Personal Ethics Of Concierge Medicine

Concierge medicine and concierge doctors used to be a rare breed. Back in the 90’s when concierge medicine began in Seattle, it was looked upon as a way for the rich to get the VIP treatment. No one considered the concierge doctor’s perspectives or feelings about their own health and well-being, everyone seemed to focus on the ethics behind charging a fee for health care. That stigma has stuck with concierge medicine to this day, even as doctors convert their practices to concierge medicine in incredible numbers as they become fed up with the health care system.

Our current health care system is broken, everyone knows that and every politician is currently campaigning on that. Everyone is looking at the patients; worried about their coverage, their plans, their health and well-being. The ironic part of the health care conversation is the fact that it isn’t very often you hear about what the physicians think, how they’re feeling about their situations, and how their health and well-being is holding up throughout health care reform.

Physicians are expected to work more and make less, while already putting in ten to twelve hour days, drowning in red tape and paperwork, neglecting their own health and missing out on their own lives to make the lives of others better and healthier. These same physicians are seemingly ignored when it comes to the health care debate. Take, for example, this quote from a physician’s blog:

“I made about $140,000/yr as a traditional physician. This is a respectable income, but the personal sacrifice was high. I started my day at 8AM, making rounds on my hospitalized patients. Got to the office at 9AM, saw patients till 1PM, worked through lunch answering phone calls, saw patients again from 2 to 5PM, spent the next 3 hours finishing charting and answering calls, and then usually went back to the hospital to finish rounds before going home at around 9PM. Then there were the usual 5-6 phone calls during the night. And that’s when I was not on call. The weekends were easier. I usually only had to work 6-8 hours on each of those days. My two sons grew up during those years, most of which I don’t remember, since my dedication was often more to my patients than to my family.”

Take this quote from another blog that we stumbled across this morning:

“Even before medical school, he was already aware that doctors no longer control much of what happens in doctors’ offices and hospitals. However, he pursued his dream of becoming a physician.

He assumed that he would be the final decision maker at least in terms of treating individual patients. Now, he finds that he could practice quality medicine by his own high. standards, but only at the risk of violating several cost-driven Medibest directives composed by people with no clinical training and with minimal if any physician input.”

The same article goes on to state that “concierge medicine is a product of the fight between some physicians, some health care executives, and the government over who will control the flow of patients and dollars spent on medical services.”

When we take a moment to focus on the physician, the professional who is should be in charge of our health an d well-being, and realize that many of them are considering retirement or turning to education as a way to leave this profession and the hours, it’s easy to understand why so many are turning to concierge medicine. As our original blogger states:

“Concierge medicine is merely one alternative to the traditional office. It is not better than the other. It just serves a certain community of patients who require more help and more time than what the average volume-driven primary care office is able to provide and still take good care of their other patients. The traditional doctor doesn’t have the time and maybe not even the desire in some cases to take care of severely chronically ill patients who require a 30-60 minute office visit every week to keep them out of the hospital. Nor can they spend an hour with a grieving widow or with the anxious patient who has many questions about their health. These are not elite or wealthy patients, but they have a need that is difficult to fulfill in an office where 15 minute visits are the rule. I see no conflict between the two types of practice, which, in my opinion could easily co-exist side by side. In fact one could even be a referral source for the other depending on the particular needs of the patient.”

(Sources: http://www.art-of-patient-care.com/concierge-medicine.html , http://findarticles.com/p/articles/mi_m0843/is_5_35/ai_n39397499/ )

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Does Tufts Have The Answer To The Endless Ethics Debate?

Just a few days ago, the New York Times ran an article regarding concierge medicine, and since then the national focus has gone from Social Security and Medicare to concierge medicine and personalized care. When concierge medicine takes center stage, so does the debate on ethics. And while the New York Times’ blog turned into an advertisement for Tuft Medical Center in Massachusetts by the end of the discussion, Tuft Medical Center just might have the right idea to squelch the ethics debate.

At Tufts, they are practicing concierge medicine as well as traditional general medicine, and they allow patients to decide which option is better for them. For the patients who chose a more personalized approach to their health care, a concierge medicine option is available where those patients have “longer doctor visits, around-the-clock access to physicians, comprehensive wellness and prevention screenings (or what we like to call executive physicals) and on-time office appointments within 24 hours of a request.” Sounds extremely similar to what we do here at SignatureMD.

The ethics issue is tossed out the window when you consider the fact that the concierge medicine yearly fee goes directly back into Tufts’ medical school, “teaching medical students and trainees” and allowing Tufts to offer “free care to impoverished patients.” So in this model, everyone truly wins because concierge patients retain the personalized care that they seek, while ‘ethical standards’ are upheld by providing for “impoverished patients.”

