Forefront Of High Class Concierge Practices.

On a recent morning, Edward S. Goldberg, an unusually affable internist who bears the look of a scholarly Robert De Niro, sat in his office on the Upper East Side and described the realities of practicing general medicine in the Manhattan of the 21st century. Dr. Goldberg, who also retains a specialty in gastroenterology, opened his practice in 1993 and accepted insurance for the first 16 years. By 2008 his reimbursements for office visits had been, in some cases, reduced to a tenth of what they were in the previous decade, he said. Colonoscopies, which had once rendered him $1,800 per procedure, were now bringing in $350.

Because there has been so much excess in the system, and because American doctors are among the highest paid in the developed world, their complaints about diminishing returns — a strain of grievance that has intensified around the Affordable Care Act — are hardly immediate triggers of our collective sympathy. Median compensation for practitioners of internal medicine was about $210,000 last year.

And yet Dr. Goldberg’s experience illustrates the difficulties primary-care physicians often face in a city where staffing and real estate costs vastly outpace those in the rest of the country. By the time Dr. Goldberg stopped taking insurance in 2009 he had become unable to deliver the level of patient service he aspired to and couldn’t afford to maintain his practice as it stood, he told me.

“I really had nothing left to lose,” he said.

The health care market in New York is sufficiently unusual that members of the affluent classes routinely question the merits of doctors who do take insurance. How could the doctor satisfied to receive a $20 co-pay also be the doctor skilled enough to know that your palm’s itch is really the early sign of something rare and disfiguring? This psychology, along with the cost-cutting strategies pursued by insurance companies over the years, have driven the field of concierge medicine — typically, boutique general practices that charge premiums for enhanced attention. Five years ago there were 28 concierge doctors in the New York metropolitan area, according to the group Concierge Medicine Today, which studies the field. Today there are 124.

In recent years, some of Dr. Goldberg’s patients have made unusual requests that he has obliged. In one instance, when a patient didn’t want to be seen having a colonoscopy, Dr. Goldberg closed his office for four hours to grant her more privacy. Another requested allergy shots at home and another his accompaniment to a stressful M.R.I. where Dr. Goldberg held the patient’s toe to supply comfort.

All of this led him and a new partner, Daniel Yadegar.


About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

No comments yet... Be the first to leave a reply!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: