Some doctors have decided to limit their practice of medicine to patients who pay directly for treatment and do not require physicians to submit forms and other paperwork to insurance companies. This kind of medical practice has been called "Boutique" of "Concierge" medicine. The doctors do not participate in Medicare nor do they accept insurance payments. Patients retain their medical insurance to cover specialists and hospitalizations, but pay a yearly fee to their primary physicians for medical services, a fee which can range from $1,000 to $15,000. This not only avoids paperwork for the doctor’s office, but increases their salaries and provides more time to spend with each patient as the number of patients seen daily is much smaller. Rather than see a large number of patients daily who ware shuffled in and out in an assembly line manner, concierge medicine allows doctors to spend a long time with each patient and to have a real understanding of their medical conditions and daily lives. Preventative medicine is emphasized. Patients are offered weekend appointments, home visits, and 24 hour access to physicians As more careful medicine and more time spent with patients equates with less error, these doctors are offered much less expensive malpractice insurance and the patients received higher quality care. Does concierge medicine lead to a two tiered medical system, one catering to the wealthy, another to the poor? Or is it a return to the family doctor style of medicine when house calls were routine?
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