Concierge care is often discussed as a way for primary care to survive in the United States.

Pauline Chen talks about the concept in her recent New York Times column, discussing the well-known issues involving “two-tiered” care that boutique practices inevitably bring.

But what I found fascinating was how Tufts University utilized the concept.

Here’s how it works:

Since 2004, the primary care physicians at Tufts Medical Center have offered patients the option of being part of either a traditional general medical practice or a retainer practice. Patients in the retainer practice have longer visits, around-the-clock access to one of five physicians, comprehensive wellness and prevention screenings and on-time office appointments within 24 hours of a request. But unlike other boutique practices, the retainer fee of $1,800 per year that these patients pay does not go directly to the doctors’ coffers. Instead, it is used to support the traditional general medical practice, the teaching of medical students and trainees and free care to impoverished patients.

Interesting.  A couple of things to note here.

First, I’d be curious to know if both the concierge doctors and the traditional physicians were under a similar salary structure.  On one hand, the boutique physicians would see less patients during the day, but would have to be available 24-hours a day to provide “VIP” services, while the traditional doctors may have to see more patients in the clinic, but would be off-pager during the evening.

And second, it’s starkly implicit that the traditional primary care needs the revenue generated from the concierge arm to function at all — it’s a depressing sign that it’s impossible for a traditional primary care practice to fiscally self-sustain.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on Facebook, Twitter, and LinkedIn.