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Academic Retainer Medicine: An Innovative Business Model for Cross-Subsidizing Primary Care

Lucier, David J.; Frisch, Nicholas B.; Cohen, Brian J. MD, SM; Wagner, Michael MD; Salem, Deeb MD; Fairchild, David G. MD, MPH

doi: 10.1097/ACM.0b013e3181dbe19e
Primary Care

Retainer-medicine primary care practices, commonly referred to as “luxury” or “concierge” practices, provide enhanced services to patients beyond those available in traditional practices for a yearly retainer fee. Adoption of retainer practices has been largely absent in academic health centers (AHCs). Reasons for this trend stem primarily from ethical concerns, such as the potential for patient abandonment when physicians downsize from larger, traditional practices to smaller, retainer-medicine practices.

In 2004, the Department of Medicine at Tufts Medical Center developed an academic retainer-medicine primary care practice within the Division of General Medicine that not only generates financial support for the division but also incorporates a clinical and business model that is aligned with the mission and ethics of an academic institution.

In contrast to private retainer-medicine practices, this unique business model addresses several of the ethical issues associated with traditional retainer practices—it does not restrict net access to care and it neutralizes concerns about patient abandonment. Addressing the growing primary care shortage, the model also presents the opportunity for a retainer practice to cross-subsidize the expansion of general medicine in an academic medical setting. The authors elucidate the benefits, as well as the inherent challenges, of embedding an academic retainer-medicine practice within an AHC.

Mr. Lucier is a second-year MD/MBA student, Tufts University School of Medicine, Boston, Massachusetts.

Mr. Frisch is a second-year MD/MBA student, Tufts University School of Medicine, Boston, Massachusetts.

Dr. Cohen is director, Pratt Diagnostic Center, Tufts Medical Center, Boston, Massachusetts.

Dr. Wagner is chief, Division of Internal Medicine and Adult Primary Care, Tufts Medical Center, Boston, Massachusetts.

Dr. Salem is chair, Department of Medicine, Tufts Medical Center, Boston, Massachusetts.

Dr. Fairchild is chief medical officer, Tufts Medical Center, Boston, Massachusetts.

Correspondence should be addressed to Dr. Fairchild, Tufts Medical Center, Box 451, 800 Washington Street, Boston, MA 02111; telephone: (617) 636-1166; fax: (617) 636-7623; e-mail: dfairchild@tuftsmedicalcenter.org.

© 2010 Association of American Medical Colleges