[jeremy151]

> If you want safe and really high quality medical care you should absolutely have a personal physician you have a personal relationship with, who understands your lifestyle, your risk factors for side effects, and your medical needs deeply. How many Americans have that? Maybe a few dozen?

A bit of a tangent: I have this here in the US, through a model called Direct Primary Care. I pay $50/mo for a single provider, unlimited visits / communication, and highly discounted labs. She makes house calls on occasion. This doctor is working solely in my interest, and has little concern of insurance, except to help me navigate that system should I need a specialist, prior authorization, etc.

I do worry that it's sustainable, but I think there must by a way to scale up this practice of the general practitioner working in the interest of the patient.

My previous doctor was part of a large health system, who also happens to be directly associated with the large regional insurance provider whom my employer supplied to me without another choice. Every 8 minute visit centered around insurance and billing, with my health seeming to be a distant second. It seemed every visit had to end in some kind of prescription or referral, arrived at quickly and without much discussion. It quickly became clear they were not working in my interest, and I sought other options, eventually landing on the Direct Primary Care model. Now I have full 1 hour visits, and someone who seeks to understand what is happening for me completely, not through the lens of a payer.

[lmm]

> I pay $50/mo for a single provider, unlimited visits / communication, and highly discounted labs. She makes house calls on occasion. This doctor is working solely in my interest, and has little concern of insurance, except to help me navigate that system should I need a specialist, prior authorization, etc.

Someone's presumably paying her more than $50/hr, which will burn through your monthly fees pretty quickly. Where's the money coming from?

[genocidicbunny]

It works the same way that health insurance works -- most people don't need all that much care, and when time-consuming care is needed, it is often pushed to the specialists rather than the generalist. Your $50/mo payment might not seem like much, but if all you're doing is a bi-monthly checkin with them over the phone, you're really paying more like $100/visit for a 15-30 minute visit.

A lot of these 'concierge medicine' services are set up to deal with mostly people who don't need all that much medical care, beyond relatively brisk access to the doctor in a few rare circumstances. Since they also don't really do much in terms of specialty care, they tend to have fewer Px who need extensive personal care.

[zetazzed]

In the models I've seen, they still require and bill insurance. The monthly fee is a supplement for the doc practices.

[fluidcruft]

You're also probably fairly healthy and not much work. Concierge care for my elderly parents with complex diseases has been quoted at $20k/year.

[nikkwong]

How could this possibly work out for her financially? To make 120k a year, she would have to be doing this with.. 200 patients; and I think the average GP makes a bit more than that in the US. That doesn't like a good bargain on her end.

[classichasclass]

200 patients is an extremely small panel size for the typical primary care provider in the United States. Many have several thousand.

[aiforecastthway]

I do not think I have ever spent more than an hour per visit actually in the room with my GP. I have an annual checkup. For a while there my GP was world class and also a blood relative.

200 patients at one hour per is a bit more than a month of 9-5s.

If I visited my GP once per 1.5 months I’d be paying a fuckload more than $50/mo in copayments alone, in addition to my incredible premiums.

Healthcare becomes pretty affordable when you’re not paying for actuaries and other scammers.

[maxerickson]

Not paying someone to chase insurance saves something anyway.

I'm at about 1 hour per year with my GP (I guess they can be spending additional time on notes or whatever, but I don't think it's much).

[decafninja]

I’ve heard of this, also known as concierge medicine right?

But the figures I’ve seen quoted for such service usually begin in the four digits, sometimes five digits, annually.

[trillic]

I've anecdotally done some research and in SoCal a true concierge medicine for what I would be looking for with a brick-and-mortar location and imaging on-site is ~$5000/yr.

[bongodongobob]

$50 + health insurance? I saw my PCP after my health insurance had unknowingly lapsed and a physical was ~$1k with just some basic blood work.

[jjcob]

How people justify paying $1000 for probably less than 15 minutes of work is beyond me.

[nradov]

Studies have shown that patient satisfaction scores are highly correlated with whether the doctor writes a prescription. When patients leave with a prescription then they feel like they got their money's worth, regardless of whether they really need it.

[pasquinelli]

a lot of actual conditions are actually treated with actual perscription drugs.

[spacecadet]

Im sorry that has been your experience. I am too on a patient of a doctor who belongs to a "large health system/insurance system provided by my employer with no choice". I have never once discussed billing. Every visit, while short 10-15 minutes, is focused on my health and if I asked questions, can extend to 30+ or more... really depends on my questions. I have never needed an hour with a GP, maybe a specialist.

[jeremy151]

I should clarify: the billing talk would come out when talking about options. “Let’s try X because insurance will need to see that we tried it before we try Y.” I don’t blame the provider. Navigating insurance still comes up with my direct primary care doc, but it’s not most of the visit. The real value I see is a willingness to take the whole picture into account (not just symptom -> med/specialist) and teach me about how things work and why. I have some complexity in my history for which this helps a lot.

Regarding the patient load discussion elsewhere, our entire family uses this doctor, we’re in for $200/mo but if we added up the interaction time even with me (a more complicated customer) it’s maybe 5 hours a year + some text communications with the MA / prescription wrangling. Their model seems to be all about effective scaling, I hope it is worth it for them, because my experience is vastly improved.

[throwaway2037]

    > I do worry that it's sustainable

What is the maximum price that you are willing to pay?