Frank Pasquale


Retainer care arrangements allow patients to pay a retainer directly to a physician's office in order to obtain special access to care. Practices usually convert to retainer status by focusing their attention on those willing to pay a retainer fee, and dropping the majority of their patients, who are left to be absorbed by other practices. Also known as "boutique medicine," "concierge care," or "innovative practice design," retainer practices have drawn thousands of enthusiastic patients.

They have also provoked scrutiny from politicians and consumer groups. Few recent developments in the business of medicine provoke emotional conflicts like retainer care does. Retainer care physicians are thrilled to break out of the vise of managed care, lavishing medical attention where they used to face the stark choice of rationing or involuntarily donating their services. Critics decry an ever-widening gap between haves and have-nots, and view retainer care as one more excess for the wealthy in an age of increasing medical scarcity.