{"id":896,"date":"2025-04-16T09:00:00","date_gmt":"2025-04-16T09:00:00","guid":{"rendered":"http:\/\/www.walkwithremar.com\/?p=896"},"modified":"2025-04-18T19:24:35","modified_gmt":"2025-04-18T19:24:35","slug":"in-rural-massachusetts-patients-and-physicians-weigh-trade-offs-of-concierge-medicine","status":"publish","type":"post","link":"http:\/\/www.walkwithremar.com\/index.php\/2025\/04\/16\/in-rural-massachusetts-patients-and-physicians-weigh-trade-offs-of-concierge-medicine\/","title":{"rendered":"In Rural Massachusetts, Patients and Physicians Weigh Trade-Offs of Concierge Medicine"},"content":{"rendered":"

Michele Andrews had been seeing her internist in Northampton, Massachusetts, a small city two hours west of Boston, for about 10 years. She was happy with the care, though she started to notice it was becoming harder<\/a> to get an appointment.<\/p>\n

\u201cYou\u2019d call and you\u2019re talking about weeks to a month,\u201d Andrews said.<\/p>\n

That\u2019s not surprising, as many workplace surveys show the supply of primary care doctors has fallen well below the demand, especially in rural areas such as western Massachusetts. But Andrews still wasn\u2019t prepared for the letter that arrived last summer from her doctor, Christine Baker, at Pioneer Valley Internal Medicine<\/a>.<\/p>\n

\u201cWe are writing to inform you of an exciting change we will be making in our Internal Medicine Practice,\u201d the letter read. \u201cAs of September 1st, 2024, we will be switching to Concierge Membership Practice.\u201d<\/p>\n

Concierge medicine is a business model in which a doctor charges patients a monthly or annual membership fee \u2014 even as the patients continue paying insurance premiums, copays, and deductibles. In exchange for the membership fee, doctors limit their number of patients.<\/p>\n

Many physicians who\u2019ve made the change said it resolved some of the pressures they faced in primary care, such as having too many patients to see in too short a time.<\/p>\n

Andrews was floored when she got the letter. \u201cThe second paragraph tells me the yearly fee for joining will be $1,000 per year for existing patients. It\u2019ll be $1,500 for new patients,\u201d she said.<\/p>\n

Although numbers are not tracked in any one place, the trade magazine Concierge Medicine Today estimates there are 7,000 to 22,000<\/a> concierge physicians in the U.S. Membership fees range from $1,000 to as high as $50,000 a year.<\/p>\n

Critics say concierge medicine helps only patients who have extra money to spend on health care, while shrinking the supply of more traditional primary care practices in a community. It can particularly affect rural communities already experiencing a shortage of primary care options.<\/p>\n

Andrews and her husband had three months to either join and pay the fee or leave the practice. They left.<\/p>\n

\u201cI\u2019m insulted and I\u2019m offended,\u201d Andrews said. \u201cI would never, never expect to have to pay more out of my pocket to get the kind of care that I should be getting with my insurance premiums.\u201d<\/p>\n

Baker, Andrews\u2019 former physician, said fewer than half her patients opted to stay \u2014 shrinking her patient load from 1,700 to around 800, which she considers much more manageable. Baker said she had been feeling so stressed that she considered retiring.<\/p>\n

\u201cI knew some people would be very unhappy. I knew some would like it,\u201d she said. \u201cAnd a lot of people who didn\u2019t sign up said, \u2018I get why you\u2019re doing it.\u2019\u201d<\/p>\n

Patty Healey, another patient at Baker\u2019s practice, said she didn\u2019t consider leaving.<\/p>\n

\u201cI knew I had to pay,\u201d Healey said. As a retired nurse, Healey knew about the shortages in primary care, and she was convinced that if she left, she\u2019d have a very difficult time finding a new doctor. Healey was open to the idea that she might like the concierge model.<\/p>\n

\u201cIt might be to my benefit, because maybe I\u2019ll get earlier appointments and maybe I\u2019ll be able to spend a longer period of time talking about my concerns,\u201d she said.<\/p>\n

This is the conundrum of concierge medicine, according to Michael Dill, director of workforce studies at the Association of American Medical Colleges<\/a>. The quality of care may go up for those who can and do pay the fees, Dill said. \u201cBut that means fewer people have access,\u201d he said. \u201cSo each time any physician makes that switch, it exacerbates the shortage.\u201d<\/p>\n

His association estimates<\/a> the U.S. will face a shortage of 20,200 to 40,400 primary care doctors<\/a> within the next decade.<\/p>\n

A state analysis<\/a> found that the percentage of residents in western Massachusetts who said they had a primary care provider was lower than in several other regions of the state.<\/p>\n

Dill said the impact of concierge care is worse in rural areas, which often already experience physician shortages. \u201cIf even one or two make that switch, you\u2019re going to feel it,\u201d Dill said.<\/p>\n

Rebecca Starr, an internist who specializes in geriatric care, recently started a concierge practice in Northampton.<\/p>\n

