017 Discussing Healthcare: Why are physicians changing to concierge medicine? (part 2 of 2)


The New York Times published an article titled “New Law’s Demands on Doctors Have Many Seeking a Network.” The article is about 2 primary care physicians and their choice to practice in 2 different environments.  One physician chose to join a hospital network and is now an employee.  His job is less stressful, although he remains busy, the hospital system now takes care of the business part of his practice so he can focus on patient care.  The other physician has chosen to remain as an independent practitioner in her own clinic.  Running the business is a burden for her, especially in the current healthcare environment with decreasing reimbursement and increasing overhead.  It is an interesting look at how healthcare is changing in our nation.

A gentlemen in Mississippi was pronounced dead…but did he really die?  Well, I’m not sure.  But, he did come back to life prior to embalming.  A strange story, indeed.

Dead Mississippi Man Begins Breathing in Embalming Room, Coroner Says

Mark Sexton, MD

Mark Sexton, MD

Mark Sexton, MD Part 2

In the first half of the interview (episode 16) Dr. Sexton began a discussion about the reasons physicians are choosing to change their practice to concierge medicine.  The discussion was prompted by a TIME article titled “My Doctor, the Concierge,” where the author wrote a commentary piece and concluded that physicians are not taking the Hippocratic Oath seriously by practicing concierge medicine.

We discussed many of the underlying reasons for physicians to choose to leave the third party payer system and practice medicine independently, charging cash instead of billing insurance companies. Two topics that were discussed specifically were 1) there were and perhaps are a large percentage of physicians who are trying to get out of medicine, 2) the cost of medical education is outrageously high.  Here are some links to articles that support both of these claims:

Claim 1: Physicians want to leave the practice of medicine –

Claim 2: Medical school costs are outrageously high –

Dr. Sexton was always drawn to critical care and emergency medicine, but trained in family medicine.  He once worked as a primary care provider, but changed his practice to emergency medicine.  Much of his decision to practice emergency medicine was based on his desire to be in a more acute care setting.  But, he states many reasons why he left primary care, from dealing with the everyday business of running a clinic to dealing with the bureaucracies of the government and insurance companies.  In his current work environment he can focus more on patient care and less on the other aspects of practicing medicine.  He claims that physician satisfaction is not based on money, rather a combination of factors that have more to do with patient care and autonomy as a physician.

Dr. Sexton did refer to decreasing number of applicants to medical school.  Although he did not give a specific time period there is data available from 2001-present.  The data over this time period actually shows an increase in the number of medical school applicants from about 34,000 to about 45,000 applicants per year.  Please refer to the data from the AAMC – applicants to US medical schools from 2001-2012. However, I did not find data prior to 2001 and medical school applications may have been down during that time.

Both the cost of medical education leading to extraordinary education debt and decreasing reimbursement for primary care doctors is leading to the decrease in the number of medical students seeking training in primary care fields.  This has resulted in a decrease in primary care providers.  And further, those primary care providers that are changing their practice to concierge medicine are further decreasing the available number of primary care doctors.  This is a recipe for disaster.

About the Author

I am Joshua Lewis, MD, the creator of Discussing Healthcare, LLC and a board certified Emergency Physician who currently practices in the Phoenix, Arizona area. I hope you will gain meaningful insight into our healthcare system through the information provided by Discussing Healthcare. Thank you for your interest and I encourage you to contribute by calling, emailing, or leaving comments on the website.

2 Enlightened Replies

Trackback  •  Comments RSS

  1. Dawn Martinez says:

    Could you consider doing a piece on online physicians, ie. StatDoctors. Does this somewhat tie into the over use of antibiotics, where you are telling the online physician your symptoms & they prescribe without seeing you, except maybe through video screen. Also, costs doctors may save due to not running an office. What kind of care are you really getting for you or a family member. I’d be interested to hear how some physicians feel about online doctor visits.
    Thank you,

    • J Lewis, MD says:

      Dawn, Great question! I will definitely cover this topic in a future episode of the Discussing Healthcare podcast. There are so many issues with obtaining medical care online or over the phone. Many times it is appropriate, but there are certainly times when a healthcare provider needs to lay hands on a patient. Thanks for the question…J Lewis, MD

Post a Reply

Your email address will not be published. Required fields are marked *