Concierge Mailbag

This week's show on concierge medicine generated a strong difference of opinion from you.  Provital Health & Wellness, based in Calgary is one such clinic. Provital charges paying patients an annual membership fee of $3500.  The high annual fee is usually justified on the basis that the fee pays for unlimited access to dieticians, massage therapists, psychologists and other health care workers whose services are generally not paid for by the provinces.

 Some of you wrote in to express your disapproval for concierge medical clinics. Hit the jump below to read a selection of your comments.

"I have to be honest that I was quite angry listening to your interview with the doctor running the clinic in Calgary. I lived in Calgary for 10 years and had access to a family physician for only 3 of those years. I am quite sure that the surge in private medicine in that city has reduced the number of doctors available to the public. Taxpayers' money is going into the public system, so why should I have to pay a couple of thousand dollars a year to gain access to doctors that should be in the public system anyway?  Unacceptable."  From:  Kathleen Matthews, Toronto

"Privatization CAN'T be the only answer here.  You privatize healthcare, then it's the schools, the police forces and so on.  None of that gated-community mentality is a useful Canadian solution.  I don't want to leave anybody behind, but I don't want to be lying there unable to even dial 911 by myself (as is the case occasionally) with no system in place to support me.  Government: figure this out; balance our legitimate corporate priorities with the needs of real human beings in a fair and equitable arrangement, and stop relying on dogmatic free-market hocus-pocus to magically come up with the answers."  From:  Peter Brown, Toronto

"I am incensed at the notion of concierge medicine.  It does deplete the pool of physicians available to the public health care system.  It is both unethical and immoral, because it amounts to might makes right.  It is selfishness to the detriment of all of us.  It is an example of the general malaise of narcissism that has afflicted North America in the past 15 years or so.  Narcissism is a sickness that tells people so deluded that they are so much more important, valuable, and worthwhile than others that they deserve first consideration.  Yet they demonstrably are not!  The proof is that they think they are.  They should all take a long walk off a short pier.  Thanks for your show.  Never miss it."  From:  Doug Resell, Branchville, Ontario.

 "I found it quite perturbing to hear Dr. Donovan Kreutzer describe the clientele of his $3500 per year clinic as those who have fallen through the cracks of the medical system. Given the price tag, it seems reasonable to assume that only the most affluent members of Canadian society are able to access Dr Kreutzer's services. Since a higher income bracket tends to correspond with better health and greater engagement in matters pertaining to personal health, it is fair to assume that the patients who frequent clinics like Provital are far from being the sickest or most needy members of Canadian society. While medicare is far from perfect, the principles of fairness and equity that are at the heart of the Canadian medical system are also at the heart of the Canadian identity. Clinics like Provital threaten these values, encouraging a two-tier system with inequitable access to important services. While Canadians certainly deserve the best healthcare possible, the exacerbation of systemic health inequalities between Canadians is not the way to bring about necessary change."  From:  Alice Cavanagh, Toronto

"I can see why physicians would think its a good business idea: more money, maybe more time off and the ability to do better work.  My problem is it will become the American system very quickly.  I'm a 50 year old who needs a bypass and limited medical cover.  I may have to refinance the house and arrange for my buisness or job to be taken care of.  If there is a complication and that time goes over, I may have to take legal action or I lose everything I've worked for."  From: Rob Mowrey, Bowser, Saskatchewan.

"I would like to know how much of the concierge medicine you discussed is tax-deductible? I expect that some or all of the $3,500 annual individual fee is being "written off" from the taxes paid by the individual or their companies.  Therefore, private front-of-the-line concierge medicine" is being subsidized by regular taxpayer who don't get to join in the benefits."  From:  Mark Richardson, Toronto.

Some of you wrote to us in support of concierge clinics. 

