So my PCP is going concierge

Just got a letter from my PCP: This summer he’s dropping all insurance and is going pure-concierge, $1800+ a year.

I understand his frustrations - in fact my previous doctor at the same practice left health care entirely and became a freakin’ FOREST RANGER to get away from the rat race of not having enough time to spend with his patients.

But I’m left wondering what to do. I already see a really good Endo every 3 months. I’ve had a little catalogs of specialists (cardio, two eye doctors, orthopedist) that have me in their systems in the past couple years. I was only seeing the PCP once a year for a physical, and also his office was my first point of contact on non-diabetes things (for example pre-op physicals) which are rare but maybe will be becoming increasingly common.

And my PCP almost always deferred to specialists on everything anyway.

I really like the PCP, but $1800+ a year when he defers me to specialists for everything under the sun to begin with? But maybe if I was paying him $1800+ a year he would actually start coordinating like I thought he should? With T1 for 40 years, who knows what complications might be coming up?, a whole lot of cardio risk factors, and a number of other aches and pains, maybe it is the right thing to have a doctor on call for the big price tag.

I’m a T1 for 40 years and feel like I just was getting the hang of the medical system and who I should call for appointments and when. Heck I was just getting the hang of calling a doctor and asking for an appointment. Imagine what folks with less experience with the medical system feel when they get dropped by a doctor.

The alternative I guess is to start cold-calling other practices to see if they are taking new patients. Here coming out of winter covid season is NOT A GOOD TIME to try this because pretty much zero practices are taking new patients to begin with (I know, I tried to find one who could see my adult daughter over several months in the winter).

Is it reasonable for me to only see specialists without a PCP? Will the specialists be OK with that? Nominally the PCP was supposed to be coordinating all the specialists but I don’t feel the PCP practice was really doing that.

Thoughts? Is it a thing anymore, to ask my endo to essentially be my PCP? Things used to work that way for me almost half a century ago but I don’t know if that’s something that’s done in today’s super-specialized world.

Talk to your endo and she if she/he is comfortable being your PCP as well. Mine says she’s the only doctor some of her patients see, so she orders the annual blood tests. The lab my PCP uses prints each result on a separate sheet of paper, which generates a ton of paper, which I don’t like.

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I would call around and get a new pcp. You don’ t need one right away but some may have cancellations for new patient visits. Until then you can go to walk in clinics for things you would normally go to pcp for. If your endo will do it then do that instead maybe.

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I would also look for a new pcp. Good luck. Nancy50

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@Tim12 my 2c: it’s in your interest to have a PCP. If you don’t want to stay with your now-concierge dr, a few ideas:

  • survey local friends / family for PCPs that they have and like; call to see if they’re taking new patients
  • find out if your drs within your current PCP’s office are staying and have availability
  • join your local Facebook “parents” group (or NextDoor) and ask for recommendations there

I am finding that although I have a PPO and don’t require referrals for specialists, some are still asking for referrals from my PCP, I guess just to be sure that I actually do need the appointment with them?! This business is incredibly frustrating and I’m sorry that you’re out a good doctor. (My family was in a concierge practice for a brief period (when my husband’s company paid for it) and while there were some benefits to it, I never would have used my own funds to pay for access to that network and that especially holds true for people who already have relationships with specialists relevant to their health.)

Good luck! Jessica

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@Tim12 ;

My PCP “went concierge” several years ago … and I didn’t consider following.

I think that a lot depends both on your insurance, the size of the practice with whom your PCP is affiliated, etc.

As I recall, even though it wasn’t included in the original concierge letter, my PCP had a list of other PCPs that had agreed to take some of his load. Plus, as I recall, because it was something of a “ forced transfer”, it didn’t have to meet the accepting new patients criteria.

This was all in a sizable clinic, so your experience may vary …

I am now getting better care and managing T1 better than I was. My original PCP never suggested I see an endo, consider CGM or a pump. I’m much happier now!

Best of luck.

