letters | concierge care a new wrinkle in medicine

Close gap between primary care doctors, specialists

There is no doubt that we have a severe shortage of primary care physicians in our country (“The concierge shakedown,” Alex Beam, Op-ed, Aug. 8). The average wait for a new patient to be seen by a family physician or internist in the Boston area is more than one month. Abundant data demonstrate that a primary-to-specialist ratio of 50-50 is optimal and associated with lower costs and higher quality. In the United States, it is closer to 30-70.

All of us in primary care know full well that we are underpaid and overworked. For those of us concerned with the health care of populations, concierge medicine is not the solution. Large annual retainer fees, which are paid even before insurers are billed for services, are good for a small number of doctors and for the patients who can afford these fees.


Meanwhile, in the United Kingdom and Canada, the number of general practitioners has been climbing. This has been accomplished by narrowing the huge gap in income between specialists and generalists, and making the job of general practice fun again.

The primary care shortage in the United States will become a risk of monumental proportions as baby boomers age. All of us — patients and doctors alike — need to be of one mind about this and act decisively before it’s too late.

Dr. Robert L. Dickman


The writer was founding chair of family medicine at Tufts University School of Medicine.

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