- Ultrawealthy and sometimes asymptomatic Americans are using concierge doctors to access COVID-19 tests amid a nationwide shortage.
- The doctors, whose monthly fees can range up to $10,000 a month and don’t accept insurance, can offer coronavirus antibody test results in as little as two hours; results for the general public can take days.
- Even some concierge doctors question the ethics of offering tests to their wealthy clientele that aren’t available to the general public.
- Both concierge doctors and their clients told Business Insider that America’s health care system is dysfunctional, and that patients are healthier operating outside it.
- Visit Business Insider’s homepage for more stories.
Jamie Gerdsen, the 46-year-old CEO of Cincinnati-based construction company Apollo Home, wanted his 200 employees to know how seriously he was taking the coronavirus pandemic. To prove it, he decided to get tested in April.
For Gerdsen, the process was simple. All he had to do was call his doctor, set up an appointment time for him and his wife, and get to his doctor’s drive-through testing center. At the center, they showed their IDs, answered a few questions, and got their fingers pricked, all without getting out of their car. The results came into Gerdsen’s email inbox two hours later.
They were negative, but that wasn’t a surprise to Gerdsen and his wife. They never suspected they had the virus to begin with, but they could easily double-check with a test because they have access to the kind of doctor that most don’t: a concierge doctor.
Business Insider talked to six concierge doctors to see why they entered the field and what kind of treatment most Americans are missing out on. We found that the kind of personalized attention they give to their patients can be more efficient, but that even concierge doctors themselves get uncomfortable with the ethics of the different tiers of American health care. The concierge model isn’t the problem, they told us; it’s the rest of the health care system.
For most Americans who believe they’re infected, getting tested isn’t so simple
Oswald Mendez, a small business owner in New York City, had a dramatically different experience getting tested than Gerdsen did.
Despite having had what he originally thought was a cold in early March, Mendez had to visit three different urgent care clinics before he found one willing to test him for the coronavirus. Then, he had to spend an hour in a waiting room before he could get the same type of test that Gerdsen took and completed in a five-minute drive-through. He wanted a same-day test, because he wanted to make sure he wasn’t infected before his elderly mother visited him. But where Gerdsen got emailed results within a few hours, Mendez had to wait another three to five business days to get his results. In fact, he said that seven business days later, he still hadn’t received his test results.
Mendez’s experience aligns with that of many Americans right now. For those who don’t have the means to retain a private doctor, the testing process often includes an hourslong trip to the emergency room that can rack up thousands of dollars in medical bills even before the attending physician agrees to administer the nasal swab test (which has to be pushed so far into the nostril that some patients pass out).
Gerdsen was able to sidestep nearly every single pain point in the testing process by going to a relatively rare direct-care physician, more commonly known as a concierge doctor.
For an annual fee that can stretch into the tens of thousands of dollars, concierge doctors make themselves available to their ultrawealthy clientele, which often consists of senior executives and celebrities, on a nearly 24/7 basis. With one text, patients can request same-day in-office appointments or house calls, outpatient procedures, or referrals to a specialist. While there’s certainly a high upfront cost to concierge coverage, one hospital visit alone for a coronavirus testing process generated a bill of thousands of dollars, before insurance companies agreed to waive co-pays.
National trade publication Concierge Medicine Today estimated the national number of concierge doctors at 12,000 as of June 2019, a select group compared to the 756,800 overall physicians counted by the Bureau of Labor Statics in 2018. Simply put, the vast majority of Americans don’t have access to this kind of treatment.
Because these doctors work independently of the insurance companies and the large hospital systems that dominate much of America’s healthcare system, they have been able to sidestep the federal government’s sluggish response to the crisis and prepare themselves — and their clients — for the pandemic. In some cases, they’ve sold in-demand testing kits to their high-paying clients.
An alternative to America’s ‘dysfunctional’ health care system
Not all concierge doctors enroll in medical school with dreams of becoming physicians for the rich and famous.
