Traditional Medicine Sucks. - Looking for Physician partner in Ski Town, DPC model

[m2711c]

Man, it’s almost impossible to find a practice with open spots for new patients in the upstates. I’d gladly pay $1000 to get in with a quality doctor / practice instead of having to deal with whoever isn’t good enough to keep the patient they’ve already got.



fact.

[Trackhead]

24/7 direct access sounds absolutely horrible. It's bad enough having patient messages routed through nursing staff. I can't imagine giving my cell # out to a patient.

What am I missing?

[Conundrum]

Sure--let all the primary care docs have boutique subscription practices for the affluent and let the hoi polloi go to the ER when they get sick.

Not how I would set things up but as long as medicine is for profit, the best care will go to the highest bidder. Can't fault docs for wanting to make money and not deal with insurance or large system bullshit. When I said "not a bad spot in the world", I was referring to geography and the job opportunity posted by the OP. I could think of worse places to live than Sandpoint. Unless I was trying to have a baby.

[Dromond]

Yeah. 25%+ OBs have left Idaho since the law took effect. Three practices closed for sure, maybe others. Bonner is the one you're thinking of. A friend of mine was a white internist at Kootenai Regional who adopted a couple of black kids. They moved to Bainbridge because they could make more money and their kids don't get their asses kicked at school any more. Recruitment of docs is way down too. Used to be easy with all the recreation and cheap housing. That was nice.

I laughed at "full spectrum family medicine (no OB...". Do you really feel like you can call care without OB full spectrum? Full spectrum male healthcare?

[singlesline]

I lost my prior two primary care docs because they switched to a "Concierge" model....except they were more like 3k a pop (and this was years ago, I bet it is more now).

I see the appeal of the model, but its a little hard to make it make sense with the pocketbook given that I still have to pay for insurance to cover everything else (and that insurance already includes "free" primary care visits) and still have to pay for lab tests/imaging that may or may not be in-network.

Plus, with a high deductible plan, everything that you pay for "outside the system" comes back to hit you a second time if you do have a big ER visit or something that makes the plan kick in...e.g. say you get a 5k ER visit and have a 4k deductible...but you've spent $3k on other in-network expenses that year, you're only on the hook for another $1k before the insurance kicks in. If you instead spent $3k on a subscription doctor and out-of-network labs/imaging...you're on the hook for the full $4k before your insurance starts working. I've seen this backfire on people who do stuff like cash-pay for therapy/PT for a discount vs their insurance rate and then end up paying double when they break a bone.

But $1k/yr is probably about where it starts to make sense. If you know you're someone who goes to the doctor a lot and/or values access for questions then you're getting something you can't really get from your insurance.
Probably especially appealing if you are someone who does a lot of training and/or gets a lot of minor injuries (the local option I looked at here includes stuff like wound treatment and even sutures/casts/splints in your subscription fee) and you want an actual doctor to discuss things with and monitor your progress. Bet it is also the way to go if you are gonna go down one of those rich guy anti-aging paths where you are suddenly doing lots of monitoring, getting scripts for weird cocktails of drugs, etc...then you want a doctor you can see monthly and actually talk to.

And I'm sure in a place like Sandpoint you can find plenty of both of those types of people.

[::: :::]

24/7 direct access sounds absolutely horrible. It's bad enough having patient messages routed through nursing staff. I can't imagine giving my cell # out to a patient.

What am I missing?

that it's only 500 total possible patients between two docs

[Trackhead]

that it's only 500 total possible patients between two docs

Right, but the 24/7 access via cell sounds REALLY annoying. I guess you could screen your patients quite well and avoid ones who seemed to have those tendencies.

[::: :::]

If you need to see a primary care doc to the tune of $1000/year there is a very good chance that you will need tests, xrays, specialists and hospitalization that will require additional insurance, and that additonal insurance will include primary care visits, so you are paying an extra 1000/yr for what is being advertised as personalized care, whatever that is. If the practice actually delivers that it may be worth it to you but for most people that is an extra expense that is not easy to shoulder. So like I said, a few wealthy people.

I don't think this is for people who medically need to see a primary regularly, as much as for ones who don't want to be treated like a database entry when they do. So, yes, it likely means someone who has the financial stretch to do it. But it may also mean they don't need gold coverage necessarily; it may assist going with a lower deductible plan or even med savings plan.

[::: :::]

Right, but the 24/7 access via cell sounds REALLY annoying. I guess you could screen your patients quite well and avoid ones who seemed to have those tendencies.

for sure

[mcski]

Right, but the 24/7 access via cell sounds REALLY annoying. I guess you could screen your patients quite well and avoid ones who seemed to have those tendencies.

