QUALITY CARE: Doctors switch to ‘concierge’ practice to offer more personalized care with less stress

By Kenn Alltucker | The Arizona Republic, July 24, 2008

Dr. Neil J. Sapin wooed his patients last week with a wine-and-hors d’oeuvres reception at his Glendale office. Next month, the doctor plans an encore bash at Arrowhead Country Club.

Such receptions are an unusual way for a doctor to mingle with patients, but Sapin has an unusual request for his patients. He wants them to pay an annual retainer of $1,500, a fee that will buy these patients better access and more attention from the busy doctor.

Sapin is among a handful of Arizona doctors who are so frustrated with the pressures of being a primary-care physician that they are striking a new, more exclusive path known as concierge medicine. The practice typically involves charging an annual fee in exchange for better access, longer appointments, more emphasis on preventative care and other medical perks.

“The idea behind it is nothing more than a return to the days of Marcus Welby,” said Dr. Steven Knope, a Tucson physician who operates a concierge practice for about 125 patients.

Concierge medicine is an appealing option for some primary-care doctors who want to break free from the assembly-line method of patient care that they say they are forced to adopt.

Primary-care doctors say this limited practice is appealing for many reasons. They cite the drumbeat of threatened pay cuts from government programs such as Medicare and the red tape and restrictions of private insurance companies. Other factors include the rising cost of malpractice insurance and the expense of hiring assistants and office managers who must push paperwork.

The trend underscores the fact that the role of primary-care practitioner is a less appealing option for young doctors who see more lucrative career paths in specialized areas of medicine such as dermatology or plastic surgery. Many young doctors don’t want to deal with the stresses of being a primary-care doctor. Medical-school students increasingly are picking careers in fields other than general internal medicine, according to a 2006 study by the American College of Physicians.

Sapin said he wants to convert his practice because he doesn’t feel he gives his patients enough attention.

“I used to see 18 patients per day, but now I’m up to 24 or 25,” Sapin said. “It becomes difficult to give people as much time as I’d like to.”

He believes the concierge practice will make his work-load more manageable. His traditional practice cared for about 1,600 patients. He expects the concierge practice will have about 500 fee-paying patients, who will have 24/7 access to the doctor via cell-phone, email and electronic medical records.

“That will allow me to see fewer patients per day,” Sapin said. “I will also have time to stress preventative health and dietary counseling.”

MANAGEABLE LOAD

The types of concierge-medicine practice can vary greatly. Some doctors charge patients more expensive annual fees, but they agree to limit the number of patients they will keep.

Knope said his patients pay an annual fee of $6,000. He does not accept private insurance plans from health-maintenance organizations.

Not all patients use his services equally. Those who are battling chronic diseases such as diabetes or heart disease typically visit him once every other week. Other patients may stop by for an extensive annual physical and little else.

Dr. Helene Wechsler, a Scottsdale doctor who converted to a concierge practice after 15 years of traditional family medicine, said she sets aside a minimum of 30 minutes for each patient. Some appointments are as long as two hours. She even makes house calls if a patient requests.

Patients who are very sickly appreciate having a doctor who can take more time and make sure all of their needs are being met,” Wechsler said.

Wechsler said she is able to run a more efficient office with one manager and a medical assistant. She doesn’t have to hire additional administrators to pore over complicated insurance forms or other paperwork.

She said the concierge is much more manageable than her traditional 3,000-patient practice, which averaged 20 patients a day.

“I was spending less and less time with patients in order to pay for increasing overhead,” Wechsler said. “I decided to change my practice four years ago. Not only am I much happier, but my patients are much happier.”

AFFORDABILITY ISSUES

Yet not all patients can afford to pay an annual fee to keep their doctors. These patients, particularly those who are on government-funded insurance plans, have expressed frustration over losing their doctor.

Jack Brami, 64, of Glendale, recently learned that he would have to switch doctors. Brami said he cannot afford to pay Sapin’s annual fee, so he must quickly find another doctor to help manage his chronic health conditions such as rheumatoid arthritis, high blood pressure and lymphodema (swelling of the legs).

“For a guy like me who lives strictly on a government check, this is an inconvenience of getting another doctor,” said Brami, a Vietnam veteran. “This is what medicine has come to?”

Patients such as Brami believe that the trend represents health care for the elite. Not everybody can afford to pay such a fee to keep their doctor.

“I think that is a legitimate criticism,” Sapin said. “It may be somewhat elitist. Not everybody can do this.”

But sapin added that there are enough health-care options for patients unwilling or unable to join his new practice. He said his staff will even assist patients in finding new primary-care doctors.

Many concierge doctors say they still handle a small percentage of charity cases or patients enrolled in Medicaid, the government’s insurance for low-income residents..

Some experts don’t think fees charged by doctors are unreasonable. People often spend thousands on medical care each year, said Chic Older, executive vice president of the Arizona Medical Association.

“When people hear the word ‘concierge,’ they automatically think it is akin to a five-star hotel or first class on an airplane,” Older said. “It can be a very basic, down-to-earth practice.”

FEW IN NUMBER

Most experts don’t think that a large number of doctors will switch to concierge medicine. The practice has been around for a decade or longer in some larger, coastal cities such as New York and Los Angeles. About a dozen or so doctors in the Phoenix area have adopted this practice. Also, health-care providers such as the Mayo Clinic and Kronos Optimal Health offer similar programs targeting patients such as corporate executives.

But some believe the rise of concierge medicine may lure more young doctors back into primary care.

“If we are able to create an attractive career alternative for medical-school residents, we will increase the supply of primary-care physicians,” said Jami Doucette, whose Scottsdale-based company, Modern Med, helps doctors establish concierge-medicine practices.

Doucette said he has experienced firsthand medical students’ frustration with the field. He completed medical school but opted not to pursue a career as a doctor. He worked briefly as a health-care analyst for an investment firm in Tennessee before launching Modern Med.

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