SILVER SPRING, Md. — Dr. Angela Marshall likes to take her time with patients. She wants to ensure they are seen and heard.
But these days, she feels like she's just trying to avoid the carousel of care that, she says, the health care industry has created.
"When I started in medicine, we would schedule 20, 30-minute appointments," said Marshall, president and CEO of Comprehensive Women's Health. "Doctors have been pressured to see more patients in the same amount of time. And, as those visit times shrink, so does the quality."
The primary care physician said it's not only the patients that are suffering in this model.
"Think about how stressed you are when you're behind for a meeting," she said. "Feeling that all day, every day is, you know, really tough."
Dr. Marshall said appointments that she used to schedule for 30 minutes have shrunk to half that time, leading to health care inequities that she writes about in her book, "Dismissed."
"Quite honestly, I'm convinced it's really impossible to give great quality care in a 10 or 15-minute visit," Marshall said.
So, Dr. Marshall turned to concierge medicine, a growing trend among health care providers. According to experts, the number of concierge practices in the U.S. are hard to track. But, in 2021, the trade magazine Concierge Medicine Today put the number of concierge medical offices at around 12,000 and growing.
So, what is concierge medicine? It's a boutique model that promises to give patients 24-7 access to their doctors, day-of-appointments and longer visits. Patients pay for a yearly membership out of their own pocket. The fees can range from $1,500 to $10,000.
Marshall admits to being skeptical of the concierge model at first.
"I felt that concierge care would be kind of like care for haves without regard for the have nots, and I'm a very big supporter of health care access," the doctor said. "I thought being able and using insurance, would promote access. But the reality is that model, because there's such a shortage of primary care doctors, and such demand in need, that didn't represent a scenario for good access, because patients couldn't get in to see me. They had to wait, because there's so many people that needed to be seen."
With concierge services, patients still need insurance to cover medical screenings, prescriptions, hospital stays and other medical procedures.
"The episodes of primary care reimbursement are just paltry compared to the effort that it takes to keep people healthy," Marshall said.
Claudia Tellez is with the Medical Society of Northern Virginia. She's compiled a report that highlights the disparities in reimbursements between hospitals and private practices. One example showed how doctors' offices receive between $600 to $900 less for the same service.
"I see concierge medicine really as a symptom of what's happening in the health care delivery system with all the regulation, shrinkage of reimbursement for physicians," Tellez said.
Dr. Soheila Rostami is a physician and a patient who followed her doctor when she moved to concierge medicine to spend more time with patients and supplement the costs insurance won't cover. Rostami pays a $2,000 annual membership, a fee she admits is out of reach for many.
When Dr. Rostami was asked if doctors are making the decision to transition to a concierge practice to survive while leaving some patients behind she said, "You have to undersand they're not trying to leave the patients behind."
"It's something that we've resisted doing for the past 10 years," Dr. Marshall added.
Marshall said she knows not all of her patients will be able to afford the yearly membership fee, so she's come to a compromise. Nurse practitioners and physician assistants will continue to see patients in her traditional practice, while she focuses on concierge medicine.
"Concierge medicine, I hope, is a temporary fix, because I hope that we will fix this health care system so that primary care is supported the way it should be," Marshall concluded.