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M.D. 'concierge' service has its fans and foes
Cox News Service
ATLANTA - Eighty-nine-year-old Florence Day "felt abandoned" when her doctor told her that she'd have to pay $1,500 cash to keep seeing him.
"I'm on a fixed income, and just couldn't afford it," said Day, who had to find another doctor. "It's a terrible thing for people. I would have liked to have stayed, but I couldn't. I was very disappointed."
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Florida-based MDVIP, a company helping doctors run concierge practices, requires affiliating physicians to be accessible 24/7 by cellphone and e-mail, provide head-to-toe annual exams and build in time to allow for same-day visits.
Its doctors help patients who leave their practices find new physicians who accept their insurance.
Experts say such practices - also called "boutique," "retainer," "preventive" and "executive" medicine - are growing because doctors are seeking new ways to find more time for patients, and provide better care. Experts estimate there are about 1,100 concierge practices nationwide, most formed by small groups of doctors who generally follow the MDVIP model.
A few months ago, Tom G. Stanek, 60, was told by his doctor he'd need to pay an annual fee of $1,600 or find a new physician.
"Even though it's hard to leave somebody you've been with for so long - over 15 years - it's just too much money," Stanek said. "I told him it was the fee. He had 3,000 patients, and he's going down to 600. I can see his point of view, but ... I'll lose that great relationship developed over the years."
He and Day are among tens of thousands of people who've decided they can't afford to pay more or don't feel they need a closer relationship with their doctors.
But thousands of others, like Harriett Powell, 51, are concluding that it's dangerous to put a price ceiling on health care. She's paid the $1,500 fee requested by her doctor.
"The focus now is on wellness," she said. "I love it. It's almost a fear of what might be missed. Now, my visits aren't rushed, I can call him 24/7, and when I call after hours, he answers his cell."
Her physician, Dr. Kelly Ahn, 41, affiliated with MDVIP, which describes its practices as "personalized preventive care" models.
In MDVIP practices, in which doctors keep $1,000 of the fee, physicians are required to accept no more than 600 patients, rather than the 2,500 typical of family practices.
It provides each person with a CD ROM containing their medical histories and creates Internet "portals" that can be visited via password for instant communication with doctors and their staffs.
MDVIP, which keeps records of the health of more than 80,000 people, reports that preliminary data show that patients in its practices - 250 nationally - are admitted to hospitals less often, that diseases are detected earlier and that overall health is better.
"Patients get a level of care that is not possible in a traditional primary-care practice of 2,500 patients," said Dr. Edward Goldman, co-founder and CEO of MDVIP.
For the fee, patients in MDVIP practices get a comprehensive annual evaluation, which includes the identification of risk factors that predict the diseases a person is most likely to develop, based upon personal and family history, genetics, lifestyle, habits and occupation.
Ahn said he chose to join because he was frustrated that he had so many patients he couldn't "take care of them" like he wanted.
"I could see them for eight to 10 minutes," he said. "Now, it's as long as it takes. I talk personally over the phone. And it's really neat to be able to hear the appreciation of a patient you can see on the same day they call, when a person calling can get me and not the nurse."
But he added, "to have to say goodbye to patients was very, very hard."
Dr. Reginald Fowler, 55, said many patients told him they wanted to stay, but couldn't afford the price.
Before, he said, "patients could have read (the novel) 'War and Peace' in the waiting room. But now I'm not working 'till 8:30 in the evenings. And patient care is better."
Since converting in June, he has caught one case of lung cancer that might have been missed before.
The trend is catching on at a time when the number of doctors going into primary care is dropping. Last year, only 7 percent of medical school graduates chose family practice, a field with a median income of $150,000, according to the American Academy of Family Physicians.
The American Medical Association reports that there are about 250,000 practicing family physicians, internists and general practitioners, compared to about 472,000 specialists.
Many family doctors have upwards of 2,500 patients on their rolls, said William Custer, director of the Center for Health Services Research at Georgia State University. It makes sense, he added, to assume patients get better care in retainer practices.
Critics contend that concierge practices are elitist, dumping thousands of patients into longer lines in emergency rooms and in offices of family doctors who remain independent.
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said he has "sympathy for some of the doctors who are overwhelmed," but that "concierge medicine can't be done without excluding people."
The AMA said in a policy statement that the practices could "raise ethical concerns" if they become so widespread as to threaten access to care, which hasn't happened yet. Dr. Jim King, president of the American Academy of Family Physicians, said retainer practices are "a symptom of a broken system, with a lot of physicians looking for a way to keep the light bill paid."
But Goldman said such practices already are improving the lot of doctors and their patients.
He said MDVIP provides 401(k) plans to member doctors and their staffs, arranges for vaccines to be delivered at "favorable terms," and handles enough billing so that physicians need fewer people in the back office.
He said preliminary research on 14,000 people found that MDVIP patients had 53 percent fewer hospitalizations than those in traditional practices.
Custer said "everybody is frustrated with the medical system, which is why it's part of the presidential debate," and that concierge medicine "is no more unfair than people driving BMWs while the rest of us drive Toyotas."
Kathryn Unverzagt, 65, agreed. She and her husband have their doctor's personal phone numbers, which provide "peace of mind."
"I would scrimp and save in other areas to stay with Dr. Ahn," she said. "I would forego eating."
Concierge Medicine : 9/22/2008
As president of SIMPD, the Society for Innovative Medical Practice Design,the professional society open to all concierge and other direct practice doctors, I thank you for your objective discussion of it. Interest in concierge medicine is rapidly growing. Starting with the first such practice about ten years ago in Seattle and growing exponentially, there are now thousands of such practices in the USA, some are associated with franchises though most are independent. A national society of concierge doctors and other direct practice doctors has existed since 2003 called The Society for Innovative Medical Practice Design, or SIMPD for short. Direct practice doctors and those who wish to adopt the direct practice model can join the society and get many benefits including up to 55% discounts on malpractice insurance, practice marketing help, national care networks and many other services. Patients can go to SIMPD's web site at http://www.simpd.org for information and to find such a doctor in their own community. This is the ideal way for patients to get personalized, prompt, excellent primary medical care in a unhurried, pleasant setting. Money is actually saved on patients in such practices because ER visits and hospitalizations are drastically reduced by the personalized, immediate, detailed care. SIMPD believes most Americans can eventually be cared for in such practices resulting in better care, lower cost and a return of interest in primary care by students who now shun the field as undervalued, underpaid and undesirable compared with other medical specialties. Thomas W. LaGrelius, MD, FAAFP President, SIMPD http://www.simpd.org
Working as an Internist : 9/22/2008
I would NEVER again recommend working as an Internist in America. You must touch people in places you dont want to touch them and have to listen to them complain... The American financial system is in CRISIS MODE and the Healthcare system is next. If you are considering becoming an Internal Medicine physician, do not do it. SPECIALIZE