Here’s the rub; what is ethical about a traditional practice physician is falling into the red because of healthcare reform bureaucracy, is losing money due to Medicare cuts, and is forced to see more patients in less time? Is it unethical for that physician to seek out a better alternative so that they might live a better, healthier life?

Here’s some irony as well; the NYTimes article refers to a national meeting that took place this past year to discuss the ethics of concierge medicine. It was expected to be a day of debate and heated arguments titled “Concierge Medicine: The Debate Continues.” The day ended up being an informational seminar for physicians who were more interested in converting to concierge medicine than debating the ethics of it.

As one attendee put it; “I thought it was like skimming the cream and I don’t want any part of it. On the other hand, when you see how crippled you are in general internal medicine, you have to say there must be some other way to do it.”

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Once again, we’re a little behind on the happy birthdays. Medicare celebrated its anniversary just a few weeks ago, as did Social Security. And since the both seem to go hand-in-hand, and both seem to be a hot button topic, we’ll wish Social Security a happy birthday as well.

Social Security is now 75 years old! For Social Security’s birthday, the New York Times ran an interesting article on the effectiveness of the program and whether or not Social Security will last for our children. First, though, a little history lesson, according to Wikipedia:

U.S. Social Security is a social insurance program that is funded through dedicated payroll taxes called Federal Insurance Contributions Act (FICA). Tax deposits are formally entrusted to the Federal Old-Age and Survivors Insurance Trust Fund, the Federal Disability Insurance Trust Fund, the Federal Hospital Insurance Trust Fund, or the Federal Supplementary Medical Insurance Trust Fund.

By dollars paid, the U.S. Social Security program is the largest government program in the world and the single greatest expenditure in the federal budget, with 20.8% for social security, compared to 20.5% for discretionary defense and 20.1% for Medicare/Medicaid. Social Security is currently the largest social insurance program in the U.S., constituting 37% of government expenditure and 7% of the gross domestic product and is currently estimated to keep roughly 40% of all Americans age 65 or older out of poverty. The Social Security Administration is headquartered in Woodlawn, Maryland, just to the west of Baltimore.

In 2008, there were 50,898,244 beneficiaries of Social Security amounting to $165,344,000,000.00! With the baby boomer generation retiring, those numbers are surely to shoot through the roof. There are expected to be over 80 million Social Security beneficiaries due to the baby boomers upcoming retirement, which will put a considerable strain on those numbers.

But, since it’s Social Security’s birthday, we wish the program a happy birthday and many happy birthdays to come!

Michael Douglas Takes On New Role vs Throat Tumor

There are many moments throughout your life when you will sit back and think, “why didn’t I do that when I had the chance.” When you’re worried about the onset of cancer, wondering if your primary care physician caught it in time, the idea of concierge medicine sounds pretty good. As Michael Douglas releases news about his throat tumor and the treatment he’s going to have to endure, we should all take a moment to revaluate our health care situations.

While the tumor in Michael Douglas’ throat has not been classified as malignant or benign, it’s a safe bet to assume he’s not going through radiation and chemotherapy for a benign lump in his throat. Fortunately for Michael Douglas, his physicians noticed the tumor in time and he is expected to make a full recovery. Unfortunately, physicians are making their own speculations about the cause of the tumor, saying that the likely cause is Douglas’ smoking and drinking habits.

Michael Douglas will undergo 8 weeks of radiation and chemo, and it expected to give up smoking and drinking. While he’s “very optimistic” about the diagnosis and treatment, throat cancer can lead to many other complications such as airway obstruction, difficulty swallowing, loss of voice and speaking ability, and worst of all the threat of that cancer spreading to the rest of the body.

If you are a male in your 50’s and have noticed a small lump as you shave (the most common way that men see first signs of throat tumors), contact your concierge physician immediately. Your concierge doctor will perform a laryngoscopy, which is examination by use of a tube with a small lighted camera which allows the concierge doctor to look into the mouth and down the throat to see the tumor, according to Google Health.

Above all, if your concierge doctor catches the tumor early, as in the case of Michael Douglas, throat cancer can be cured in 90% of patients. Fortunately for patients of concierge medicine, these are the conditions that can be instantly diagnosed with a yearly executive physical.

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CBS News On Boutique Medicine

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Based On Assumptions

With all of the talk about Medicare, we decided to make it a bit more visual. It’s a complicated issue, but the simple facts remain the same. There are a lot of assumptions being made about how health care reform will truly work, and many of those assumptions place a lot of pressure on our already struggling primary care physicians. Feel free to use this infographic in your own blog or website. We appreciate all links. (Click on the image to enlarge)

More on This Topic:

Medicare Cuts, Funding, Aggravation

How Will Health Care Reform Change Medicare?

