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Retainer Medicine

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The Argument for using Retainer Medicine as a Means of Improving Primary Care
Huddle, M.D., PHD, Centor, M.D. (2011) “Retainer Medicine: An Ethically Legitimate Form of Practice That Can Improve Primary Care.” Annals of Internal Medicine, Volume 55, Number 9
In retainer practices, Primary Care Physicians (PCPs) contract with patients who are willing to pay a flat annual fee either for all primary care services or for services beyond those covered by conventional insurance. The physician with a retainer practice limits his or her patient panel size to a manageable number, creating a more satisfying practice style and more time for both practice and other pursuits; these physicians and their patients have a better primary care experience than before. Critics of retainer medicine suggest that such arrangements breach a de facto social contract between physicians and society and will worsen the current imbalance between the number of primary caregivers and the patients who need them. So far, professional organizations have not taken a stance on retainer medicine, although the American College of Physicians has sounded a cautionary note about its ethical status. The authors contend that retainer medicine is an ethical form of practice that will eventually improve the work conditions for primary caregivers and thereby diminish the shortage of PCPs in the United States. Part of the authors’ argument is they do not believe the pursuit of social justice is an integral aspect of physician identity, despite numerous contemporary assertions to that effect. They contend that social justice is a civic virtue that makes its claims upon physicians as citizens and if physicians are obligated to further health care access for every member of society, then they have that obligation as members of society, not as physicians. It is enough that physicians concentrate their moral...

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