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| Letters to the Editor |
Astral Projections
11/01/2005
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Substance over Style
Dear Editor:
I am writing in response to the feature article entitled “Concierge Medicine”
(July 2005). While we applaud Dr. Howard Maron’s ingenuity and
innovation, it was his elitist practice model (MD2) that led to the
media-generated nomenclature (concierge, boutique) that inappropriately
stereotyped all dialects of the original concept. Furthermore, we successfully
developed what was thought to be the first non-transitioned, retainer-based
practice in the United States, avoiding any perception of patient abandonment.
As such, it is reasonable to consider a more accurate, and less biased, global
reference to this method of health care delivery: Membership Medical Practices
(MMP).
 If research in the future validates recent pilot data, then care quality in MMPs
might objectively justify their existence. Similarly, while there are definite
levels of intellectual and practical capabilities that must be maintained by all
physicians, it is unfair to make claims that physicians within these settings
have diminished skill or knowledge. There is no evidence that physicians
practicing in low-volume settings have less favorable success with specialty
board testing or are responsible for more medical errors. In fact, it may be
argued that practicing within a more manageable environment allows physicians to
more efficiently utilize their knowledge and skill, rather than often serving as
a triage depot constrained by the demands of volume. It is also inaccurate to
assume that these physicians care for only healthy individuals, since a large
number of medically complex persons migrate to these practices because of
previously unmet health care needs. While being subjected to more patients may
increase exposure to pathology, it may restrict a practitioner’s ability to
intimately follow and actively participate in many aspects of a patient’s care
or perform procedures due to time constraints. Importantly, it is primarily the
health care system that is responsible for the deficiencies in care and service,
not the physicians trapped within its domain.
 We agree that the actual impact of this concept is limited and grossly
overemphasized (currently estimated at less than 1 percent of all practicing
primary care physicians in this country!). In fact, the Government
Accountability Office has recently determined that this concept is not a threat
to the legitimacy of Medicare or the health care system. Any “controversy” is
merely perceived and based only on fallacies and unjustified assumptions.
Discussion and debate are natural components of health care evolution, but this
should not be a distraction to reality.
Patients have the right to choose their method of receiving health care, and
physician businessmen have the right to choose their method of delivering health
care. As long as legal and ethical prerequisites are not ignored, MMPs could
complement a pluralistic health care system.
Michael O’Neal, DO
CooperativeMed
Tampa, Fla.
Only Themselves to Blame
Dear Editor:
The comments made by John Harrison in “From the Mouths of Babes” (September
2005, page 128) regarding teenagers and intolerance were really annoying. First
he denigrates people who work hard in school and life by implying that these are
not the primary factors in individual success. Then he states that the economic
“deck of life” is stacked against those without the proper skin color, social
connections or access to the tools of wealth creation.
Mr. Harrison need only look at the long-term studies of wealth creation in
immigrant families to understand that individual initiative and sacrifice can
and do overcome all the factors he mentions. Long hours of study, the discipline
to save and a tireless work ethic will forever count for more than the
“limousine liberal” concepts of social justice and sustainability championed by
his organization (Resource Generation).
Charlie Smith Pittsburgh
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