Gerdsen’s physician, Dr. Lisa Larkin, had spent about half of her career as an internist working at the University of Cincinnati Medical Center. Over the course of 30 years, Larkin had worked at UCMC in a couple different spells and had a private practice that wasn’t a concierge model. When she sold her private practice to UCMC in 2012 and returned to lead a new women’s health department, she said she was disappointed to find that the program didn’t come with the budget she had expected.
To make ends meet, Larkin said she still had to spend much of her time seeing patients, and after a year, she said the hospital’s counsel blocked a crucial hire that upended her entire vision for the center.
“I found myself back as an employed physician in a large, complicated dysfunctional health system and was incredibly frustrated,” Larkin told Business Insider. She said her frustration prompted her to leave UCMC in 2016, and open Lisa Larkin, MD & Associates, the concierge practice where Gerdsen received his coronavirus antibody test.
The concierge model isn’t the problem, they told us; it’s the rest of the health care system.
Another concierge doctor, Malibu-based Lisa Benya, described the primary-care physician’s relationship with insurers as a “hamster wheel.” Before she converted her own practice to a concierge model, Benya told Business Insider that she had been under constant pressure to squeeze more and more patients into each day to bring in enough to keep their doors open.
“I chose not to do that,” Benya told Business Insider. “Very often in this country, primary care has to make some decisions. Either we would have to sell the practice to a large group or a hospital, or join with multiple physicians in order to provide the coverage and the manpower that is needed to keep up with the changing times in medicine.”
Benya charges her patients a $1,000 monthly retainer that includes unlimited phone calls and visits. An enhanced package that includes access to a spa facility attached to her practice costs $10,000 a month.
The biggest perk a concierge doctor’s fee buys is personalized medical attention
Concierge physicians say that having a doctor on retainer often ends up saving patients time and money in a crisis, as compared to urgent care and emergency room visits. During a fast-moving health crisis like the novel coronavirus that has infected over a million Americans, eliminated more than 30 million jobs, and put 85% of the country’s population under some form of lockdown, doctors told Business Insider that flexibility is especially vital to achieving good health outcomes.
“I can pivot,” Larkin told Business Insider. “You can dart back and completely change course in a speedboat much easier than you can when you’re trying to move the Titanic. And I think that’s been an advantage in this situation right now.”
While the broader health care system ignored the signs that the coronavirus had begun to spread in the United States earlier this year, Larkin said she was working to provide her patients with access to tests that weren’t yet being offered to Cincinnati’s general population. Larkin said that while her husband, Dr. Arthur Pancioli, a physician who oversees three emergency rooms as the chair of emergency medicine at UCMC, had to wait for the local health department to develop the capacity to run tests, she was able to purchase them directly from private labs like LabCorp.
A representative for the UCMC did not respond to Business Insider’s request for comment on its COVID-19 testing procedures, or on Larkin’s professional history at the hospital.
At the beginning of the pandemic, Larkin could send nasal swabs off and get results within 48 hours. But as other health care providers, including urgent care centers, began to send in tests of their own, wait times for results soon stretched to 14 days. To combat this delay, Larkin and other concierge doctors began buying antibody tests that claim to be able to detect not only if a patient is infected, but if they have been infected in the past. In some cases, concierge doctors were able to get these tests weeks before labs started selling them to the public online.
Even some concierge doctors question the ethics of offering tests that aren’t available to the general public
Doctors hawking high-priced extras that are, as Larkin put it, “maybe cutting edge or maybe fringe, depending on who you ask,” is nothing new for the concierge medicine space.
Beverly Hills concierge Dr. David Narzarian, whose Instagram account features photos of him posing in his waiting room with stars like Dennis Quaid, Kendall Jenner, and Kelly Rowland, also performs IV vitamin therapy and anti-aging medicine in addition to primary care and COVID-19 tests. Benya’s practice, CURE, also has its own salon and medical spa.
