This article yesterday got me thinking about what boutique or concierge practice membership costs, and whether those fees are worth it.

I decided to play around with some numbers.

Let's imagine you, the Sick-of-slaving-for-peanuts newly-minted Concierge Doc, decide to levy an annual fee on your patients, to provide them with same day access, round-the-clock service and satisfying appointment lengths.

You decide to charge adult patients $2500 a year as a membership fee.

Which is $208 a month.

Or $6.85 a day (a latte plus croissant? A burger and fries for lunch? Or a pack and a half of cigarettes?)

Now let's imagine a typical patient who elects to become a member of your practice and who earns $50 an hour (an average). And this patient sees you 6 times a year for mild hypertension, a slightly elevated cholesterol and weight that is 20lbs above ideal body weight for age. Plus you do an annual physical in January based on age-appropriate screening history, exam and tests. So that is 7 visits a year.

You see this patient immediately on arrival at your office, instead of him or her having to wait 45 minutes for Dr. Tortoise 3 blocks away. And the EKG/labwork/check-out process takes 10 minutes (averaged out over the year) instead of 30 over at Dr. T's.

This produces an effective annual savings to the patient of $379 (45 +20 minutes = 65 minutes x 7 visits = 7.6 hours, times $50 an hour of lost earning time = $379).

And I haven't even figured in the savings to your patient of time not having to spend on the phone locating the on-call doctor who doesn't know anything about him or her. Because remember, you've given your home and cell phone number to your members and they can call you directly.

And neither have I figured in the savings of avoiding going to the local Urgent Care Center after hours when Dr Tortoise's covering doc recommends it. Because many of you meet your needy patients in your office after hours, or you even (heaven forbid) make home visits!

So the daily cost of having this kind of access is now reduced to less than $5.85, even without adding in the other big time savers ($379 savings divided by 365 days is just over $1 a day).

Now I ask myself - How much money do I waste in a typical day? On extra toys for my daughter, or another pair of shoes, or food that gets thrown out at the end of the meal, or water that runs too long, or lights that don't get turned off after leaving the room? I bet it exceeds $5.85 a day.

And then there are reputable practices like Qliance in Seattle that are truly pushing the envelope and are charging as little as $79 a month for patients 65 and older (down to $49 for patients 0-19 years of age) for comprehensive care. Who says concierge medicine is for the elite!

Of course, there is a monkey wrench you could throw into my argument. It's the big cost-of-time factor that I haven't addressed - the cost of your patient's time, having to spend 30-60 minutes per appointment with you, receiving your thorough attention and care, instead of their usual 7.5 minutes with Dr. Tortoise. Maybe they are wasting too much of their productive earning time learning how to eat well and exercise, or why taking medications correctly matters.

Is this math way too hard for the average patient? Or is it just that giving up the daily Jamba juice or Pinkberry yogurt in exchange for personalized health care is just too much to ask of anyone? 

BTW - I don't have a bias towards any particular kind of care. I just have a bias against folks who complain when asked to pay for this kind of access they keep whining about not getting. I also don't know too many of them who are earning the $15 or $20 an hour Dr. Ron Sroka of Maryland claims he is working for!

How about you?