Tiered access redux

[thedarkages]

In my last post, I proposed tiered access pricing for research librarians. However, it occurs to me that I have already experienced tiered access pricing in medicine, and it's not fun being on the other side.

A couple of years ago, my then-doctor, James Strebig, announced that he would be limiting his practice to 400 patients. Each patient would be charged $2,500 yearly for the privilege of being his patient, in addition to actual medical charges incurred. In exchange, he would personally respond to emails and phone calls, all blood work would be done by an in-house lab, and visits could be up to a half-hour in length. I believe this is called a "concierge practice." Neither Beth nor I could afford $5,000 a year. So we left his practice for one of the few doctors left on our insurance plan, who probably has 1,000 patients on the books, who takes ten days to schedule an appointment (recommending the ER for anything more imperative), visits to whom are about 5-10 minutes long, and whose practice is in a pretty scary part of town.

Is there any distinction between the research librarian model and the physician model that would make one implementation of tiered access intrinsically better or worse than the other?

Comments

[willendorf5761.livejournal.com]

Your Dr. Strebig sounds like a rip-off artist. My own internist returns most calls herself, is available by phone 24/7, an appointment with her typically lasts 45 minutes to an hour -- and she doesn't charge any extra. I assume she makes a good living or she wouldn't work this way. The down side is that it's difficult to get an appointment with her, and she rarely accepts new patients -- for the past 10 years or so, you've had to know someone in order to get an appointment with her. An appointment with my psychiatrist typically lasts about 15 minutes, but that's actually all the time I need with him, and when things were bad a number of years ago he was pretty easy to get ahold of by telephone.

As for librarians, well. . . . Assuming any Ploni Almoni off the street can still walk into a library and talk to a librarian during normal operating hours, I don't see a real problem with people paying a little extra for extra privileges. But it seems like kind of a weird thing for a *public* library to be providing. I dunno. I will ask Best Beloved what she thinks.