Summary:
The central point of this article is that due to a shortage of doctors and lack of quality doctor-patient care in Hawaii, as well as the rest of the nation, a new health care model called "concierge" or "boutique" medicine has developed which may or may not be a good thing. The author, James Ireland, says that the recently approved Patient Protection and Affordable Healthcare Act, more commonly known as Obamacare, will grant affordable healthcare services to many people throughout the nation who currently do not have insurance or who cannot afford it. However, there is already a shortage of doctors in Hawaii and while this new law may give people affordable health care, it does not necessarily mean that they can find a doctor that is accepting new patients.
Ireland also mentions that although more students are enrolling in medical school nationwide, the federally funded internship and residency programs that are needed for medical student graduates to become practicing doctors are not increasing the number of positions available due to a cap set in 1997. Unfortunately, because these medical student graduates have to compete with each other and wait for open positions to intern and perform their residency, this increases the length of time it takes for them to begin their own practices, hindering the increase of doctors to help with the shortage.
Many patients in Hawaii and across the country are becoming frustrated with the shortage of doctors. For some, it is difficult to find a doctor that will accept new patients. For others, even when they have an appointment, waiting room times are longer while actual visit time with the doctor is shorter. However, the patients are not the only ones frustrated -- the doctors are too. Many doctors want to have more quality time with patients and give better care by having that one-on-one doctor-patient relationship that used to be common a generation ago, but because of the high demand of patients, they are forced into squeezing as many patients as possible into a single day. This is where "concierge" or "boutique" medicine comes into play.
Concierge medicine provides personalized care and 24 - hour access to your doctor. Concierge medicine wants you to feel like you can take all the time you need with your doctor during appointments and not feel rushed. A company called MDVIP offers this type of healthcare in Hawaii (four doctors on Oahu and two doctors on Maui) and the mainland. Instead of using insurance coverage, MDVIP members pay annual fees starting at $1500 per year. The number of patients accepted is usually limited to no more than 600 patients.
For family practice doctors who transition to the new concierge model, the patients are offered to either join or decline membership. If they decline, then they must now look for a new doctor. So while concierge medicine offers great doctor-patient relationships, it adversely increases the number of patients looking for a new doctor during a time of an already stressful doctor shortage.
Reaction:
The topic of the article, healthcare in Hawaii, was of great interest to me since I currently work in the healthcare field and plan to become a nurse one day. The central point/main idea of the article was that a new healthcare model, "concierge" medicine has developed, which may or may not be good for patients in Hawaii and also the mainland.
I'm sure we can all relate to the frustration involved in making and having a doctor's appointment. To start, we are already feeling sick or have something medically wrong, which is why we go to the doctor in the first place. On top of that, to have to take time off of work, schedule an appointment -- yet still wait for what feels like hours -- just to see a doctor for 10 minutes, who will 90% of the time write a prescription for antibiotics that you may not even need (which is a whole other issue in itself that I won't get into at this time) seems ridiculous!
However, I do understand that there are doctors out there who actually do care about their patients and want to have that one on one time. I can appreciate the fact that concierge doctors want to give quality care to patients. I was surprised to learn that my grandpa actually goes to one of the doctors on Maui who is employed by MDVIP, the company that is mentioned in the article. When I called to ask my parents if they pay for yearly membership, they said no. Interestingly enough, my grandpa was already a patient of this doctor before he switched to concierge medicine. My grandparents received a letter in the mail asking if they wanted to accept or decline the MDVIP services. Although they declined, my grandpa still sees this doctor under his regular Medicare insurance. I found this peculiar since in the article it states that the remaining patients who decline the switch to concierge medicine are forced to find other doctors. My parents are going to inquire whether this is the case with my grandpa. As of now, they have received no notice of needing to find a doctor and the doctor continues to accept Medicare. So perhaps this doctor on Maui has not reached his maximum amount of patients he is allowed through MDVIP? Or perhaps the author has been misinformed about his information?
Personally, I feel that the idea and reasoning behind concierge medicine makes sense and I understand why doctors would want to follow this model. On the other hand, I think it's just like any other thing in this country -- in order to receive the best medical care (or anything for that matter), you must have money! Also, the article states that the "starting" cost for MDVIP is $1500 per year. What does "starting" cost mean? Typically, that means there are plans that are more expensive. The article mentions boutique medicine places in the mainland costing as much as $20,000 per year. Realistically, most people would not pay for this, especially when they can receive insurance from their work at a much cheaper price, or now with Obamacare, many for free!
I do not have a solution for the current doctor shortage that Hawaii faces; however, I do think that looking at the cap made on interns and residencies in 1997 should be revisited by Congress. This would be a good start to a solution. If more interns and residencies were opened up, then ideally that would create more opportunities for doctors to start private practices or for companies to hire more qualified doctors. What I do know is that when I become a nurse, I hope that I can still remember why I decided to become a nurse in the first place. Some nurses let the stress of too many patients get to them and they forget that one of the main reasons a nurse is there is to make the patient feel comfortable and give the one-on-one care that the doctors are unable to do in this shortage.
I do not have a solution for the current doctor shortage that Hawaii faces; however, I do think that looking at the cap made on interns and residencies in 1997 should be revisited by Congress. This would be a good start to a solution. If more interns and residencies were opened up, then ideally that would create more opportunities for doctors to start private practices or for companies to hire more qualified doctors. What I do know is that when I become a nurse, I hope that I can still remember why I decided to become a nurse in the first place. Some nurses let the stress of too many patients get to them and they forget that one of the main reasons a nurse is there is to make the patient feel comfortable and give the one-on-one care that the doctors are unable to do in this shortage.
