The Dish

Why Not A Two-Tiered Medical System? Ctd

A reader writes:

As a general proposition, I’m against the adoption of a two-tiered medical system. The best doctors will gravitate toward the concierge system, leaving the worst doctors to treat the masses. This is just another example of the widening split in this country between the haves and have-nots.

Another sighs:

It always makes my brain break when I read people who obviously don’t know much about the medical industry suggest things like “AMA guidelines” to deal with specialists who require cash payments. First, the AMA is not an oversight body. It’s a voluntary lobbying association representing solely the most conservative physicians, with a heavy focus on pure internal medicine – unspecialized physicians who only see adults.

The only regulatory body for medicine in the United States is the US government, and the only entities with any reliable power are Medicare and Medicaid, because they control the purse strings. (If you break their rules, you don’t get paid). The AMA has no authority, and these days a rapidly declining membership of cantankerous old men. By definition all AMA guidelines are vague, because nobody gives a hoot.

If you want good professional guidelines that are actually followed, look at the individual society for that field. In my case, as a pediatrician, it’s the American Academy of Pediatrics (AAP).

Finally, concierge practice is just the newest iteration of a very old form of practice, that of the “society” physician. Every city has its pediatrician and internists that the best people go to, with wait lists and other shenanigans. These doctors always went the extra mile, gave antibiotics when they weren’t indicated, and did all sorts of medically dubious things to keep their entitled patient population happy (and they still do). The concierge version of this just reflects the newer iteration, where doctors are not as attached to their titular independence, and are getting paid more to sacrifice their time and common sense.