David D. Leonard, MD, FAAFP
Kathleen T. Crane-Lee, MD

3911 Old Lee Highway
Suite 41-C
Fairfax, Virginia 22030
703-352-7100 Phone
703-539-8579 Fax
    

Why Concierge Medicine

"David D. Leonard, MD 1/20/2015 Abridged version"

Why I Opted to Upgrade My Practice to a Concierge Program:
First, I want to give a heartfelt thank you all for being such wonderful patients who have given me such professional joy and satisfaction over the past 25 plus years.

As the storm clouds gather over the private practice of medicine, many independent primary care practices are closing. There is increasing government regulation, rising costs, declining revenue, escalating paper work, and annual Medicare cuts to physicians. In our healthcare system there is an increasing shortage of primary care physicians—especially those of us who have a subspecialty in geriatric medicine. There are less than 7000 board certified geriatricians left practicing in the United States with an estimated demand for over 36000 to care for our aging population. The US is training less than 300 per year. Most geriatricians practice in academic settings as it is becoming economically not feasible for them to practice independently.

There is also an uneven economically playing field in medicine with large corporate-based and hospital-based practices having an advantage due to economies of scale. Smaller private practices are rapidly becoming extinct as many physicians are retiring prematurely. Other private practices are desperately seeking shelter in the storm by being bought out by larger organizations.

To continue to work for you and survive, our practice needs to adapt to the rapidly changing healthcare environment. Under the present conditions the future of our practice is grim and it will only get worse. I have no choice but to change my practice business model or I will have to close its doors. The system is at its breaking point as the economic model does not support small independent primary care practices. What worked 10 or even five years ago does not work now.

What are my options? I could sell my practice to the highest bidder and lose my control over how my patients are cared for. My hands would be tied and I would be forced to see a patient every five to seven minutes. I am not interested in retiring as I enjoy practicing medicine. I could hire five or six nurse practitioners and just supervise them. I am not interested because that would take me away from direct patient care.

After much study, I choose an option which allows me to maintain my independence, continue to work for you, spend the necessary time to properly diagnose and take care of patients the way I was trained. I desire to continue to be proud of the medicine I practice.

That option is to offer my patients a concierge program to provide enhanced services to its members and allow me to continue to deliver the highest quality of medicine possible. Many of you have suggested I do this and have expressed enthusiasm for the idea. This program will have numerous benefits to member patients.

I do this program with mixed emotions and a heavy heart. In order to maintain the highest standards of excellence, I will devote my full energies to this program and cap the concierge practice to a maximum of 600 members. There will be a waiting list above that amount. This program is offered to all patients on a first come basis. If you do not join, you will not be abandoned. You can still be cared for by the practice, but will have to see one of the other providers.

Let me finish by saying I am very enthused about this program as it will help the practice to weather the coming storms and allow us to provide high quality medical care to all of our traditional patients. For patients in my concierge practice, I will provide personalized outstanding care to them for many years to come. Thank you.

"Heading David D. Leonard, MD 1/20/15 Long version"

Why I Opted to Upgrade My Practice to a Concierge Program:
First, I want to give a heartfelt thank you all for being such wonderful patients who have given me such professional joy and satisfaction over the past 25 plus years.

The purpose of the letter is to inform you of upcoming and necessary changes in my practice which many of you have been requesting for some time. I want to be clear that none of our patients will be asked to leave our practice if they do not join our program. The Concierge program will be available to all patients in our practice. I am pleased that Dr. Crane will also be offering this program along with me.

As the storm clouds gather over the private practice of medicine, many independent primary care practices are closing. There is increasing government regulation, rising costs, declining revenue, escalating paper work, and annual Medicare cuts to physicians. In our healthcare system there is an increasing shortage of primary care physicians—especially those who have a subspecialty in geriatric medicine. There are less than 7000 of us board certified geriatricians left practicing in the United States with an estimated demand for over 36000 to care for our aging population. The US is training less than 300 per year. Most geriatricians practice in academic settings as it is becoming economically not feasible for them to practice independently. The American Health care system pays doctors more for performing procedures or (actions) while it pays less and devalues the time in conversation (problem solving) spent with patients. The elderly patients simply have more complex medical problems which take more office time to properly diagnose and treat. Many geriatricians are doing some of the most complex patient care yet getting reimbursed the least.

There is also an uneven economically playing field with large corporate-based and hospital-based practices having an advantage. There are economies of scale. Smaller private practices are rapidly becoming extinct as many physicians are retiring prematurely. Other private practices are desperately seeking shelter in the storm by being bought out by larger organizations. This may give those doctors a sanctuary; but it comes at a steep cost for both the physicians and their patients.

WHY? What is wrong with being part of a large organization? Because the physician who is owned must now follow the guidelines imposed on him and his practice. He is told what medicines to prescribe, to whom he can refer to, and which tests and labs he is allowed to order, and the number of patients he needs to see per hour. He is no longer able to work for his patients. Instead, he works for the company which now employs him. There has been a major shift in medicine where the focus of care is no longer on the individual patient but more on taking care of a population as a whole. Controlling costs and rationing care has become a top priority -- to the detriment of individual patient’s health.

AS your personal physician, Let me make this clear: I did not devote my life learning and practicing my profession to have your health care dictated to me by the government or by an insurance clerk or by an accountant who has no idea who you are and does not care what happens to you!! I am your patient advocate and work with you to navigate through a complex sometimes frustrating medical system.

There is one question that patients should ask their physician: Who do you work for? It is a simple question: Who do you work for?Let me answer that question. First off, I do not work for United Healthcare. I do not work for Aetna. I do not work for CIGNA, I do not work for Medicare, I do not work for Blue Cross and I certainly do not work for Kaiser. I do not work for any insurance company. I work for you.

To continue to work for you and survive, our practice needs to adapt to the rapidly changing healthcare environment. Under the present conditions the future of our practice is grim and it will only get worse. I have no choice but to change my practice business model or I will have to close its doors. The system is at its breaking point as the economic model does not support small independent primary care practices. What worked 10 or even five years ago does not work now.

What are my options? I could sell my practice to the highest bidder and lose my control over how my patients are cared for. My hands would be tied and I would be forced to see a patient every five to seven minutes. I am not interested in retiring as I enjoy practicing medicine. I could hire five or six nurse practitioners and just supervise them. I am not interested because that would take me away from direct patient care.

After much study, there is only one good option which allows me to maintain my independence, continue to work for you, spend the necessary time to properly diagnose and take care of patients the way I was trained, and continue to be proud of the medicine I practice.

That option is to offer my patients a concierge VIP program which will provide enhanced services to its members and allow me to continue to deliver the highest quality of medicine possible. Many of you have suggested I do this and have expressed enthusiasm for the idea. This program will have numerous benefits to member patients.

I do this program with mixed emotions and a heavy heart because in order to maintain the highest standards of excellence, and back up my firm commitment to this program, I will devote my full energies to this program and have to cap the concierge practice to a maximum of 600 members. There will be a waiting list above that amount. This program is offered to all patients on a first come basis. If you do not join, you will not be abandoned. You can still be cared for by the practice, but will have to see one of the other providers.

Let me finish by saying I am very enthused about this program as it will allow the practice to survive. It strengthens the overall practice so it can weather the coming storms and continue to provide high quality medical care to all of our traditional patients. For patients in my concierge practice, I will provide personalized outstanding care to them for many years to come. Again I invite you to join. Thank you.
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