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We frequently read of the growth of direct primary care or concierge medicine, whereby patients contract with a medical practice to pay a monthly fee for enhanced access, such as frequent or unlimited appointments with little wait time. These arrangements are undeniably advantageous to care providers and to patients who can afford them, but they raise serious ethical concerns.
I believe it is wrong — and compromises medical ethics — for the rich to be able to buy privileged access and crowd out the poor. We see enough of that elsewhere in our economy. It is one thing if we are talking about access to fine wines and other luxuries. But it is another when it comes to distributing health care.
It would be wonderful for everyone concerned if doctors were able to spend more time with their patients. Membership arrangements facilitate doctor-patient relationships that are closer to the ideal. But I believe this consideration is outweighed by the ethical principle that care be delivered without discrimination as to socioeconomic class.
A physician’s time is not unlimited, and there are workforce shortages throughout our health care system. When a vital service is in short supply, conscience demands that it be allocated equitably.
Michael P. Bacon
Westbrook
