Gabriel Scott

Dec. 4th, 2014

Masters Colloquium
Retainer Medicine Analysis
Should doctors be held to a higher standard concerning health care for
society as a whole? This question is at the heart of the debate in regards to retainer
medicine. Retainer medicine is essentially a business model by primary care
physicians that offers luxury primary care visits at a fixed expense. Patients still
need to have insurance but because most services are covered under the retainer
medicine plan these patients can opt for buying lower cost, high deductible
insurance. The business model offers advantages for the primary care physicians
involved as well as their patients, however, adds increasing disparity to the
underprivileged with low access to healthcare. Hence, bringing us back to the
original question, is it the individual physicians responsibility to help alleviate
health care access problems?
Two physicians, Huddle and Centor, have argued that this problem falls onto
the hands of the government and health care organizationsi. This argument however
is nave and it trivializes the power that individual physicians have politically and
their responsibility to use that influence to help enforce improvements to the health
care system. Working within the confines of a broken system to allow yourself
benefit does not absolve you of moral and ethical responsibilities. Unless we wish to
define ethics as rules established by law and organizational guidelines, then it is not
a compelling argument to push the blame of unethical practices on institutions
higher than the individual. This is not to argue that government regulations and
health care organizations dont need to improve and help define the roles of the
physician in health care access, but regardless of those changes there lies an
inherent ethical responsibility at the individual basis of health care providers.
While physicians should be able to model their practice as they see fit, they
are also on the front lines concerning problems with access to health care.
According to a study in 2011, 31% of physicians were unwilling to accept new
Medicaid patientsii. Also, the Kaiser Family Foundation states that 30% of uninsured
patients went without needed care each year due to costiii. With rates this high
affecting patient care, should primary care physicians feel no obligation to help? It is
unfair to place the weight of these decisions on individual physicians, however,
physicians should be fighting for better government oversight in regards to this
matter instead of practicing in business models that merely act as a bandage to a
much larger issue. Retainer medicine adds short-term incentive to primary care
physicians and a wealthier patient subset, but how long is this practice sustainable
before the lack of health care access for impoverished patients becomes so great
that it brings the health care system down with it. At a certain point, government
officials will need to step in if the health care disparities continue to increase and
this will possibly be in ways harmful to the livelihood of future primary care
physicians.
This is why it is imperative to act on this issue now. Primary care physicians
should work as a whole to force higher payment reimbursement for their provided
services. This is not the time to fragment primary care physicians into those willing
to care for the underprivileged and those who only care for those wealthy enough to

Gabriel Scott
Dec. 4th, 2014
Masters Colloquium
Retainer Medicine Analysis
afford those services. Instead physicians should band together and use their political
influence to start improving the system which all physicians are part of. What
physicians need is to gain a strong lobbying group. As physicians, taking time to play
a role in political lobbying is sometimes seen as unfeasible due to the already hectic
schedule of the day to day physicians duties. However, without actively striving to
achieve change, it is unlikely that it will occur on its own. It is a necessary burden
that physicians will have to bear in the short term, in order to achieve long term
benefits.
If physicians feel the need to enter into the model of retainer medicine, it
should give them additional motivation to use their extra time to help provide a
long-term benefit scenario for all physicians, including those who choose to care for
patients who cant afford retainer services. Physicians are stronger as a team than
solely as an individual, and it will take the power of numbers to create the change
needed to improve health care not only for physicians in the profession but also for
society as a whole.
i

Huddle, Thomas S., and Robert M. Centor. "Retainer Medicine: An Ethically Legitimate

Form of Practice That Can Improve Primary Care." Annals of Internal Medicine 155.9
(2011): 633. Web.
ii

Decker, S. L. "In 2011 Nearly One-Third Of Physicians Said They Would Not Accept New

Medicaid Patients, But Rising Fees May Help." Health Affairs 31.8 (2012): 1673-679. Web.
iii

"Key Facts about the Uninsured Population." Key Facts about the Uninsured Population.

Kaiser Family Foundation, 29 Oct. 2014. Web. 03 Dec. 2014.