While some may say that selling coronavirus tests isn’t much different from administering Botox injections, there is a key difference: The former are in short supply. Even after weeks of ramping up testing capacity, many states can only handle testing a few thousand residents a day. Every test sold to a patient who doesn’t meet the CDC’s criteria for testing takes one test away from another patient who does. An Insider poll conducted April 28 through April 29 found that 33% of Americans believe they may have been infected by coronavirus — but just 5% of those people have gotten tests.
“That’s where the ethics of this comes into play, because I do have a lot of patients who naturally want to be tested just to be sure,” Eitches said. With demand for testing exceeding capacity, Eitches said, it will be up to health care workers to decide who gets a test, which raises a question of its own: “Are we going to triage based on your access due to your socioeconomic status?”
The Medical Board of California is also considering the ethics of concierge doctors selling coronavirus tests, having confirmed to the Los Angeles Times that it is reviewing the matter, following a previous report by the newspaper’s Adam Elmahrek, Amy Kaufman, and Ben Poston. A board spokesperson declined to comment further to Business Insider, saying that both investigations undertaken by the board and complaints made to it are confidential by law.
Even if average Americans could afford to buy coronavirus tests, most on the market today have not been approved by the FDA, and are notorious for giving false positives
Antibody tests can still provide a useful service for some patients who find themselves in a gray area.
New York-based ophthalmologist Dr. Yuna Rapoport continued to see patients at her practice, Manhattan Eye, even as the city’s outbreak spiraled into the worst in the country. Rapoport soon developed symptoms that she described to Business Insider as mild — a low-grade fever, fatigue, and a dry cough — but said that she felt so sick in early April that she missed her appointment to get a nasal swab test. So, Rapoport decided to turn to a concierge doctor.
When a concierge doctor that Rapoport often consults with started offering antibody tests in late April, she decided to take one, even though she had already self-isolated and recovered from her symptoms. All Rapoport had to do was text the doctor the night before, answer a few questions, submit to a temperature test, and get a quick finger prick. A few hours later, she found out that she was positive for coronavirus antibodies.
What the test results actually mean for patients’ daily lives is just as ambiguous as their accuracy. Even though Rapoport now knows that she has antibodies, she said she still isn’t sure if that means she can’t contract the virus again.
Scientists aren’t sure if a person can contract the coronavirus twice, Elizabeth Halloran, a biostatistician at Fred Hutchinson Cancer Research Center and the University of Washington, previously told Business Insider. “What we hope is if you get it once, you’ll be protected against it for at least a year,” Halloran said. “We don’t know that, but that’s what we hope.”
For this reason, Rapoport said that, while she has started seeing patients again in her office, she hasn’t given up social distancing outside of it.
Concierge doctors have also tested many patients who have less compelling reasons to verify their immunity than Rapoport. UFC commentator and former “Fear Factor” host Joe Rogan sparked outrage among his fans when he said on his podcast that he had been tested for the virus twice, and was paying for every guest who appears on his podcasts to get tested, too. “I’m just going to test myself every three or four days,” Rogan said on “The Joe Rogan Experience.” “F— it.”
Concierge MD LA, where the doctor who performed Rogan’s test works, advertises both nasal swab and antibody tests for COVID-19 on its website for $299. A representative for Concierge MD LA did not respond to Business Insider’s request for comment on its testing practices.
COVID-19 has created a surge in interest in concierge medicine
As the pandemic highlights the disparities between the health care received by the rich and poor in America, concierge doctors are both an embodiment of the problem, and, in some cases, simultaneously trying to be its solution.
Some concierge doctors, including Larkin, have not only tested their clients for free, but have opened up their testing centers to the general public. The drive-through where Gerdsen was tested was part of a two-week clinical trial in partnership with the UCMC. When it closed on May 1, it had tested over 1,200 people.
Benya said she’s seen a dramatic increase in interest from potential new patients. Larkin, meanwhile, has had so many inquiries about coronavirus tests that she had to stop scheduling new appointments.
“I hope that medicine shifts this way for everyone in the future,” Benya said of the benefits of concierge medicine. “It’s rewarding and satisfying for both sides.”
But given how rare concierge practices are, and the high upfront cost they entail, that future could be a long way off for most Americans.