New practice designs deviate from tradition

Ethics Forum. Nov. 3, 2003.

Are premium or retainer practices at odds with medical ethics?

A growing number of physicians are converting their practices to boutique or concierge medicine. The AMA has not found such practices to be inconsistent with a pluralistic means of health care delivery, but it has identified ethical concerns that warrant careful attention. What are the arguments for and against this type of practice?

Reply:

As healers, we physicians always have had to struggle with the inherent conflict between our personal and professional commitment to care for the sick and the understanding that our intelligence, experience and technical abilities have substantial economic value.

How much it is worth to have your life saved by the insights of an internist or the hands of a surgeon?

We have developed a system with both implicit and explicit mechanisms to govern our use of this power. A fee schedule controls what we are paid, or we work in a system that rewards us with a salary and incentives.

Professional traditions give us to understand that it is not "ethical" to capitalize on our advantage in the marketplace of the sick and needy. But as a profession we have a long tradition of working at the edge of these higher ideals. There is little high ground here.

The creation of retainer practices is much like creating a medical (or surgical) club. We ask patients to pay a fee to become part of a group with some special privileges, such as cell phone access, newsletters, e-mail bulletins and so forth. With membership comes improved access and enhancement of care.