This is one of those “well, of course they would” moments. Forbes estimates that one in every ten doctors will be switching over to “concierge” practices in the next three years, or sooner. This is reflected by continuing rejection by doctors of taking any insurance and instead providing “direct primary care.” That’s a nice way of saying “cash” on delivery:

The movement is across all medical disciplines with 6.8 percent of all physicians planning to stop taking insurance in favor of concierge-style medicine or so-called “direct primary care.”

Instead of becoming government employees, many doctors are going “off the grid”:

“Physicians have been running for cover for several years now,” said Mark Smith, president of Merritt Hawkins. “There is a lot of uncertainty in now and the only certainty is there is a lot of talk about cutting physicians fees. One way to get out of it is to go off the grid.”

This has been going on for quite a while now. When I last saw my in December (everything’s ok, thanks) we talked about her “going private.” She said she has a sweet deal where she is, with someone else worrying about the overhead and paying her a “per-patient” fee. As long as she sees enough patients, she’s happy. She’s a wonderful doctor and so plenty of people are asking for her.

But I asked about when she couldn’t work any harder, or it became necessary for her clinic to cut her income, what would happen next? She deferred, saying she would wait until then to decide what to do. I expect a different answer when I see her again.

Here’s how her practice might look if she “goes private”:

Under direct primary care, doctors contract directly with patients to provide all of their primary care needs free of insurance interference at a price generally between $50 and $60 a month per patient…

The direct primary care approach provides unlimited visits to a physician’s office plus 24-hour access to doctors through e-mail consultations.

I’d be glad to pay her $50 a month just to know that she’s there. It’s like having an attorney on retainer. I hope I never get sued but…  Just like I hope I never get sick but…



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