John

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I don’t think I would pay for a doctor that I was unsure of the care? If I really liked the doctor got along with them really well and could afford it, I might.

But you probably need a pcp or an internist. Look at it this way, my dogs were playing chase and one 45 pound dog ran directly into my knee and sent me flying. I could barely walk and went to emergency who did x-rays and said nothing looks broken but follow up with your doctor in a week as you might have soft tissue damage…

If you didn’t have a pcp who would you follow up with that would order the tests that might be needed? Probably an ortho, but a knee ortho and I suppose your other ortho might be able to tell you who to go to by e-mail but…and an ortho is mostly for surgery, what if you wanted to try physical therapy first? The pcp is usually the one that sends you there too.

So you probably need a pcp or an internist.

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Over time, a PCP will become more and more important. My PCP is useless from a medical point of view but I need him for the rare cases that a referral is required. Additionally, as tests and procedures can more and more be ordered directly by an individual, many places will require a PCP to send the results to. I get periodic CAC scans which I order and pay for myself, but no institution in Massachusetts that does these scans will give you the results. They require that the results go to a PCP and the PCP forwards them to the patient, even though no referral is required for the scan.

I know in some states, this is not the case so like diabetes, your mileage may vary.

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My PCP went the same route BUT had a NP who took over his non-concierge patients with him monitoring. I chose to find a new PCP who is next to useless but can help if I have the flu or need something similar. What wonderful healthcare is for the wealthy here in the USA.

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My PCP went concierge several years ago, but brought in another PCP part time to continue on with patients who wanted to continue using insurance. This doctor happened to be good. When he left that practice to devote full time to his own, I just started going there. So I got lucky.

I know some PCPs think they can manage diabetics, but really a good Endo is going stay more up to date on new meds, devices and procedures than PCPs. I would ask around and make calls. Hopefully you will come up with someone who does a decent job as PCP.

I have to find a new PCP and endo this year due to insurance. I did not mind losing the PCP but I was so upset about needing to look for a new endo. My old PCP did not listen, rushed everything and pretended I didn’t have Type 1 because she knew nothing about it. I was running out of my thyroid medication so I finally made an appointment with a new PCP. First thing she said to me was “You have Type 1 diabetes? You’re going to have to find someone else to treat that because we’re not equipped to handle it here”. At least she was honest!

I always found it much easier to get a PCP appointment than an endo appointment. Generally endos are booked 3 months in advance where I am. So if you have something urgent like an ear infection it’s good to have a PCP so you can be seen and treated quickly.

Hi Tim12,
I know your predicament. Been there. My PCP of many decades went concierge several years ago. I loved him, did not want to change docs, but the $1800 in addition to insurance was not in my budget. Yes, the annual fee did not eliminate insurance. I also had 8 specialists so my PCP was only for once in a while and annual check ups. I signed up with his concierge program just until I could find a replacement. Well, many years later, I still had not found a replacement. Then, my 40 year relationship with my PCP, came to an abrupt end last June when he died suddenly and unexpectedly.

My endocrinologist agreed to treat me “temporarily” as a PCP but only until I could find a new PCP. He refilled my non-diabetes scripts for 6 months but kept pushing me to find a new PCP soon. My insurance company was pushing me to find a new PCP, too.

That proved to be a much more difficult task than I had expected. It shouldn’t have come as a surprise because I was paying that concierge fee far longer than anticipated for that very reason, . . . I had not found a new PCP.

My endo refused to refill my scripts for non-diabetes meds any longer. I finally settled upon a new PCP in February. I met with him and brought my medical records and hope that my interactions will be minimal but I now have someone “on record”. My new PCP knows most of my specialists and is willing to coordinate and work with them for my care. I think he is relieved that his role will be to take care of some minor issues that could arise and the difficult stuff will fall upon my specialists.

Good luck with your search. You really do need to have a PCP at least on the record. No one will ever be able to replace my PCP of 40 plus years. He was one of a kind.