How Much Is Your Relationship With Your Doctor Worth?

An over-65 year old friend and I had an interesting conversation. He was being asked to pay almost $2000 a year for himself and the same amount for his wife to remain patients of a physician who was reducing his practice to 600 patients. The only patients who would remain in the practice were to be those paying the access ("access" is my term, not the physician's) fee.

I wondered about this arrangement, which has the name of a major American household product company associated with it.  But the first issue, was the most difficult. In economic terms, how does a patient (who is not an expert on the competence, quantity or quality of care a particular physician generally provides, but may have strong emotional ties to the physician) calculate the value of his or her relationship with a particular physician?

I had lots of questions. How does the physician's proposal match up with licensing obligations and his role as a Medicare provider or a provider under the Affordable Care Act ("Health Reform")?  How does the proposed relationship coordinate with the various HMOs, PPOs and other insurance arrangements of my friend, which describe themselves as paying for a limited group and range of services and have their own set of "access" requirements?  How do the arrangements mesh with the physician's need to take time off from call, sleep, go on vacations, and attend medical education meetings?  Assuming that the physician has "on-call" coverage arrangements with other physicians, will those physicians honor the "special relationship" that the up-front cash access payment to the doctor is said to provide? Will consultants to whom the patient may be referred be limited to physicians who engage in similar financial arrangements?  Will the patient receive money back if he or she develops a condition requiring intensive care from a different physician, such as an oncologist (cancer), hematologist (benign and malignant blood disorders), nephrologist (kidney disease) or other specialist? What will happen if the physician decides to reduce practice size even further?  What will happen if the physician decides to retire? Is the physician moving into "borderline" issues in which the physician is at an unfair advantage, and the patient at a serious disadvantage, in the economic arrangement? Does the "access" fee create a conflict of interest?

In these days of "full disclosure," does the arrangement require special disclosure of information to the patient which might affect the patient's decision: information relating to the quality and quantity of continuing medical education, physician health (including medications taken and substance abuse) or social problems, deficiency notices from medical organizations, hospital medical staffs, governmental bodies, or personal debt which might impact on his practice?  After all, the patient is being asked to pay for access not for actual health care, and perhaps "truth in advertising" concepts should apply.

Is the proposed arrangement beneficial to my friend?  I don't know. But he has a lot to discuss with his wife and their doctor.  After all, we're not just talking about which dishwashing detergent to buy here.