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Barriers to access have always been a problem in healthcare.
Here at Peptide Partners Corner, we’ve reported not only on changes in doctor-patient interface post-COVID but popular enthusiasm for wellness and longevity treatments that fall outside the remit of traditional medical care — not to mention outside the narrow scope of procedures that are billable to insurance.
What we’ve observed is information that probably won’t be new to you: our healthcare system is an ailing behemoth jammed up by an outsized demand for a limited number of doctors who are constantly de-incentivized from remaining at in-network clinics. Access to doctors is difficult to come by and limited when you do; doctors are severely limited in the treatment they can provide to patients (a 15-minute window and a simple set of blood tests will have to suffice); patients experience ongoing complications from ineffective treatments; doctors experience burnout and consider leaving the profession altogether.
It’s no wonder that more and more primary care physicians are turning to the concierge medicine and direct primary care models: they allow for more time with patients and actual supervision of ongoing care as well as higher wages for physicians who feel they’re at risk of crashing and burning from the unsustainable model of the in-network clinic.
But this also raises a very important question of access. Who are the individuals who can afford a monthly subscription service to a direct primary care physician, or a physician kept on retainer for a handsome fee? These are unlikely to be the same uninsured individuals currently struggling to make the $300 out-of-pocket payment for a single emergency room visit.
A recent essay in The Cut reported that while many doctors see concierge medicine as the difference between practicing medicine with a more limited group of patients versus not practicing medicine at all, many in the field also see concierge medicine as a violation of medical ethics.
“What is the meaning of the doctor-patient relationship if it can be terminated so abruptly, and for such coarse reasons?” Troy Brennan MD wrote in a 2003 op-ed about concierge practices in the Journal of American Medicine. “I do get paid for caring for [my patients], but I care for them because I enjoy being a doctor.”
Does concierge medicine present a further barrier of access to care for individuals in need? Is it the wave of the future, something that could eliminate the cracks in the network insurance system that millions are helplessly slipping though? Or is it something else altogether?
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What will healthcare look like 20 years from now?
There is much to speculate about when it comes to American healthcare and our increasingly derelict insurance system. It’s common knowledge that we’re falling disastrously short of the idealized, developed world goal of quality healthcare for all. This is not just because all who want it cannot afford healthcare under the current model, but because even those who can afford it are not always guaranteed quality care given the time and resource limits currently imposed on primary care physicians by the insurance system.
It’s easy to imagine a future similar to that of the recent Scrubs reboot, where concierge physicians attend to the ailments (real and imagined) of the ultra-wealthy while the masses are left to struggle with insufficient care. In such a world, popular access to medical care would rely on the integrity of the primary care physician: us normals would only get the benefit of seeing a doctor if she experiences a Troy Brennan-like crisis of conscience, quits tending to the petty rich, and returns to the world of medical insurance and burned-out physicians.
But what if there’s a different world where concierge medicine could incentivize a restructuring of the entire medical profession? What if doctors making individual house calls could mean a higher-quality, community-based standard of care that would eventually allow for sliding-scale patient fees and local clinical work to treat those unable to afford sliding-scale fees?
And what if, under this model, those who can purchase concierge care at the highest level are also purchasing medical and biotech research over which the researchers are free to retain complete intellectual sovereignty?
Perhaps this sounds like a pie in the sky set of ideals for a sector that has already fallen prey to scarcity, urgency and self-interest within the current paradigm. Why should any of us believe that we as private individuals could usher a collapsed system into a better era through the power of intention alone?
It’s a fair question, and though we at Peptide Partners Corner have no definitive answers, we do have robust evidence that the current system isn’t working. We have medical patients turning to telehealth, direct to consumer pharmaceuticals, and compounding pharmacies en masse. We have a major resurgence of interest in alternative medicine — including wellness practices from over a century ago — and patients who are willing to travel fair afield of the clinic to shady Reddit threads and Discord group buys in pursuit of treatment.
We’ve already seen how market demand for alternative treatments can galvanize research interest and even shape regulatory decision-making. Can market demand for good healthcare incentivize a private system with vastly expanded access? Will more clinics be able to open their doors to more patients when treatments are more effective and comorbities and chronic complications less prevalent?
It’s hard to say, but there’s one thing for sure: the American healthcare system might as well change, because it’s got nothing to lose.