Most patients feel frustration with multiple aspects of the current U.S. healthcare system. When patients are sick, it is often impossible to speak with their doctor by phone or get an appointment in a timely fashion. During appointments, patients often detect that doctors have limited time to listen to them and answer all of their questions. Moreover, the doctors are not able to consider all of the details of their overall health including previous labs and evaluations from other doctors. This type of fragmented care creates suboptimal diagnoses that focus on the part of the body manifesting illness versus a holistic view of the whole person. Additionally, there is little focus on preventive approaches that see each patient as a unique individual and can decrease the risk of future disease.
How Did Concierge Medicine Start?
Concierge medicine started in the 1990s as the insurance-based healthcare model increased its focus on quantity over quality. During this time, patients were seeking increased access to care, closer relationships with their doctors, and higher quality of care that focused more on prevention. On the physician side, volume-based care became increasingly frustrating due to increased administrative demands and declines in reimbursement. This desire of patients to return to the personalized practices of past incarnations of medicine and integrate cutting edge scientific diagnostic tools that better characterize them as individuals, has led to the rapid growth of concierge medicine.
A 2020 poll conducted by the Harvard T.H. Chan School of Public Health showed that about 20% of wealthy Americans who can afford concierge medicine have signed up with a concierge physician.
As of 2021, the trade publication Concierge Medicine Today estimates that there are about 12000 concierge practices in the US taking care of over 4 million patients.
Three Significant Benefits of Concierge Medicine
Most concierge doctors offer a level of education that distinguishes them from their peers. In Dr Rabin and Dr Hatano’s practice, all of their education including college, medical school, and residency has been completed at Stanford, UCSF, and Harvard. At each of these levels they received academic awards and have published numerous papers in academic journals. In the context of rapidly changing science it is helpful to have a rigorous academic physician constantly curating current literature and evolving their practice to optimize patient care. Secondly, Dr Rabin and Dr Hatano are both dual trained–Dr Rabin in Emergency Medicine and Dr Hatano in Infectious Disease. This complimentary level of expertise gives them a deeper understanding when caring for acute and critical patients. For example, primary care doctors may see decades of chest pain and abdominal pain, but never have the chance to take care of heart attacks and appendicitis.
Increased Focus on Preventive Care
While insurance-based practices try to focus on preventive care, healthcare data shows that the majority of Americans die from preventable diseases such as heart attacks, diabetes, hip fractures, and common cancers (such as colon) despite available, effective screening tests. Concierge practices go beyond reacting to acute health issues and collaborate with patients to create a plan to decrease the risk of chronic disease over the future decades. Of note, a study in the American Journal of Managed Care showed that concierge patients were more than 50% less likely to experience an elective or emergent hospital admission. Also readmission for common conditions such as heart attack, congestive heart failure, and pneumonia was 97%, 95%, and 91% less frequent.
In Dr Rabin and Dr Hatano’s practice, prevention also includes a detailed understanding of innovations in nutrition such as detailed dietary practices to influence inflammation, as well as monitoring exercise performance such as upper body, core, and lower body strength. Together nutrition and exercise performance correlate to quality and duration of life. Beyond nutrition and exercise, we integrate other areas of longevity medicine including wearables that provide precise feedback for each individual on daily wellness measures and advanced cancer screening tools that look around corners to identify potential health risks that are not seen with traditional screening tools.
Increased Access to Care:
Typical primary practices take care of about 2500 patients and see about 24 patients per day. In contrast, concierge practices are commonly a tenth of that size and have the ability to provide more personalized and preventive care. This means responding to phone and email messages directly and offering longer, same day, or next day appointments. Concierge doctors also coordinate care with other providers, and have more time to follow-up on the results of these consults, as well as their impact on a patient’s health. While in certain contexts that offers the convenience of more efficient diagnosis and treatment, it also includes collaborating with specialists and advocating for the patients during critical hospitalizations to make sure that thoughtful, smart decisions are made.
For patients interested in understanding more about the benefits of concierge medicine, please reach out to Dr Rabin and Dr Hatano.
Dr. Bradford Rabin received his BA from Stanford University with honors in economics. In 1998, he received his MD, from Stanford University, along with the Dean’s award for Outstanding Research for nine neuroscience publications examining the biochemical pathways involved in sleep. Dr. Rabin completed his internal medicine residency at the University of California San Francisco. After his residency, he worked as a clinical instructor in the UCSF Department of Internal Medicine.