How to answer “Should concierge medicine be allowed?” in a medical school interview

A strong answer to "should concierge medicine be allowed" defines the arrangement precisely, names who gains and who loses access when a practice shrinks, and takes a position with the conditions you'd attach. The interviewer is testing whether you can weigh one patient's freedom to pay against everyone else's place in line.

What the interviewer is assessing

• Health systems and advocacy
• Ethical reasoning

The question puts two values against each other: a patient's freedom to choose their care, and the fair distribution of a scarce resource, which here is a family physician's time. The interviewer listens for whether you understand what the fee buys, who is left out when a practice cuts its list, and how the rules differ between systems. In a panel interview, the question often follows one about health care as a right. In a multiple mini interview (MMI), it appears as a policy station, sometimes with the fee named, as in this prompt.

Concierge medicine, also called retainer medicine, charges patients an annual or monthly fee for faster access, longer visits and a physician with fewer patients. In the US, concierge practices are legal. In Canada, charging a patient for access to services the public plan covers is restricted under the Canada Health Act and provincial law. A Canadian clinic that charges an annual fee is supposed to charge only for uninsured services, and the fee can't be a condition of getting insured care.

How to structure your answer

1. Define the arrangement in one sentence, including what the fee buys and what happens to the practice's other patients.
2. Name the stakeholders: the patients who pay, the patients who are dropped or never taken on, the physician, the clinics and emergency departments that take on the rest, and the public plan or insurer.
3. Give the strongest case for allowing it, including that longer visits can mean better care, that a physician near burnout may stay in practice, and that patients may spend their own money on their health.
4. Give the strongest case against, including that access then follows income, that a scarce physician serves fewer people, and that in a public system the fee can amount to paying for a place in line.
5. Take a position with conditions, say whether it changes in a region where many people have no family physician, and say what would change your mind.
6. Close with what your position means for the patient who can't pay the fee and has nowhere else to go.

The strength of the case against depends on how scarce family physicians are in the area, so say whether your view changes when nobody is waiting for one. With three minutes, define the arrangement in thirty seconds and spend the rest on the trade-off and your conditions.

Common mistakes

• Treating the question as a plain yes or no skips the condition the prompt builds in, which is that the practice takes on fewer patients.
• Assuming the arrangement is illegal everywhere, or legal everywhere, tells the panel you don't know the system you're interviewing in.
• Arguing only from the paying patient's point of view leaves out everyone whose access shrinks.
• Dismissing the physician's reasons, such as burnout and time for each visit, makes the answer a verdict rather than an argument.
• Leaving out who takes on the dropped patients, whether emergency departments, walk-in clinics or nobody, misses the cost to the system.

Follow-up questions to prepare for

• Would your answer change if the fee were $200 instead of $2,500?
• Is this different from a patient paying to skip a wait for an MRI?
• Should a physician who charges the fee also be allowed to bill the public plan or insurers?
• What would you say to a patient the practice dropped?
• Does it matter whether the longer visits produce better health outcomes?