Academic Medicine and Concierge Practice

TO THE EDITOR: Doherty (1) neglects to mention that many luxury care clinics are sponsored by academic medical centers. Some partner with national concierge care companies. Marketing for such clinics is directed at the heads of successful small and large companies, who are disproportionately white men. Many physicians who staff luxury care clinics limit their practices to the wealthy (2, 3). Physicians in retainer practices care for fewer African Americans, Hispanics, and Medicaid patients than those in other types of practices; moreover, physicians who switch to a retainer practice keep an average of only 12% of their former patients, thus burdening other, already overworked physicians in the community (4). The general public contributes substantially to the education and training of new physicians through state and federal taxes and thus might find it hard to accept physicians limiting their practices to wealthy persons (5). Although academic medical centers, traditional providers for the poor and underserved, might justify sponsoring luxury clinics via a utilitarian argument, only 2 programs use income from these ventures to cross-subsidize care for indigent persons or teaching programs. There is no high-quality evidence documenting a higher caliber of care in concierge practices, and few data support the clinical or cost-effectiveness of many of the unnecessary tests offered to asymptomatic clients (2, 3). Overtesting may result in false-positive results, leading to further unnecessary investigations, additional costs, and heightened anxiety. True-positive results may lead to overdiagnosis of conditions that would not have become clinically significant, leading to further risky interventions and possibly impairing future insurability. The use of clinically unjustifiable tests erodes the scientific underpinnings of medical practice, runs counter to the ethical obligations of physicians to responsibly manage limited health care resources, and likely leads to worse care. Most training in professional ethics, as well as the development and teaching of evidence-based practice guidelines, takes place in medical schools and teaching hospitals. No data are available on the participation of medical students and residents in luxury care clinics at teaching hospitals. For such institutions to teach students to treat all patients equally, combat inequalities in health care access and outcomes, and practice evidence-based medicine while at the same time supporting clinics that do the antithesis is troubling. At the least, trainees should not be allowed to work in such clinics.