Reading certain media reports, one might think that concierge medical care is a service solely for the super-rich, an exclusive realm of $1 million in-home emergency rooms and $30,000 annual fees for round-the-clock access to physicians. But the concierge model actually encompasses a range of services, often costing significantly less than the stratospheric figures cited in stories about health care providers who cater to the 1%.
"An increasing number of physicians have turned to concierge medicine," explains Physicians News Digest, "also known as retainer or boutique medicine, to retain their individual practices."
In concierge medicine, patients pay their primary care physicians a retainer in return for basic services and augmented care. These flat fees are sometimes the physician's sole source of income; in other cases, doctors continue to take insurance and use their concierge patients' retainers as supplementary fees. For patients, the perquisites vary from practice to practice, but can include more personal attention, house calls and even the doctor's cell phone number for 24-hour access.
For David Woolfe, 57, whose primary care physician is a concierge doctor, one key perk is the comprehensive annual physical. "It's just a broader spectrum kind of assessment. They do a mental acuity thing, which had never been part of my physical previously, vision and hearing in a more determined sense, that sort of thing."
The enhanced exam is a two-step process: "You do the physical and the lab work, then come in to discuss." Woolfe also receives "a nice little CD" explaining his results.
For services like this, along with the ability to contact his doctor on her cell phone -- which he has done only once -- Woolfe pays $1,500 a year; his insurance covers regular visits. "It's costlier," Woolfe concedes, "and I don't know quite frankly if it's worth the additional expense. The physical is good, though, in the sense that it creates a real baseline: This is what things were when you were healthy, so you know when things start to change."
Woolfe didn't exactly come to concierge medicine of his own choosing. "I didn't switch so much as my doctor switched to a concierge model within her practice," he says. "So, in order to stay with her -- and I like her very much -- that was my primary motivation." And he's hardly a high-flying member of the wealthy elite: A resident of Long Island, he works as a religious educator and freelance writer.
"In terms of bang for the buck," Woolfe concludes, "other than having access to the doctor I want treating me on a regular basis, it's not worth it to me."
"But," he adds, "I don't really have any issues that require that kind of attention. Frankly, I don't think many people do. That's why it's called 'concierge.' It's just nice, it's not really necessary."
Jumping Off the Conveyor Belt
David Katzman is an internist in St. Louis who used to see five or six patients an hour -- 25 or 30 a day. "It was difficult to do," he says, "and really difficult to do well." But even churning through patients that fast, Katzman was finding it hard to make ends meet: "Expenses go up, whether it's postage, or malpractice insurance or rent, and you really don't have control over what you get for patient visits, what you can charge or what you receive. The only way you can make up your cost is taking on more patients." Other revenue-enhancing options -- doing lab tests, dispensing drugs, selling supplements, or opening a weight loss clinic in his office (or speaking for drug companies) -- didn't appeal to him.
"I couldn't take care of patients the way I wanted to," Katzman says. "I had to have a panel of 3,000 to 4,000 patients. It wasn't very personally rewarding to me."
His solution was to switch the concierge model. He made the transition in 2003.
Now, Katzman's patients are given an hour for every physical examination. They can call his office, request an appointment, and see him on the same day. They can text, email, or call him on his cell phone. And they can be confident that "their doctor knows them, and knows their medical history," Katzman explains, "because I don't have nearly as many patients."
His office has the time to schedule consults with specialists, and calls patients with lab results quickly. Katzman and his partner will visit their patients in the hospital, which many primary care doctors no longer do, and they can cover for each other relatively seamlessly, since they know many of each other's patients.
This deeper engagement has given Katzman the sense of professional satisfaction he lacked when he was engaged in what has been called "conveyer belt medicine."
Concierge medicine, he says, is "sort of like turning the clock back 40 or 50 years to a relationship between the doctor and the patient which is in many ways like a family relationship." Katzman even makes house calls a couple of times a month -- he did one just two days before speaking with DailyFinance.
Affordable, If You Make It a Priority
Katzman's practice is far from an exclusive haven for the most affluent. "I certainly have super-rich patients," he says, "but the majority of people are middle class or upper-middle class."
About 10% of Katzman's patients see him on scholarship, meaning he doesn't charge them at all. "These are patients who could obviously never afford this," he says. Many were in his practice before he became a concierge doctor, but some have been added since the switch. "Sometimes you're on call in the ER and patients get admitted that way," Katzman explains. "Usually, if I start with a patient I'll continue with them. Sometimes it's employees of people who are patients, like the housekeeper of a patient. Or there's somebody who knows someone who's having a problem and needs help."
For patients not on scholarship, Katzman charges an annual retainer of $1,800 for those over 50, and $1,200 for those younger. "The fee is relatively modest," he says, "compared to other fees in life. If somebody values being in a practice like this, they can do it in place of going out to dinner twice a month, or instead of the extended package on cable TV, or whatever. It's about picking and choosing what's important."
