Concierge physicians…a bit like home birth midwives
Tonight, Channel 5 of Boston ran a news story about the shortage of Primary Care Providers in the state. They featured Dr. Mark Costa, a Mass General internist who left his Downtown Crossing office to launch a private “concierge” practice out of his home in Newton. His wife, a registered nurse, and he charge a $2,400 annual fee to offer care for an exclusive number of patients and promise 24 hour access and unrushed visits.
“The patients leave here saying this is the best office visit, or best experience that I’ve had with a doctor ever. Because you’re relaxed and I feel completely listened to and taken care of,” said Costa .
Any woman who has used the services of a certified professional midwife for a pregnancy knows exactly what he is talking about. The midwifery model of care is the original concierge health service. A home birth midwife spends an hour with you at each prenatal visit, talking about all of your concerns about your pregnancy, your diet, your feelings about birth, anything you want, and she is available to you at all hours. You know her, and she knows you.
Dr. Costa claims that even though he had over 2000 patients at his former practice, the insurance companies were pressuring him to take on more, to serve them all even less effectively. By coincidence, I was a former patient in that practice several years ago. I recall a horrible visit when I took a $20 cab ride, too sick to drive, to his office, experiencing the worst virus in recent memory. I was shown to a room where I was left and forgotten about. In my sickly state, I fell asleep on the examining table, woke up an hour later, and still, no one had come to see me, so I just left…for good.
Anyone who has had the care of a home birth midwife can see how broken our medical system is when they compare the quality of care to HMO offerings, and sadly, like concierge medical practices, women pay thousands of dollars out of pocket for the privledge of such personal care. I will make an educated guess that the average rate of home birth midwifery services in the Greater Boston area is $4,000.
Medical care disparity is such a problem in this country that I hate to see an increasing trend of elite primary care, but the one upside is that future studies may show better health outcomes for all populations receiving the “midwifery model” of more personal, continuous care.
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