Physicals With the Works
In this age of managed care, many of us no longer have easy access to the best and brightest in medicine. Unless, of course, money is no object--or someone else is picking up the tab. If that’s the case, you might get to experience something called the “executive physical.”
For $2,000 and up, you can spend two days getting poked and prodded, undergoing a battery of tests and talking at length to a top-notch doctor about your eating habits, family medical history and exercise routine.
Executive physicals--a type of red-carpet treatment for corporate honchos, Hollywood celebrities and the like--have become popular at some top-flight medical institutions, including UCLA Medical Center, the Mayo Clinic in Rochester, Minn., the Cleveland Clinic in Ohio, Johns Hopkins in Baltimore and Rush-Presbyterian in Chicago.
Executive physicals offer patients something increasingly rare in our health system: time with a doctor who isn’t rushing to get to the next patient.
Even if you have a good insurance plan, an executive physical probably won’t be covered. In some cases, people pay out of pocket for these programs. In others, corporations will provide such physicals as a perk for key executives.
“There is a move among corporate America and among some wealthy people to get what they see as the state-of-the-art physical exam,” said Dr. Ben Ansell, who runs UCLA’s Comprehensive Health Program, which began just eight months ago. About 700 people are expected to go through the program this year, but Ansell confidently predicts that the patient count could jump to 2,000 next year.
The price tag for UCLA’s program is $2,000 to $3,000. For $3,500 to $4,800, you can get the “Executive Physical Plus,” where the two days of care will include an extra three to four hours of additional consultations with expert specialists.
Some doctors are skeptical, wondering if patients who undergo extensive physicals are really getting better care than the rest of us i get at our annual exam.
Ordinary folks can “obtain the same information from their physicians at home,” said Dr. Yank Coble, an endocrinologist and professor of medicine at the University of Florida at Gainesville, speaking on behalf of the American Medical Assn. Blood tests are blood tests, mammograms are mammograms, no matter where you get them. UCLA’s Ansell acknowledges that CAT scans and cholesterol tests aren’t any better at an academic research center than an ordinary medical clinic.
What UCLA offers, he says, is a chance to talk to experts. Some men find it reassuring to know that their prostate exam will be done by a leading specialist. A woman with questions about hormone-replacement therapy may prefer to discuss the issue with an academic researcher who is leading an important national study of women’s health.
From a business standpoint, executive physical programs are a valued employee benefit that may also reduce the likelihood that a company’s chief executive will be knocked out of action by health problems, said Kate Sullivan, director of health policy issues at the U.S. Chamber of Commerce.
Top executives, she noted, often are rushing from one appointment to another, traveling to out-of-town business trips and attending board meetings and charity events.
“Operating at a top-level job generates a lot of stress,” Sullivan said.
A major advantage of the executive physical is convenience. A patient sees some doctors, lots of tests are run and the results come back quickly, with minimal disruption to one’s schedule. Specialists are available right there and can handle any immediate problems that come up.
That contrasts with the delays and inconvenience that most of us must put up with when we visit the doctor.
Our doctor gives a physical exam and orders some blood tests, which must be performed at a laboratory at another location approved by the HMO.
Blood and urine samples are taken and then we wait to get a card in the mail from the doctor--maybe a few weeks later--telling us to come in to talk about the results.
One big health-care company that is skeptical of the executive physical concept is Kaiser Permanente, which pioneered the concept of thrifty medical care.
“Our philosophy is, we are going to provide the maximum health outcomes to all our members within our resources,” said Dr. Allen Bredt, a Kaiser oncologist who explains that the big HMO does not perform executive physicals.
The procedures for a physical are identical for all Kaiser patients “whether they are an executive, a farmer, a nurse, a doctor or whatever,” he said.
From a societal standpoint, Bredt argues, it is a waste of medical resources to spend additional money on a group such as top corporate executives, who already are among the healthiest groups of people. That’s because there is a correlation between economic status and health: The wealthy are healthier.
If an executive physical turns up any problems that can’t be handled quickly, the patient must go to his or her regular doctor and rely on insurance coverage to pay for any further treatment.
Even if there is no problem, the follow-up can be an added burden for the regular doctor, who may have to check a fat sheaf of reports generated by the executive physical.
During his 32-year career, Bredt said he has seen a handful of patients who had executive physicals outside the Kaiser system.
“They would bring in reams of paper from their physicals. The only thing I ever had were false positive results,” he said. “I had to do additional studies and track things down and the patient was always concerned.”
There is no conclusive proof that people who get the executive physicals stay healthier and live longer than the rest of us. Nobody’s done a scientifically controlled randomized study comparing the results of the executive physical with the one for the rest of us.
It’s a nice treat if you’ve got $2,000 to spare. But until somebody proves it provides more years of life, a healthy dose of skepticism is in order.
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Bob Rosenblatt welcomes your questions, suggestions and tips about coping with the changing world of health care. He can be reached by e-mail at bobblatt@aol.com. Dollars & Sense runs the fourth Monday of each month.
