True or False? Concierge Doctors are Only in it for the Money
Entering the Relationship-Based Medicine Era
As interest grows in concierge, membership-based models of clinical care from practicing physicians and patients alike, the trend has begged the question: Do doctors only become concierge physicians for the money?
In the second episode of the ROAMD podcast, Dr. Scott Pope sits down with Dr. Yumi Ando, who shares her story about burning out in a traditional Fee-For-Service (FFS) multi-specialty group practice model, and how her journey into concierge practice restored the joy of medicine.
With a background in public health and internal medicine, Dr. Ando explored a diverse career in business and global health before settling down to practice in a traditional FFS group practice. While, like many young doctors, she came out of her medical training “bright-eyed and bushy-tailed,” she quickly found herself worn down and overwhelmed by the daily grind of impersonal, volume-driven appointments — a grind that’s all too familiar to doctors who make their money in this old model:
“When I was working for a year in the multispecialty group practice, in the volume-based system, it really took the joy out of medicine for me. A typical day would be, roll into the office at eight in the morning, do your chart review till maybe nine, start seeing your first patient around nine thirty, go back to back patients, work through lunch, where you don’t even have time for a break, [so you] eat lunch at your desk, see your last patient at four thirty, sit at your desk making phone calls to follow up on labs or tests and probably do that until six or seven, and then take a whole stack of charts home with me in the car, eat dinner, and then start charting from nine to eleven. And then you repeat that every day.”
Broken Incentives and a Fractured Patient-Doctor Relationship
Dr. Ando shares how her burnout led to a crisis that ultimately culminated in her decision to quit and focus on public health: “You go into medicine because you want to help people, and then you start kind of resenting your patients…I started, after this year, really dehumanizing my patients, and then I really said to myself: Why? This isn’t something I can do for the next 30 years of my life; it really took the joy out of it.” Becoming a doctor for the money is a rare thing, making this type of grind all the worse for many medical practitioners.
Her experiences convinced her that the US medical care system is completely broken because it financially rewards doctors for the wrong incentive: volume of patient care, rather than the quality of patient visits and the patient experience: “We’re not rewarding doctors for time… I think concierge medicine has evolved to change that dynamic and really reward patients and doctors for their time. As soon as you start doing that, you change the equation: you have a happier patient population, and you have a happier doctor population.”
Addressing the elephant in the room, Dr. Ando argues that the majority of doctors who become concierge medicine practitioners are not in it for the money, but for the extra time they get to spend with their patients, as well as a much improved work-life balance. She points out that concierge physicians are not necessarily less busy than doctors in conventional practice, but that the dynamic is much different: “You’re working hard, but your hours are less crazy; you don’t have the frenzy that you’re falling behind, that patients are slipping through the cracks.”
Compared to the revolving door of patients coming in and out of the exam room, Dr. Ando speaks to the depth of care she’s been able to reach through focusing on each patient as an individual: “Now my visits are 90 minutes when I do an annual exam, and the first thing that someone says to me is ‘I’ve never had a doctor spend this much time with me.” I like to start with a timeline, I start with the day they were born and I want to know everything about them, early childhood events, what makes them happy, what motivates them, what are their social support networks, all of this really creates much more dimension to the doctor-patient relationship.”
Even though Dr. Ando has not looked back at the FFS care model, its impacts still linger: “When I get a new patient, I will often look at their old patient records and I’ll look for their previous physical with other doctors. It’s always surprising to me how little depth there is… sometimes [there’s] nothing about their occupation, what they do, are they married, do they have kids, what are their kids’ names. Those are things I always look for, and it’s astonishing to me how often it’s missing, which I think is really a shame.”
Less is more: Concierge medicine for flexible, responsive care
Asked for her thoughts on an ideal panel size, Dr. Ando is clear: less is more. She prefers no more than 200 patients, and says she has heard of other concierge doctors aiming for the 250-350 range, a small fraction of the 2,000-3,000 patient panels that have become standard in large, FFS-driven models.
She is quick to point out that when it comes to panel size, demographics and case mix certainly matter; seeing slightly younger patients in their 50’s, 60’s, and 70’s, who feel empowered to communicate with their doctor is preferable to seeing older patients whose myriad medical needs cannot often be fully addressed in the narrow windows of care afforded in traditional practice.
She also reveals that with a smaller panel, she is able to deliver more personalized care, which has included in some instances, being able to deliver house calls – something she never would have been able to do: “When you see someone in their own setting, it adds that much more richness to understanding who they are, what they’re like; helps you understand how they live.”
Dr. Ando is hardly alone in her outlook. With physician burnout reaching epidemic proportions over the course of the last decade, it’s become clear that status quo models of providing patient care leave much to be desired. That’s why we founded ROAMD as a curated physician network that supports concierge, DPC, and private practices, so they can remain independent without being alone. We’re built for doctors, by doctors – Learn more today.
Dr. Yumi Ando was born and raised in Bangkok, Thailand. After attending high school in the U.S., she earned her Bachelor of Arts in East Asian Studies at Harvard and her Master of Public Health in Population Planning and International Health from the University of Michigan.
In 2002, Dr. Ando received an American Association for the Advancement of Science Award (AAAS) Diplomacy Fellowship and moved to Washington, D.C. to work at the U.S. State Department in the Bureau of Population, Refugees, and Migration where she received a Meritorious Honor Award.
In 2005, Dr. Ando returned to the San Francisco Bay Area, where she worked in concierge practices and pursued training in acupuncture and integrative medicine before launching her own integrative concierge medical practice in Menlo Park
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