Keeping it ethical: Retainer practices have rules and restrictions

So-called retainer or boutique practices can be beneficial to physicians and patients -- if all legal guidelines are followed.

Editorial. May 3, 2004.

For physicians tired of limits on reimbursements and the time they spend with patients, the idea of a retainer practice can seem quite appealing.

In such a setting -- also referred to as a boutique or concierge practice -- physicians charge patients an annual or monthly fee that not only covers office visits, but also gives patients perks such as a direct, 24-hour phone line to a physician or guaranteed same-day appointments. Physicians are charging anywhere from $500 to $20,000 a year, and some are converting their practices to nothing but retainer fee-paying patients.

However, there are serious ethical and legal considerations that come along with a retainer practice. They revolve largely around the principle that quality care is not something that should come only with a premium price tag. While a retainer practice can be a viable opportunity for physicians and patients, anyone thinking of using it merely for financial gain should think twice.

When it appeared that there was growing physician interest in retainer medicine, the AMA addressed the issue by crafting ethical guidelines to give physicians standards for working in such a setting. The guidelines, approved by the AMA House of Delegates at its 2003 Annual Meeting, were based on in-depth analysis of the patient-physician relationship and the implications of offering special additional services. They were presented to delegates by the Council on Ethical and Judicial Affairs and were based on work by the Council on Medical Service.