The Need For Concierge Medicine

Concierge Medicine & The Lion King: “Simba, it is time…”

It is indeed a dark time in medicine. Nature is out of balance. The wrong species are in charge. The pride lands – once ruled by medical giants – are now barren. Internists are now nonexistent in the hospitals, a place where they once roamed free. Similarly, the strong and proud general surgeons are all but extinct. In their place is a group of complacent, demoralized, cubs – the emasculated sons of warriors - who willingly accept the rule of the hyenas. 

I was a pioneer in the concierge medicine movement. I opened one of the first concierge medicine practices 10 years ago. I could not accept the mandates of the bureaucrats of Medicare, the pack predators of the HMOs or the crony-capitalism of big insurance and big government. I opted out. 

The weak and politically correct lions in my medical community were initially very critical of my independence and autonomy. I was publicly scolded for “pandering to the rich”, as they participated with unethical third-party payers to ration care for their patients, lining the pockets of the HMOs…all to protect a guaranteed income stream. I was described as mercenary and selfish for contracting directly with my patients, as if this were somehow violating the ethical gold standard set by United Healthcare, Humana or Senator Pete Stark. I was assailed by one academic physician on the front page of the Arizona Daily Star stating that what I was doing was, “boutique medicine at its mercenary worst.” 

In my opinion, much of the destruction of medicine has been due to an epidemic of acquired hypogonadism among doctors. Perhaps more accurately, it has been a peculiarly, voluntary castration. The present distortion in the medical food chain is due, in large part, to the complacency of doctors.

Many physicians share the same pitiful attitude of Simba in Disney’s The Lion King. Just listen to the whining that goes on in every doctor’s lounge across the country. Instead of taking their rightful place as medical leaders in the circle of life, they have indulged in self-pity, viewed themselves as victims, and hidden behind a false pretense of “humanitarianism” – as if it is somehow humanitarian to cede control of their profession to others. Somehow, it is “caring” to accept the absurdities of ObamaCare, work for Medicare or Medicaid or have a clerk at an HMO tell you that the MRI of the brain that you ordered for your patient is unnecessary.   

The future of the pride lands is now at stake. Clearly, ObamaCare will not save medicine; it will only hasten its demise. However, ObamaCare may have the unintended consequence of causing physicians to wake up. In this current landscape, dominated by medical hyenas, I would argue that Mr. Obama is very much the “Scar” figure. He is an agitator and a manipulator, who has overpromised to his opportunistic pack. He has no skill set upon which to turn his words into reality. He has promised all the hyenas – the trial lawyers, the insurance companies, the big unions – that he will create great prosperity for them all. And yet his most transparent act of “audacity” has been to pretend that you can “reform” healthcare, without even considering tort reform. Obamacare will ultimately fail, but it will cause much suffering until it is repealed. 

To the disenfranchised, Obama has demonized those of us who have given countless hours of free medical care to the poor during our careers. He has said that he will wrestle power from the greedy doctors…you know…those surgeons who would rather “amputate a leg for $50,000 than prevent the diabetic foot ulcer from occurring in the first place.” (Remember that gem?) 

As medical care and resources become rationed and scarce, all of the hyenas –even those who put Mr. Obama in power - will become disenchanted. Obama will ultimately share the fate of Scar.  He will be eaten by his own…the pack-predator brethren who put him in power. This is the nature of the rise and fall of the Scars of this world. It is all a part of the circle of life. It is a simple enough concept for Disney to explain to small children. 

When that day of reckoning comes, and the medical pride lands have been completely scorched, it will be time to rebuild. It will be then that doctors should heed the words of the wise Rafiki: “Simba, it is time.”   The only people who will have the expertise to rebuild medicine will be the doctors. Time will tell if they will be up to the task. To do so, they will need to find the strength to be leaders, and if necessary, they will need to find the strength to become warriors. 

The best method to restore the doctor-patient relationship and physician autonomy will be a movement toward private practice. Medicare and Medicaid will ultimately perish. In truth, they are already dead.  There is no Medicare trust fund. All of the money that was supposed to be put into the fund has been spent. Medicare is now just part of the mounting national deficit. 

The hyenas of the HMOs and insurance giants must get a clear and consistent message from physicians.  This message should be contained within a single, powerful word: “NO!”  No, you will not dictate the nature of my practice. No, you will not be the unwelcome middleman any longer. No, you will not tell me what tests to order, how to practice medicine or how much I will be paid for my services. Go back to your pack or be killed. Tell the other hyenas that your reign of terror is over. You may sell insurance plans to patients if they desire to purchase them in a free market, but that will be a relationship between you and the consumer. It will not involve us. If you choose to challenge us for control of medicine again, there will be no negotiations. The lions have returned to their rightful place in medicine. And we will do whatever is necessary to protect ourselves, our patients and our freedom. 

There is no contradiction in a healer being a warrior. Many famous physicians throughout the ages have also been martial artists. There are times where war – be it literal war or political warfare – is the only solution. Leadership, by its very nature, sometimes involves going to war. Leadership, by its nature, cannot be founded on pacifism.