The changing face of internal medicine

health_insuranceAs noted here and here, my internist converted his practice to a successful concierge practice three years ago. In this recent post, Dr. Steve Knope speculates that soon patients who are not a part of a concierge practice will not know their doctor if they have to go into the hospital:

What are the consequences for patients? What happens to the average person in Tucson, Arizona when he or she gets chest pain, develops pneumonia or has a seizure? Can they reach their internist or family practitioner for a medical emergency? Most patients who call their primary care doctor for a medical emergency can’t even reach his staff during normal office hours. Instead, they will hear a recording on an answering machine, directing them to go to call “911” for any medical emergency.

Once in the ER, the doctorless patient will be admitted to a hospital physician, who is unknown to them. This so-called hospitalist, who is a salaried shift-worker, will put in his 12 hours, and then go home. He is a doctor who knows nothing about the patient’s medical history. He has never met the patient. There will be no call from the hospital doctor to the primary care doctor in the office to get a thorough medical history. There will be no medical records transferred to the hospitalist. The hospitalist will attempt to get the best medical history he can from the patient, make some quick medical decisions, and then pass the patient off to one of his colleagues when his shift ends. And so it goes. No continuity of care, no understanding of the patient; the sick person now becomes a “case of pneumonia” or “the stroke in bed 3” to a group of unknown, rotating professionals.

Knope goes on to predict that as doctors flee from primary care (see earlier post here and here), the vacuum will be filled by nurse practitioners and medical assistants, who are far less trained in diagnostic procedures.

I don’t know about you, but I’m making sure that my payments on my concierge practice account are current.

1 thought on “The changing face of internal medicine

  1. add to your comments that the hospitalist, not uncommonly, may be beholden to the hospital and the hospital agenda of fastest discharge for best buck. this may be in form of the hospital awarding “exclusive contract” to one hospitalist group to control them, as they often do now in radiology, emergency medicine, pathology and anesthesia–to the great harm of physician autonomy and often in conflict with physician’s duty to put the patient first.
    though i do not like hospital work, i have elected to not use the hospitalists for the very reasons you articulate.
    more internists will gravitate toward taking business risk similar to your concierge doctor though in my practice i have been able to charge and collect more than insurance pays but far less than the concierge. i believe my business model will become normative for about a quarter of internists over time and serve patients who can afford and who demand, a bit more ie, no hospitalists, answered phones, etc.

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