The University of Michigan’s health system, Michigan Medicine, has rolled out a pilot program promising personalized service, reduced wait times and more time with a primary care physician for patients willing to pay a $2,700 annual fee. Hundreds of the system’s own doctors and staff, however, are criticizing the program as conflicting with its mission as a nonprofit system tied to a public university.

The program, called Victors Care, is a concierge medicine, direct primary care model that is currently accepting enrollees. Acceptance will be limited—practices will only take 20 percent of the number of patients in a traditional primary care practice. Among the listed features of being a member are 24-hour access to a physician by phone, text or email, same or next-day appointment, unhurried visits and “executive-style health management.” Joining on or before June 30 will set the annual fee at $2,700, with the price jumping up to $3,600 for later enrollees. Starting July 1, 2019, all members, regardless of when they joined, will pay the higher price. 

Michigan Medicine faculty took issue with the rollout of the program in a Jan. 29 letter to health system leaders, saying Victors Care “devalues and even belittles what we do as family doctors” and implies that in order to receive quality care, patients have to pay more.

“The University of Michigan is a public institution and our commitment is to serve the public, not a private few,” the faculty wrote. “Low-income patients with Medicaid, many underserved patients (e.g., poor, individuals with disabilities, non-white, Hispanic) and patients with severe mental and chronic illness are less likely to be able to afford the cost of a concierge program. If we were a for-profit and private corporation, we could decide not to serve such patients. But to imply that only the wealthy will get the best healthcare goes against the foundation of our training as physicians and primary care clinicians.”

In comments included in the letter, doctors said the program reinforces the perception of the University of Michigan as “an elitist institution catering to the wealthy,” offering “unfair access to specialists based on wealth and assets.” Several also expressed concern that the program will leave non-Victors Care physicians with even fewer assets than before, along with a sicker patient cohort which will lower quality scores.

Concierge medicine and direct primary care aren’t new concepts. Michigan Medicine said the program was developed “after requests from patients” for services similar to what is offered at facilities like Massachusetts General Hospital and Mayo Clinic.

In a statement, spokesperson Mary Masson acknowledged some faculty members and staff have “raised concerns” with Victors Care and it may consider changes to the program based on their feedback, but the system believes it’s a “valuable option” for its patients.

“We’re committed to ethical, accessible care for all our patients and whatever programs we put in place should not diminish that in any way,” Masson wrote. “This will not adversely affect the access of other patients to our outstanding healthcare system.”