"Great program on the emerging concierge style clinics.  Both sides made good points.  Doctors and clinics are inundated by the sheer weight of administration; taking doctors out of the system only makes the situation worse suggesting that some sort of middle way needs to be developed.  I'm a user of this style of clinic.  I have two major diagnoses including multiple sclerosis (MS).  There's no way I could get to a walk-in clinic, much less some clinic in the US.  I'm not wealthy, but I've got no choice.  I've got to have more and better access at the GP level.  If the public system can provide me the same level of service, I'd be happy to go that route, since I probably won't be able to afford the concierge clinic indefinitely.  It's ridiculous to suggest that if I want this level of service, I should go to the US to obtain it.  These clinics aren't only for the super-elite; the super-desperate and super-concerned require them as well.  And I'm speaking as someone who has waited in a hallway for over 24 hours while a hospital bed is being found.   I've waited 8 to 12 hours with full-blown MS symptoms in an emergency room, praying that I don't throw up on the chair.  If that's your life, you'll pay whatever you have to, to avoid those situations."  From:  Kevin Cockle, Calgary.

"I'm very appreciative that you addressed this topic on your show.  "Concierge" is not an appropriate label for an alternative delivery of medicine that is being chosen by both patients (rich or poor) and care providers alike.  I find it pathetic that Canadians are being forced to put up with a system that repeatedly fails their health care needs.  We all have numerous examples of failures.  If the government does not allow choice then Canadians should sue the government for failing to provide adequate care given the extremely high cost each Canadian pays.  This has occurred in Quebec and now private care is flourishing as it should while the public system fails. My father died prematurely due to separate diagnoses of melanoma that were not detected by the doctor.   I refuse to allow my daughters to suffer myself, and neither should they." From:  Carol Ramer of Hartington

"I was very interested in your item about concierge medicine.  I do not go to such a clinic; however, I can sympathize with those who do.  Perhaps it is the need for continuity of care.  We go to a Family Medicine Centre in Kingston and have done so for over 35 years.  When we make an appointment to go there, we are always asked the purpose of the visit.  There is always a new resident in training to look after us.  We are asked why we are there, thereby making us feel like a new patient as well as wasting time.  Maybe concierge medicine might afford the continuity of care that patients actually need, regrettably, for the money."  From:   Carolyn Hudson, Kenora, Ontario

"I wonder about the 'all or none' idea with public health care. The policies for doctors seem to be either you're in or you're out. And then, the concern for the public is lack of access to quality specialists who have opted out.  How about a model of care in which physicians choosing to offer fee-for-service be required to provide a certain percentage of their time to the public system, thus potentially making their expertise available within the public system as well.  Would that be do-able?"  From:  Renee Land, Edmonton.

A number of health professionals also contributed their comments. 

"As a family physician I think it's fine that a private practice MD can prattle on about how bad is the public system, while they provide boutique care to maybe a couple hundred high-dollar patients.  Are outcomes better? He didn't say.  What good is it to go to a diabetic's home in the middle of the night when they'll just go to the ER because the house call system that doctors can't set up IV fluids, electrolyte monitoring, or insulin drips. Ditto for chest pain. If waiting ten hours in the ER sounds bad, I tell myself it's better than waiting two to three weeks for a family doctor's visit.  The bottom line notes that these clinics provide an American-style option where you get care when you want it, versus when you need it. They also take publicly funded and trained doctors away from treating larger numbers of taxpayers. Doctors in the public system do a pretty good job, even if they don't fit ideal, sometimes unrealistic patient expectations."  From:  Jon Archibald MD, Peterborough, Ontario.

"I'm a registered nurse in Calgary and I work for the palliative home care program. I listened with interest to your show today, in particular to the thought that some people feel the system is not adequate, so they pay large amounts of money to have access to after-hours health care.  Here in Calgary we have a Home Care Response Team. This team of registered nurses is available to home care patients and their families between the hours of four pm and eight am. For patients on the palliative team, they can phone in and speak to a registered nurse about issues such as pain control, symptoms such as nausea and vomiting, bleeding and end of life issues. We can try to help with some of the issues by phone; if necessary we will go out to the home. We have access to a palliative care physician and an after-hours pharmacy.  So, if symptoms like pain or nausea are not well controlled, we can change the dose, change the drug, or change the route by which it is administered. We will go out to a home where someone dying and held the family emotional support or to help access the funeral home."

Thank you for your many emails. 

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