Sources: Modern Medicine, How to set up a concierge practice
The Health Care Blog

Doc, you realize your office is a lot like Disney World,” an unhappy patient quipped to Mark R. Wheeler, an internist in Louisville. “It’s a three-hour wait for a 20-second ride.”

“That comment spoke volumes about what was going on in my practice,” says Wheeler. “I was always behind. My patients weren’t happy, and neither were my staff, my family, or me.”

Today, Wheeler is a changed man, calling his partner, internist John Varga, and himself “two of the luckiest physicians on the face of this earth.”

The turning point came last September when the two physicians officially opened OneMD—a retainer or concierge-style practice that caps the number of patients at 300 per doctor. In return for a $4,000 annual fee ($6,000 per couple), patients get 24/7 access, reduced in-office waiting time, house calls, an enhanced yearly health exam, and other gold-plated services not generally covered by insurers. About 200 patients to date have enrolled—and the practice is “right on the fringe” of profitability.

“We don’t claim to be practicing better medicine,” says Wheeler, “but the fact that we can spend more time with our patients means they’re going to get better care.”

Other doctors feel the same way. Indeed, since retainer-style practices came on the scene in the late 1990s, their number has grown steadily. Florida-based MDVIP—a company that assists doctors in transitioning from traditional to retainer-style practices—has expanded its network in three years from a handful of local offices to 24 practices in seven states, with 40 more practices in the works. “We think there are as many as 2,000 primary care physicians out there who would qualify for this type of arrangement,” says former FP Edward E. Goldman, president and co-founder of the company.

Of course, that leaves a lot of physicians who aren’t cut out for custom medicine: Perhaps their patients can’t (or won’t) support it; perhaps they agree with critics who think it’s elitist; or perhaps the doctors are motivated for the wrong reasons—by anger at the system or the prospect of a quick buck. Indeed, despite the potential for high earnings in a boutique-style practice (one Florida internal medicine practice reports 575 patients have signed on at $1,500 per patient), the start-up years can be tricky.

Concierge medicine, from a doctor’s perspective, is a more gratifying and fulfilling way to practice medicine. Today’s doctors take on patient loads of up to 2,500 to 3,500 patients annually. Longer appointments with concierge physicians means a thorough discussion of patient questions and concerns. More time also translates into a real ability to monitor wellness screens such as mammograms and colonoscopies.

There exists the fear that concierge care will result in a two-tiered medical system based upon economics. In the beginning, this may have in fact been true. But as the practice has evolved over the past decade, so have individualized billing plans. Ideally, physicians should maintain long-standing relationships with patients regardless of their ability to pay out of pocket. About 250 concierge physicians exist in the United States today. Participating physicians report more time to devote to patient care and advocacy, as well as continuing medical education and family life. The result is a revolution in preventative care and a return to a more personal relationship between doctor and patient.