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Editorials: Point and Counterpoint |

Rebuttal From Drs Foreman, Lopez, and Flenaugh FREE TO VIEW

Marilyn G. Foreman, MD, FCCP; Victoria Lopez, MD; Eric L. Flenaugh, MD, FCCP
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURE: None declared.

aPulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA

bDepartment of Medicine, Morehouse School of Medicine, Atlanta, GA

CORRESPONDENCE TO: Marilyn G. Foreman, MD, FCCP, Pulmonary and Critical Care Medicine, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(2):260-261. doi:10.1016/j.chest.2016.09.044
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We agree with Dr Freedman’s assessment that disparate pressures have transformed medical practice, in which the notion of a traditional private medical practice is now an antiquated option. The modern paradigm finds that more physicians are employees rather than independent practitioners, administratively managed to achieve financial and other metrics. Loss of control, greater job dissatisfaction, and economic, bureaucratic, and other pressures on practicing physicians have trickled down to influence the career choices of medical students. Medical students consider lifestyle impact, a major criterion, when making ultimate career selections. The motivations that entice physicians to consider practicing concierge medicine have been well articulated in the accompanying Point debate, but the effect on patients and public health is largely unknown and not addressed.

Failure of a concierge physician to diagnose a case of lung cancer has been published and is among the case study files of a medical malpractice insurance company., This report is not provided to highlight the shortcomings of concierge medicine but to suggest that greater access obtained by greater resources may not guarantee better outcomes. Whether concierge practices reduce costs and improve outcomes is unproven. Again, we find agreement with Dr Freedman that insufficient information is available concerning the overall impact of concierge practices and pulmonary medicine. Informed decisions require objective, unbiased analyses independent of the concierge medicine industry.

Though we suggest caution in the wholesale acceptance of concierge pulmonary care, we strongly advocate support for innovative methods to improve global respiratory health and anticipate such outcome reports for our patients.

References

Freedman N. . Point: is it time for pulmonary concierge practices? Yes. Chest. 2017;151:255-257 [PubMed]journal
 
Hauer K.E. .Durning S.J. .Kernan W.N. .et al Factors associated with medical students' career choices regarding internal medicine. JAMA. 2008;300:1154-1164 [PubMed]journal. [CrossRef] [PubMed]
 
Samaritan G. . Concierge medicine: failure to diagnose lung cancer. J Med Assoc Ga. 2010;99:30-31 [PubMed]journal. [PubMed]
 
MagMutual Patient Safety Institute. Concierge medicine—no guarantee against failure to diagnose lung cancer.http://www.magmutual.com/sites/default/files/ConciergeMedicine2014.pdf. Accessed August 9, 2016, 2016.
 

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References

Freedman N. . Point: is it time for pulmonary concierge practices? Yes. Chest. 2017;151:255-257 [PubMed]journal
 
Hauer K.E. .Durning S.J. .Kernan W.N. .et al Factors associated with medical students' career choices regarding internal medicine. JAMA. 2008;300:1154-1164 [PubMed]journal. [CrossRef] [PubMed]
 
Samaritan G. . Concierge medicine: failure to diagnose lung cancer. J Med Assoc Ga. 2010;99:30-31 [PubMed]journal. [PubMed]
 
MagMutual Patient Safety Institute. Concierge medicine—no guarantee against failure to diagnose lung cancer.http://www.magmutual.com/sites/default/files/ConciergeMedicine2014.pdf. Accessed August 9, 2016, 2016.
 
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