Periodically, my practice receives calls from people in different parts of the country asking for an odd service. They are looking for a concierge doctor to see them for a single visit, usually at a hotel in the middle of the night, and they want the doctor to come immediately. We have to explain to them that we do not offer a call-in, nationwide, visiting doctor service. I've often wondered what made them think that was concierge care. And then it dawned on me: "Royal Pains," the television show on the USA network about a "concierge doctor" who practices in the ritzy Hamptons beach area of New York state. Our callers must think "concierge care" is what they see on TV.
When the television show "Royal Pains" started a few years ago, I was delighted to see that concierge care had made it to the small screen. However, as a company whose headquarters is about 50 miles from the Hamptons — the home of this series — I was surprised to see what they considered a "concierge company." The concierge company they portray is certainly not what we see in the marketplace.
In real life, concierge care has many variations, but there are a few characteristics that are constant: patients pay a membership fee; doctors see fewer patients; and concierge programs offer patients much-needed convenience and time.
What makes "Royal Pains'" concierge care so different from reality's version? First, they take care of rich people in the Hamptons. (Most members of concierge programs today are not rich). Second, they seem to make house calls only, with no actual medical office (not the norm in concierge care). They show physician assistants treating patients without the doctor present (not typical for PAs to treat members in concierge care). Patients on the show see different physicians (in real life, patients see their chosen physician for the most part). "Royal Pains" also seems to ignore the need for insurance and government plans, which in general, concierge programs still rely on. On the show, the addition of new members seems to occur when the doctor stumbles upon a medical emergency. Not exactly the way medicine works. Chances are it is a very unpredictable way to grow a practice.
When I lecture on concierge care, I often refer to television doctors, as they tend to embody the fantasy of what medicine is really about. Television emergency rooms are always dealing with a catastrophe, and yet, doctors have so much time to talk and interact. Then there are the private television doctors who seem to have only one or two patients a day like "Marcus Welby, MD." Even Dr. House deals with only one case at a time, with four or five doctors assisting in the diagnosis and treatment. There are not many physicians in real life that have that luxury.
In the real world, doctors are stretched thin and in short supply. This has led to the development of new medical-care options, most of which emphasize low-cost efficiency, like drug store doctors, video doctors, telephone advice doctors, urgent-care centers, and some 24-hour a day centers that are not ERs. But we have also seen growth in private sector medicine that emphasizes time and service, though there are very few physicians who have a "Royal Pains" practice model. I doubt that even in the Hamptons, just hours away from New York City, there is enough support for this model, but who knows what the future may bring. Perhaps the physician shortage will be such that the ultra rich will pay anything for care.
While "Royal Pains" and the other relaxed doctors we see on TV don't quite reflect reality, they do reflect the kind of care we wish we could have. We believe that as healthcare options continue to diversify, the trend will only continue toward growth in private-sector medicine, particularly in primary care. Our growing membership lists say it all. Patients want more time and personalized care from their physician. TV may not get it right, but concierge medicine is a star for a growing number of physicians and patients today.