Ultimately, Woolfe agrees about the price, even if he sounds ambivalent about the value. "One would never say to someone who doesn't have $1500 that it's nothing -- it's a nice chunk of change. But in and of itself, it's not a reason to say you've got to be wealthy to do this."
Concierge Doctors: They're Not Just for the Super-Rich Anymore
When most people think of gold, they usually think of jewelery, or coins and bars -- the metal as a hard investment. Today, though, gold is used in host of technological and industrial applications.
Article by Paul Ausick
Jewelry still accounts for the biggest share of demand for the precious metal. In the second quarter of 2011, jewelery makers purchased nearly half of the total gold demand of 920 metric tons, according to the World Gold Council's latest Gold Demand Trends report. Demand from investors accounted for 39% of the total. Only 13%, or 118 metric tons, went for technological and industrial uses.
The precious metal's unusual chemical and physical qualities make it a highly desirable material for use in six specific industries, according to the the World Gold Council: electronics, nanotechnology, automotive, space, engineering, and medicine. Some of the uses are fairly mature: dental fillings, for example. Other uses in engineering and nanotechnology are still in their early days.
Of the 118 metric tons used last year industrially, 84 metric tons went to electronics and 11 metric tons to dentistry. Of the remaining 23 metric tons, most of the gold was likely used in electroplating, as the other technology applications use minute amounts and many are not even available commercially.
Gold's current high prices are no doubt curbing a more widespread use of the metal as an industrial commodity. While miners and investors might not mind the steep rise in price, industrial users and consumers will either search for substitutes or delay buying.
The world today is full of electronic circuit boards, from computers to cellphones. Because gold is a highly efficient conductor, it's used to make the bonding wires that connect those circuit boards' components -- and there are thousands of connections on a single circuit board. But because those bonding wires are thinner than a human hair, the total amount of gold used is minuscule. A mobile device like a smartphone or tablet PC contains about 0.0002 ounces of gold. At $1,800 an ounce for gold, that's only 36¢ worth of gold in a typical device. Of course, with 1 billion phones manufactured each year, demand for gold from that industry alone adds up to 91 metric tons of gold -- $360 million worth. More will be accounted for by the 400 million desktops and laptops, and the more than 250 million TVs that will be manufactured in 2011 alone.
For centuries, gold has been used to make stained glass -- and not just golden-hued glass, either. When it's broken down into nano-sized particles -- we're talking billionths of a meter -- the precious metal stops being gold colored and reflects a deep crimson red or a light blue. Nanoparticle gold also has a wide variety of other uses -- especially as a chemical catalyst. Using gold as a catalyst in making paints and adhesives could lead to the elimination of toxic mercury from the process. In chemical processes, a gold catalyst can lower both the temperature and pressure needed to start a reaction, thereby reducing the amount of fuel needed -- and thus the cost of production.
Using gold leaf as a decorative element on buildings has a long history: The Egyptians were the first to figure out how to stretch a single ounce of gold into a thin sheet that could cover 200 square feet. Today, even thinner films of gold are used as a reflective coatings on windows to keep buildings cooler. It's now possible to stretch an ounce of gold to cover up to 1,000 square feet of window surface. Similarly, a gold-palladium alloy is used to braze metals subjected to very high operating temperatures, like jet engines. A thin plating of gold is also used on some parts of fuel cells to reduce corrosion and increase electrical conductivity.
Catalytic converters have used precious metals for years to remove harmful emissions from car and truck exhausts. Platinum and palladium are the most popular, but the recent addition of gold to catalytic converters used on diesel-powered vehicles opens up a new use for the metal. These gold-added converters are coming into widespread use in Europe, where engines have to meet the world's most stringent emission requirements. When the technology was introduced in 2008, gold was cheaper than platinum or palladium, making those catalytic converters at the time cheaper than those using other precious metals. For the moment, this is no longer the case.
Gold's attributes of high reflectivity, electrical conductivity and corrosion resistance have made it a mainstay of space programs. In the U.S., the now-defunct space shuttle program used about 90 pounds of gold in each shuttle -- about $2.4 million worth at today's prices. Putting gold into space may be the equivalent of sending coal to Newcastle: Recent research indicates that the Earth's gold may have come from a massive meteor shower that hit the planet 4 billion years ago. And there's plenty more where that came from. The single asteroid Eros contains more gold than has ever been mined on Earth.
Because of its resistance to tarnishing and decay, gold has been used in medicine for thousands of years. Ayurveda practitioners in India today are estimated to consume a few metric tons of gold every year. In the seventh century BCE, the Etruscans used fine gold wire to fasten false teeth. Modern dentistry continues to demand gold -- 11 metric tons of it in the second quarter of 2011 alone. Nanoparticles of gold serve many other modern medical uses -- in pregnancy test kits, in treatments for rheumatoid arthritis and certain cancerous tumors, to detect quickly the presence of food-borne pathogens like salmonella and E. coli, and to provide rapid screening tests for HIV.