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Medicare Cuts

[tweetmeme]When it comes to health care reform, Medicare and Social Security, there are A LOT of assumptions carrying the weight of millions of Americans. Whether you’re for or against the health care overhaul, for or against concierge medicine, or on the fence about everything health related, it’s impossible to overlook the amount of assumptions that are being made about almost everything.

Are we obsessing over Medicare and health care reform right now? Probably, but with good reason. When family physicians are expected to increase their productivity while at the same time losing income, it’s something to be concerned and obsessed about. Medicare cuts are looming, and they could come as large at 30 to 40 percent very soon. That will have a huge affect on physician’s income and overall care of their patients.

This morning in the Sun Times, we came across an article that points out, bullet point by bullet point, the assumptions that The Hill is making with regards to Medicare and health care reform. It’s incredibly interesting:

Medicare – Assuming Too Much

• The trustees’ report assumes Medicare physician fees will be cut by 30 percent over the next three years. Foster calls that “impossible.” (What do you think your doctor will call it?)

• The trustees’ report assumes that Medicare reimbursement rates will fall below Medicaid rates in the next decade. (That’s “code” for the fact that the poorest people will receive more costly services than those who paid into Medicare over their lifetimes.)

• The trustees’ report assumes that in the next 40 years the rates for Medicare services will be half the rates for private insurance for the same services. (And who do you think those physicians and hospitals will be focusing on, given that discrepancy in payments for services?)

• The trustees’ report assumes that productivity in medical services will match productivity in the rest of the economy. (That’s an admirable goal, but the private economy will invest resources in its businesses — resources that Medicare providers will not have under lower reimbursement rates.)

More on This Topic:

Medicare Cuts, Funding, Aggravation

How Will Health Care Reform Change Medicare?

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A personal message from Robert V. Blakeburn, M.D:

Since starting my career in primary care medicine in 1990, I have had the privilege of getting to know so many wonderful people as patients and as human beings.   It is an honor to be your physician and share in your quest for a healthy active life. 

As you know from personal experience, our health care system is extremely complex; I fear that the new healthcare reform will increase this complexity exponentially.  What does this reform mean for you the patient? It means over 35 million new patients flooding the system and not enough doctors to care for all of you. It means that you will receive “care” in 5 minute increments from anonymous providers.  As the Wall Street Journal elegantly stated, it means that “The era of the family doctor who knows and cares about you will fade away.” 

I refuse to “fade away” and to compromise your care and wellbeing.  I have pondered for many months on how I can continue to provide you with the care that you need and deserve in light of this new environment, and have made a momentous decision. I am devoting the next phase of my medical career to providing comprehensive care for a smaller group of patients, who want to achieve the best possible health through the next decades of their lives. There is good scientific documentation that preventive medicine and attention to wellness lead to longer, more active and vigorous lives. I hope to work with you to make the next segment of your life as healthy as possible. Whether you are in your 40’s, your 80’s, somewhere in between or beyond, I want you to achieve the best possible health and lifestyle that you can. 

I hope that you will join me in this new program for assured, comprehensive health care. If you do, you will have my careful and devoted attention to your personal wellness in a less hectic and more personalized medical practice. Every year we will perform a thorough physical to establish your health baseline and medical goals for a wellness program. Each quarter we will sit down and monitor your progress toward these goals. If you are not making progress, we will re-design your program of care, and I will do everything in my power to move you toward optimum health. Together we will strive for a proactive approach to keep you healthy.  I will dedicate my skills, knowledge, and 20 years of experience in primary care and hospital medicine to your quest for optimum health and happiness.   I hope you will join me in this journey. 

Presentation Information:Tuesday, September 14th at 5:00 and 7:00 PM at the Frisco Conference Center, 101 South 4th Street, Clinton, OK  73601. RSVP required: email rsvp@signaturemd.com or call 866.883.8859 x 308.

