Physicians in retainer ("concierge") practice. A national survey of physician, patient, and practice characteristics.
BACKGROUND
Retainer practices represent a new model of care whereby physicians charge an up-front fee for services that may not be covered by health insurance. The characteristics of these practices are largely unknown.


METHODS
We conducted a cross-sectional mail survey of 144 retainer physicians (58% response rate) and a national random sample of 463 nonretainer physicians (50% response rate) to compare retainer and nonretainer practices. Outcomes of interest included physician demographics, size and case-mix of patient panel, services offered and, for retainer practices, characteristics of practice development.


RESULTS
Retainer physicians have much smaller patient panels (mean 898 vs 2303 patients, P<.0001) than their nonretainer counterparts, and care for fewer African-American (mean 7% vs 16%, P<.002), Hispanic (4% vs 14%, P<.001), or Medicaid (5% vs 15%, P<.001) patients. Physicians in retainer practices are more likely to offer accompanied specialist visits (30% vs 1%), house calls (63% vs 26%), 24-hour direct physician access (91% vs 40%), and several other services (all P values <.05). Most retainer physicians (85%) converted from nonretainer practices but kept few of their former patients (mean 12%). Most retainer physicians (84%) provide charity care and many continue to see some patients (mean 17%) who do not pay retainer fees.


CONCLUSIONS
Despite differences between retainer and nonretainer practices, there is also substantial overlap in services provided. These findings, in conjunction with the scope of patient discontinuity when physicians transition to retainer practice, suggest that ethical and legal debates about the standing of these practices will endure.
Alexander
G Caleb
GC
Robert Wood Johnson Clinical Scholars Program, The University of Chicago, Chicago, IL 60637, USA. galexand@uchicago.edu
Kurlander
Jacob
J
Wynia
Matthew K
MK
D001294:Attitude to Health; D003266:Continuity of Patient Care / Q000191:economics; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups; D005251:Fees, Medical; D005260:Female; D005382:Financing, Personal; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D011216:Practice Management, Medical / Q000191:economics* / Q000941:ethics / Q000331:legislation & jurisprudence