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The medical world is constantly changing due to technology, research and of course insurance companies. Many doctors are deciding to leave certain specialties or curtail aspects of their practice to keep their insurance rates down. Other doctors who are tired of seeing thirty patients a day for small reimbursements are developing innovative strategies to balance their work load and provide optimal care.

Group Practice
This type of practice has increased in popularity over the past few years. The age of the solo practitioner is dwindling mainly because on-call schedules can be overwhelming. Physicians are not unlike other service providers, they work better in community. Many OB-GYN practices have you see all the doctors in the practice during a pregnancy because your assigned physician may not be on-call the night you go into labor.

If you're facing a chronic illness and you are going to a group practice make sure that other doctors in the practice are familiar with your disease. The most likely scenario is that your internist is medically managing your illness and is in practice with other internists with varying specialties for the broadest attraction to new patients. Illnesses that require specialists may be in a group practice, but are often solo practitioners due the scarcity of specific specialists.

Concierge Medicine
A new breed of doctor has emerged and that's the entrepreneurial physician. Doctors often suffer from battle fatigue as they beg and plead for reimbursement or authorization for tests from insurance companies. In order for the doctor to make a living they have to see more patients than they would like with shorter appointment times. For some physicians, this defeated the reason they became doctors and they came up with a solution. In essence, they create boutique medical practices.

Concierge medical practices allow the doctor to set the rules for their practice. They accept insurance but in addition to what they bill the insurance the patient is required to pay an annual fee to be a part of the practice. In return the patient gets more individualized and personal care. In many concierge practices, the physician only takes a limited number of patients in the practice. They are often on call 24 hours a day and some even will make house calls. Concierge physicians will often see you sooner than a larger practice and the appointments are usually scheduled to be longer than the 8-10 minutes managed care allots doctors for a visit.

Obviously concierge practices are exclusionary to those who cannot afford the annual fee. The fees vary and there are no guidelines for what a physician can charge for this service. It's not unusual that a fee ranging from $2,000-$4,000 annually is required. You, the patient, have to consider what is exclusive access to your doctor worth, and are you prepared to pay this fee annually. If money is a concern; this type of practice may work best during the acute phase of your illness when you may need more time and attention.

No matter the type of practice you choose be sure that you are clear on your expectations of the relationship with your physician. Be empowered to ask questions, and hold strong boundaries about getting your needs met during your appointment. Your health is not the place in your life you want to compromise.

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