May 21 at 5:30pm •

The MDVIP ad says “Old-fashioned medicine never goes out of style when you have doctors that really get to know you and listen to you.”

The concept of “old-fashioned medicine” is well known to those of us who are over seventy. That is the kind of medicine we had when we were children.  It WAS marked by physicians who knew you well and who cared about you personally.  But, it was also marked by cost which generally were $1 for an office visit; $1 for a prescription and $1 for a shot.  It was marked by physicians who could not do a great deal for you but their personal care made up for what they couldn’t do.

This professionalism begin to change when doctors who at one time “bartered” for payment – a chicken or vegetables instead of cash for payment – and then with the advent of Medicare they began to be paid for the care they once gave for free.  No one was turned away and the poor and penniless received the same care that the well to do received.  

Entrepreneurism replaced professionalism as physicians began to see how much money could be made by ordering more tests and doing more procedures.  Specialty care became the vogue as physicians realized that the ‘big money” was in procedures.  Medicare which was supposed to cost “x” in its first 25 years actually cost almost 10 X.  The reason?  Entrepreneurism invaded healthcare and supplanted professionalism..  there are other issues technology, more treatment options but none that added cost like entrepreneurism.

In 1979 and more in 2009, doctors began trying to reverse this process with patient-centered medical home care.  It is having an effect, but it is not done by eliminating care for the poor but by expanded care to all.

But just as we have tried to reverse the tide, along came MDVIP and concierge medicine.  Masquerading as patient-centered care, this ultimate expression of healthcare entrepreneurism showed doctors how to work less and make more.  

Concierge medicine even has the hubris to suggest that their entrepreneurial method is a “better” plan of care as if we can’t figure out that if you fire your sick and poor patients that your quality of care measures improve as you eliminate the needy and ill from your practice.

It is amazing how many healthcare leaders, who see the profitability of caring for the wealthy and well, are endorsing this healthcare fraud.  Doctors like the wealthy and patients like being courted by the doctor, but if ever doctor chose this very self-centered – not patient-centered – form of healthcare delivery we would have tens of million more patients who do not have access to care.