Beyond annoying. Answering phones in a practice is pretty much a full time job. I can’t imagine a dr not losing their shit after a week of that

[Trackhead]

Beyond annoying. Answering phones in a practice is pretty much a full time job. I can’t imagine a dr not losing their shit after a week of that

I mean it must work, as there are more and more people providing this model of service. Maybe the demographic that chooses this service also doesn't have the tendency to pester.

[singlesline]

The cynical response is that you can just drop any patient that is too annoying.

It is like private schools and "problem" children.

[toast2266]

Beyond annoying. Answering phones in a practice is pretty much a full time job. I can’t imagine a dr not losing their shit after a week of that

The calls have gotta be routed through some sort of answering service. I can't imagine any sane doctor would provide all of their patients direct access to their cell phone with a promise of 24/7 response.

[skaredshtles]

The calls have gotta be routed through some sort of answering service. I can't imagine any sane doctor would provide all of their patients direct access to their cell phone with a promise of 24/7 response.

This.

Most doctors are insane, don't get me wrong... but not THIS insane.

[One (+) Sentence]

Cool concept, but I can't stop thinking about the Bill Murray movie 'What About Bob?'

[old goat]

24/7 direct access sounds absolutely horrible. It's bad enough having patient messages routed through nursing staff. I can't imagine giving my cell # out to a patient.

What am I missing?

I gave my cell phone out on my business card. I pointed it out and told people to feel free to call if they needed to. I was also listed in the phone book back in the day. I can count on one hand the number of times I was called. I'm sure the situation would be different for primary care. I also made a house call in Boomtown NV on a patient I operated on in Sacramento. (I was on my way from Truckee to the Reno Airport to pick up my cousin to ski and they guy's house was visible from I80. It wasn't something I made a habit of.)

[Trackhead]

^^^my oncologist gave me her cell during chemo to “talk me off the ledge” as she put it. I appreciated the gesture but never called her.

[SkiLyft]

Plenty of patients/poas/nurses have my cell. Rarely do I get called. That said, the benefit of this pseudo concierge practice would be you can fire the ones who abuse it.


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[stuckathuntermtn]

If you need to see a primary care doc to the tune of $1000/year there is a very good chance that you will need tests, xrays, specialists and hospitalization that will require additional insurance, and that additonal insurance will include primary care visits, so you are paying an extra 1000/yr for what is being advertised as personalized care, whatever that is. If the practice actually delivers that it may be worth it to you but for most people that is an extra expense that is not easy to shoulder. So like I said, a few wealthy people.

Fair enough

[detrusor]

There is a concierge system in park city. Can best be described as being the Uber wealthy’s bitch. No fucking way

[alpinevibes]

My primary care doc has been doing the concierge thing here for 5-10 years, along with a number of other similar independent docs. I think she charges $5000/yr, maybe more now. Plenty of takers here and plenty of people rolling cash pay for most stuff. But then a year ago she told her clients that she was stopping taking insurance and you’d have to see her PA to bill your plan. That lasted about 6mo until she got bored of the lack of patients and actual work, besides the concierge crowd, so she’s back to taking insurance.

If you’re and independent provider who doesn’t have a robust or well-trained staff to manage insurance, billing and patient issues, it makes sense to chase this retainer- type cash flow and angle your business and client intake towards higher-income, cash-pay clientle.


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[old goat]

My primary care doc has been doing the concierge thing here for 5-10 years, along with a number of other similar independent docs. I think she charges $5000/yr, maybe more now. Plenty of takers here and plenty of people rolling cash pay for most stuff. But then a year ago she told her clients that she was stopping taking insurance and you’d have to see her PA to bill your plan. That lasted about 6mo until she got bored of the lack of patients and actual work, besides the concierge crowd, so she’s back to taking insurance.

If you’re and independent provider who doesn’t have a robust or well-trained staff to manage insurance, billing and patient issues, it makes sense to chase this retainer- type cash flow and angle your business and client intake towards higher-income, cash-pay clientle.


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One reason so many docs are joining groups to handle the business end of things. Often the practices are owned by hospitals, as in Truckee, but increasingly they are owned by private equity. My DIL in her last year of ER residency is having a hard time finding a non-PE job in LV; even the university group she is training with is PE owned.

[XXX-er]

Do you ^^ mean getting insurance co approvals ?

[old goat]

Do you ^^ mean getting insurance co approvals ?

that, but mainly billing, keeping the books, managing payroll, managing taxes, etc etc etc. Stuff they don't teach in med school. I worked for a salary. I can't imagine doing all the stuff solo docs have to do that has nothing to do with practicing medicine.

[fomofo]

Not how I would set things up but as long as medicine is for profit, the best care will go to the highest bidder. Can't fault docs for wanting to make money and not deal with insurance or large system bullshit. When I said "not a bad spot in the world", I was referring to geography and the job opportunity posted by the OP. I could think of worse places to live than Sandpoint. Unless I was trying to have a baby.

$hoot high!



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