 1y ago
  That included lab work, talking to the front desk people, the nurse who took the blood, the GP, the drivers, the janitors, the record-keepers, the lab techs, and the calibration work on equipment and who knows who else. That is way, way more than 15 minutes of work.
  - jjcob 1y ago
    I recently got a physical exam, including ultra sound, two urine samples, and bloodwork, at a private doctor in Austria and it cost 150€. You Americans are crazy. I'm not sure how a physical would be more than 15 minutes of work. Lab techs? Standard blood tests are all automated, the most complicated part is putting the stickers on the vials. Yes, someone needs to calibrate the machine, but the machine processes 1000s of samples per day. I just checked, the price for a standard blood panel at a local lab is 14€. It's really not a complicated procedure. Drivers? Janitors? What the hell are you paying those guys to justify a $1000 bill? And you really don't need to hire a driver to get a box of samples to the lab at the end of the day.
    - Der_Einzige 1y ago
      Americans are so much more fat and unhealthy than aussies. That’s the primary reason why it’s so much cheaper in Australia.

decafninja 1y ago

I’ve heard of this, also known as concierge medicine right? But the figures I’ve seen quoted for such service usually begin in the four digits, sometimes five digits, annually.

trillic 1y ago
I've anecdotally done some research and in SoCal a true concierge medicine for what I would be looking for with a brick-and-mortar location and imaging on-site is ~$5000/yr.
- decafninja 1y ago
  Curious what that fee covers beyond having direct access to the physician (and even there, beyond just consultations). If you needed imaging work or even procedures or surgeries - would that be extra fees?
  - genocidicbunny 1y ago
    Can't speak to the parent posters' experience, but for me, it covers a lot of imaging, routine bloodwork, cheap Rx for a lot of basic medicines (think blood pressure medications, diabetes meds.) I can get a full basic blood panel (CBC, CMP, LDH, ALT, TPT..etc) done for a few bucks instead of paying several hundred, that alone has saved me a good chunk of change over the years. One of the huge benefits for me has been that I have much simpler access to specialists. They are somehow able to punch through a lot of the scheduling bullshit for me, so when I do need to see a specialist, I am not waiting for weeks or months; Sometimes I've been able to get appointments at a specialist through them within a few days instead of the few weeks it would have been had I tried doing the same myself.

throwaway2037 1y ago

> I do worry that it's sustainable What is the maximum price that you are willing to pay?

nikkwong 1y ago

How could this possibly work out for her financially? To make 120k a year, she would have to be doing this with.. 200 patients; and I think the average GP makes a bit more than that in the US. That doesn't like a good bargain on her end.

aiforecastthway 1y ago
I do not think I have ever spent more than an hour per visit actually in the room with my GP. I have an annual checkup. For a while there my GP was world class and also a blood relative. 200 patients at one hour per is a bit more than a month of 9-5s. If I visited my GP once per 1.5 months I’d be paying a fuckload more than $50/mo in copayments alone, in addition to my incredible premiums. Healthcare becomes pretty affordable when you’re not paying for actuaries and other scammers.
maxerickson 1y ago
Not paying someone to chase insurance saves something anyway. I'm at about 1 hour per year with my GP (I guess they can be spending additional time on notes or whatever, but I don't think it's much).
- nikkwong 1y ago
  I guess I see this as somewhat different. These people are proactively choosing to maintain a relationship with a physician for an elective $50/month. I think the type of patient who wants a type of this relationship is the type who is going to solicit more than a single appointment per year; otherwise, why not just use what the current system gives us? I could see something like this being useful for me; I'm constantly nagging my physician for different drugs I am triaging for a condition I'm dealing with. But, in that case, I wouldn't be the ideal patient for the physician. I wish this kind of thing could work, but I'm not sure how I see it working in practice, unless you move up market and charge more.
classichasclass 1y ago
200 patients is an extremely small panel size for the typical primary care provider in the United States. Many have several thousand.

nradov 1y ago

Studies have shown that patient satisfaction scores are highly correlated with whether the doctor writes a prescription. When patients leave with a prescription then they feel like they got their money's worth, regardless of whether they really need it.

pasquinelli 1y ago
a lot of actual conditions are actually treated with actual perscription drugs.
- Der_Einzige 1y ago
  And even if it didn’t treat something now, it can treat things later For example, a lot of asymptomatic STDs get accidentally cured by people taking antibiotics for unrelated reasons. Less paternalistic countries let people buy very significant drugs over the counter. Being able to rule out that a simple infection is viral instead of bacterial is a huge boon. Doctors who want to cry about risk of superbugs (while eating McDonald’s during their break) can shove their opinion alongside side their antibiotic doused meat slurry straight down their pie hole. Every nice pain killer I get I keep for emergencies. You never know when you’ll actually hurt yourself and be very happy to have some extra Vicodin. Paternialism in medicine has been destructive for the human race and it has led to a lot of very very negative outcomes.

spacecadet 1y ago

Im sorry that has been your experience. I am too on a patient of a doctor who belongs to a "large health system/insurance system provided by my employer with no choice". I have never once discussed billing. Every visit, while short 10-15 minutes, is focused on my health and if I asked questions, can extend to 30+ or more... really depends on my questions. I have never needed an hour with a GP, maybe a specialist.

jeremy151 1y ago
I should clarify: the billing talk would come out when talking about options. “Let’s try X because insurance will need to see that we tried it before we try Y.” I don’t blame the provider. Navigating insurance still comes up with my direct primary care doc, but it’s not most of the visit. The real value I see is a willingness to take the whole picture into account (not just symptom -> med/specialist) and teach me about how things work and why. I have some complexity in my history for which this helps a lot. Regarding the patient load discussion elsewhere, our entire family uses this doctor, we’re in for $200/mo but if we added up the interaction time even with me (a more complicated customer) it’s maybe 5 hours a year + some text communications with the MA / prescription wrangling. Their model seems to be all about effective scaling, I hope it is worth it for them, because my experience is vastly improved.