Conrad Murray was convicted of involuntary manslaughter on Monday for his role in the death of singer Michael Jackson. Murray was Jackson’s dedicated personal physician, having signed on for a reported $150,000 per month, although Jackson died before money changed hands. How do you get your own private doctor?
Be very persuasive. The number of doctors in the United States who serve only one patient is unknown, but the arrangement is extremely rare. There are no public listings for full-time, dedicated personal physicians. You’d have to do like Michael Jackson did—find a doctor you like and convince him or her to take an enormous chance on you. It’s going to be a tough sell, though. Most accomplished doctors consider it incredibly risky to abandon an existing practice and commit their fate to a single, wealthy patient. (There are rumors of Middle Eastern royalty plucking private physicians out of prestigious American residency programs, but they’re unsubstantiated.) The arrangement also creates ethical complications, as the doctor relies financially on one patient.
Because it’s so difficult—and probably unnecessary—to land your own top-quality, full-time doctor, exceptionally wealthy patients usually share a doctor with a small number of their fellow job creators. Often this is done by word-of-mouth. Colleagues or neighbors in wealthy areas recommend top-class doctors willing to work for an annual fee rather than on a fee-for-service basis. If you’re not plugged in with the high-net-worth set, there are a few practices that publicly offer similar arrangements. One of the best known groups charges an annual fee of approximately $25,000 per family, with each primary care physician limited to 50 families.
What you get for your annual fee varies with the doctor. In some cases, it covers an unlimited number of primary care visits, with no co-pay or health insurance involvement. Other private doctors continue to charge insurers or Medicare for the services that they’re willing to cover. In any event, patients can’t drop their insurance altogether. Lab work, visits to specialists, and hospitalization can be incredibly expensive without it.
Flat-fee primary care providers occupy a legal gray area in several states. Because many exchange unlimited health care for an annual premium, some in the industry think they have crossed the line between doctor and insurer, and the law should treat them that way. Insurance companies, like banks, have to maintain a certain amount of capital to account for the possibility that a large number of policyholders might need coverage simultaneously. Few doctors could meet the capital requirements to cover all of their patients’ health care needs if a catastrophe struck, which means states that treat flat-fee doctors as insurance companies virtually prohibit the practice. Some creative doctors and their attorneys, however, have managed to get around this legal obstacle, or at least to avoid serious legal scrutiny. They charge additional fees for certain kinds of services, so that they don’t appear to offer comprehensive primary care coverage for the annual premium.
Several states have decided to explicitly allow flat-fee primary care, and a few primary care networks now offer it to large numbers of patients for a lot less than Conrad Murray was charging Michael Jackson. Qliance, for example, sells unlimited primary care in Washington State for between $49 and $89 per month, and caps the number of patients for each doctor at 800. As with many high-premium personal physicians, these companies are not part of any health insurance plan, nor do they accept Medicare. Proponents of the system say it aligns a patient’s interests with those of the doctor, because healthy patients use fewer services.
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Explainer thanks Tom Blue of the American Academy of Private Physicians and James J. Eischen, Jr. of the Eischen Law Group.