For many years, she consulted for a medical group whose patients got only 15 minutes with a primary care doctor, \u201cand that was hardly enough time to review medications, much less manage chronic conditions,\u201d she said.<\/p>\n

When Starr opened her own medical practice<\/a>, she wanted to offer longer appointments \u2014 but still bring in enough revenue to make the business work.<\/p>\n

\u201cI did feel a little torn,\u201d Starr said. While it was her dream to offer high-quality care in a small practice, she said, \u201cI have to do it in a way that I have to charge people, in addition to what insurance is paying for.\u201d<\/p>\n

Starr said her fee is $3,600 a year, and her patient load will be capped at 200, much lower than the 1,000 or even 2,000 patients that some doctors have. But she still hasn\u2019t hit her limit.<\/p>\n

\u201cCertainly there\u2019s some people that would love to join and can\u2019t join because they have limited income,\u201d Starr said.<\/p>\n

<\/p>\n

Many doctors making the switch to concierge medicine say the membership model is the only way to have the kind of personal relationships with patients that attracted them to the profession in the first place.<\/p>\n

\u201cIt\u2019s a way to practice self-preservation in this field that is punishing patients and doctors alike,\u201d said internal medicine physician Shayne Taylor, who recently opened a practice<\/a> offering \u201cdirect primary care\u201d in Northampton. The direct primary care model is similar to concierge care in that it involves charging a recurring fee to patients, but direct care<\/a> bypasses insurance companies altogether.<\/p>\n

Taylor\u2019s patients, capped at 300, pay her $225 a month for basic primary care visits \u2014 and they must have health insurance to cover care such as X-rays and medications, which her practice does not provide. But Taylor doesn\u2019t accept insurance for any of her services, which saves her administrative costs.<\/p>\n

\u201cWe get a lot of pushback because people are saying, \u2018Oh, this is elitist, and this is only going to be accessible to people that have money,\u2019\u201d Taylor said.<\/p>\n

But she said the traditional primary care model doesn\u2019t work. \u201cWe cannot spend so much time seeing so many patients and documenting in such a way to get an extra $17 from the insurance company.\u201d<\/p>\n

While much of the pushback on the membership model comes from patients and policy experts, some of the resistance comes from physicians.<\/p>\n

Paul Carlan<\/a>, a primary care doctor who runs Valley Medical Group<\/a> in western Massachusetts, said his practice is more stretched than ever. One reason is that the group\u2019s clinics are absorbing some of the patients who have lost their doctor to concierge medicine.<\/p>\n

\u201cWe all contribute through our tax dollars, which fund these training programs,\u201d Carlan said.<\/p>\n

\u201cAnd so, to some degree, the folks who practice health care in our country are a public good,\u201d Carlan said. \u201cWe should be worried when folks are making decisions about how to practice in ways that reduce their capacity to deliver that good back to the public.\u201d<\/p>\n

But Taylor, who has the direct primary care practice, said it\u2019s not fair to demand that individual doctors take on the task of fixing a dysfunctional health care system.<\/p>\n

\u201cIt\u2019s either we do something like this,\u201d Taylor said, \u201cor we quit.\u201d<\/p>\n

This article is from a partnership that includes <\/em>New England Public Media<\/em><\/a>, <\/em>NPR<\/em><\/a>, and KFF Health News.<\/em><\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

USE OUR CONTENT<\/h3>\n

This story can be republished for free (details<\/a>).<\/p>\n","protected":false},"excerpt":{"rendered":"

Michele Andrews had been seeing her internist in Northampton, Massachusetts, a small city two hours west of Boston, for about 10 years. She was happy with the care, though she started to notice it was becoming harder to get an appointment. \u201cYou\u2019d call and you\u2019re talking about weeks to a month,\u201d Andrews said. That\u2019s not […]<\/p>\n","protected":false},"author":1,"featured_media":898,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[23],"tags":[],"class_list":["post-896","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care"],"_links":{"self":[{"href":"http:\/\/www.walkwithremar.com\/index.php\/wp-json\/wp\/v2\/posts\/896","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.walkwithremar.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.walkwithremar.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.walkwithremar.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.walkwithremar.com\/index.php\/wp-json\/wp\/v2\/comments?post=896"}],"version-history":[{"count":2,"href":"http:\/\/www.walkwithremar.com\/index.php\/wp-json\/wp\/v2\/posts\/896\/revisions"}],"predecessor-version":[{"id":900,"href":"http:\/\/www.walkwithremar.com\/index.php\/wp-json\/wp\/v2\/posts\/896\/revisions\/900"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/www.walkwithremar.com\/index.php\/wp-json\/wp\/v2\/media\/898"}],"wp:attachment":[{"href":"http:\/\/www.walkwithremar.com\/index.php\/wp-json\/wp\/v2\/media?parent=896"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.walkwithremar.com\/index.php\/wp-json\/wp\/v2\/categories?post=896"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.walkwithremar.com\/index.php\/wp-json\/wp\/v2\/tags?post=896"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}