Dr. Blakeburn completed his undergraduate studies at the University of Oklahoma in 1984.  He then graduated from the University of Oklahoma College of Medicine in 1987. In 1990, he completed a Family Practice Residency while on active duty at Carswell Air Force Base in Ft. Worth, TX.  Upon completion of his residency and serving as Chief Resident, he achieved Board Certification in Family Medicine.  From 1990 to 1993 Dr. Blakeburn was an active duty physician at Vance Air Force Base in Enid, OK and was an ER physician at Bass Baptist Hospital.   He received the Meritorious Service Medal and attained the rank of Major.  In 1993 he opened his private practice in Enid where he was president and one of the founders of the Enid Clinic.  In 2001 he moved to Clinton to become the first full time ER physician at Integris Clinton Regional Hospital and to be the Medical Director of the Jim Thorpe Rehabilitation Unit.  He was chosen by the Oklahoma Foundation of Medical Quality to be one of six physicians in the state to be Champions of Quality.  In 2007 Dr. Blakeburn returned to his roots and first love and again established a private practice specializing in family and holistic medicine.  He continues to be the director of the Jim Thorpe Rehabilitation Unit, ER Director, Department of Medicine chairman, and past Chief of Staff of the Integris Clinton Regional Hospital.	Frequently Asked Questions
Dr. Blakeburn actively supports his community.  He was the Scoutmaster of local Boy Scout Troop 361 and is an Eagle Scout.  He is an ardent supporter and participant in the Western Oklahoma Ballet Theatre and Southwest Playhouse. He is currently the Lay Leader at the First United Methodist Church and has been known to fill the pulpit on occasion.  He is a board member and participating physician in the Clinton Free Medical Clinic.  He is a long time board member of Vine Life Ministries in Oklahoma City.	Request Information
For 20 years Dr. Blakeburn has been practicing Primary Care Family Medicine in Western Oklahoma while establishing a reputation as one of the top Family Medicine Specialists in the area.  His areas of interest and expertise include all facets of adult and pediatric medicine including wellness, heart disease, hypertension, cholesterol management, allergies, and diabetes.	Patient Letter
As many of his patients are aware, he is proficient in Integrative Medicine and has incorporated this into his everyday practice. Dr. Blakeburn has incorporated cosmetic treatments (i.e. Botox, Juvederm, pulse light therapy) into the practice as well as weight loss, diabetic education, allergy and immunotherapy, and anti-aging medicine. Dr. Blakeburn is dedicated to caring for the whole person and building relationships with his patients.	Member Agreement
Dr. Blakeburn is married to the former Kristin King of Clinton.  Together they are very proud of their triplet boys, Christopher, Jason, and Matthew, and their daughter, Chelsea.	Terms and Conditions

Contact Dr. Blakeburn

Robert V. Blakeburn, M.D.
800 Frisco Avenue
Clinton, OK  73601

Dr. Blakebun’s Facts

My Motivation: I have been in medical practice for over 20 years, and it is clear that medicine is changing—and not for the better. It is becoming increasingly difficult for me to deliver high quality personalized care to you through our present system of healthcare. I look forward to working with you in a partnership where I can guide you to health and longevity. I will work with you to deliver the best medical care possible emphasizing wellness and prevention. To do this I must limit my practice to 600 patients, which is a small percentage of my practice.  This innovative personalized care model is becoming increasingly popular throughout our country, and I encourage you to seriously consider joining this partnership for your health. I am looking forward to serving you in this more personalized model with the goal of making the next 20 plus years of your life as exciting and fulfilling as the last 20.
 
The Executive Physical:  The cornerstone of care will be the yearly physical.  Your exam will take approximately ninety minutes and includes comprehensive labs (complete metabolic panel, complete blood count, and cholesterol profile), resting EKG, family history evaluation, genetic cancer screening, sleep apnea screening, an exercise prescription, discussion of health risk factors for cancer and heart disease, laboratory results review, overall wellness and prevention planning.  I will work with you throughout the year to ensure that you are implementing your plan.  While we will bill your insurance for the physical, you will not be required to pay any additional out-of-pocket fee, above your standard co-payment and deductible, for the physical beyond that which insurance reimburses.
 
Benefits:  Recent studies have indicated that patients under highly personalized preventative care programs achieve far better health outcomes than do their counterparts in the standard health system.  One study suggested that patients in these types of programs experienced 65% fewer hospitalizations than did their peer group.
 
Additional Services:  We will be happy to care for dependent children, 25 and under, of members for no additional retainer fee.  When possible, we will also accommodate friends and family visiting from out of town.  Additionally we will offer a 10% discount for our cosmetic and aesthetic services.

How to Join:  Please visit the office and meet with our Patient Advocate, Esther, who will explain the benefits of the program and answer any questions that you may have. Esther will be able to provide you with all of the documents that you may need.  You may also download, review, and complete the membership agreement by visiting www.SignatureMD.com/blakeburn and clicking on the member agreement link, or attend the presentation, or simply come in to the office and enroll in the program then.  
Patients who choose not to join:  Although we would like to be able to include all 3,000 patients in this program, it is impossible to do so.  If you choose not to join the program, you will no longer be able to see me as your personal physician, but you need not worry.  We truly value all of our patients and will make arrangements to ensure that you continue to receive high quality healthcare with no interruption.

SignatureMD
2633 Lincoln Blvd., Suite 838
Santa Monica, CA 90405

Telephone: 310.910.9385 ext. 316
Fax:  310.564.1773
Email:  rblakeburn@signaturemd.com
Website:  www.SignatureMD.com