Shirah Vollmer MD

The Musings of Dr. Vollmer

A Concierge Psychiatrist?

Posted by Dr. Vollmer on August 1, 2012


Are psychiatrists going concierge? Wait, I am confused. I understand that certain primary care physicians charge patients an annual fee to be on their patient panel. In exchange for this annual fee, the patient is given more personalized service including easy access to their physician, house calls and sometimes the physician goes with the patient to their specialist. This means that the primary care physician goes from a panel of patients in the thousands to a number which is less than one hundred. The ethical dilemma is who is going to take care of the patients who are no longer seen by primary care doctors who change their practice. There is a primary care physician shortage, but whose job is it to fill in that gap? Is that the doctor’s responsibility? I recognize the dilemma both for patients and for physicians over this trend to pay for more personalized service. Now, let’s add-on. Are psychiatrists now charging patients a retainer to be on their panel? Does this make sense? Maybe. Maybe not. Fees are interesting therapeutic issues. When people pay do they value the service more? Sometimes. On the other hand, paying for service could make them value it less, as some people see financial exchange for immediate service as a right, without an appreciation for the  effort that goes in to accommodating other people. There are a limited number of hours in a day, so one has to limit the time or limit the patients somehow. What is the fairest way to do this? Maybe fair is not relevant here. Maybe this is a personal choice, where physicians choose how they practice and patients choose what makes sense for them. On the other hand, maybe there should be public service requirements of physicians, where they have to spend some time serving a low income population in order to maintain their license? Maybe The Medical Board should require physicians to teach in medical schools as a way to spread their knowledge and experience. I have no answers-just questions.

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5 Responses to “A Concierge Psychiatrist?”

  1. Jon said

    Are psychiatrists going concierge? In a simple statement of hope, please don’t.

    The Webster definition of concierge is: 1) a resident in an apartment building especially in France who serves as doorkeeper, landlord’s representative, and janitor, 2) a usually multilingual hotel staff member who handles luggage and mail, makes reservations, and arranges tours; broadly : a person employed (as by a business) to make arrangements or run errands.

    You give additional meaning in you post, but ideas still seem counterproductive to patient well being. Let a psychiatrist do psychiatric work. If additional interfacing with other doctors or other health care professionals is needed, then so be it. If a patient needs more time with a psychiatrist, then schedule more appointments.

    What am I missing?

    • What you are missing Jon is that in the business of medicine, there is a deep tension between time and money. The old style of medical care is that the more patients a physician sees, the more money they make, and so concierge medicine creates a new model where the physician sees less patients, but actually makes more money. This newer model means that a few patients get better care and the physician can practice in a way in which he/she can be more thoughtful and more thorough, but this comes at a societal price where there will be an even deeper primary care shortage. Now, taking this model to psychiatry is yet another paradigm shift. Psychiatrists who do mostly psychopharmacology are seeing a large panel of patients. If there are concierge psychiatrists, then this means a move back to the older model of psychiatry which is personalized service. Maybe, just maybe, the move towards concierge psychiatry is a way in which the doctor/patient relationship can be restored. On the other hand, maybe concierge psychiatry creates an elitism which is distasteful. I believe you are referring to the latter, but the former should also be considered. Patient care and physician satisfaction are the two dimensions which are at play here. Change is in the air. It will be interesting to see how these competing demands play out for both. Thanks.

  2. Shelly said

    In psychiatry, I would say by default that your practice is already concierge. You give individualized attention, return phone calls, speak face to face, and problem solve with your patients. What more could your patients want from you? I can see a concierge model working in primary care. Where I live, each physician sees patients separated into 5 minute slots. The physician does not know his patients, nor does the patient know the physician. Neither picks the other: patients are generally assigned based on where you live. Imagine the horror of our medical system! I indeed would pay extra for a concierge-type system in certain circumstances, however in psychiatry such as in your practice I don’t think there is a need.

    • jo said

      I would agree with Shelly — you are already providing the kind of care you’re talking about. I have a primary care doc and several specialists, but it’s my therapist who really knows what’s going on collectively with my health. An incredibly valuable resource.

    • Thanks, Shelly. As I responded to Jon, it is possible that concierge psychiatry will move some psychiatrists away from a strictly psychopharmacology practice to more personalized care. Maybe for my practice, the move will mean that I call myself by a different name. I now refer to my style as “old school,” so perhaps I will now reframe my work as “new school”. Old wine in new bottles, as we say.

      Thanks, Jo for chiming in. Yes, I often think that the therapist is a hugely valuable resource to the medical team since he/she spends so much time and energy thinking about your experience. Now, the job, my job, is to help the primary care physicians appreciate that resource. For the record, I am working on that.

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