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Boutique medicine: When wealth buys health

By David E. Williams
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(CNN) -- Dr. Bernard Kaminetsky sees about a dozen patients during a typical day at his Boca Raton, Florida, practice. His patients have his personal phone number and can schedule a same-day appointment with him.

Kaminetsky left his traditional practice in 2001 to join MDVIP, one of the leaders in the small but growing trend toward concierge, or boutique, medicine -- highly personalized care for patients who pay an annual fee.

Patients pay from $1,500 to $1,800 per year to join MDVIP. In exchange, they get a full physical and wellness plan, 24/7 access to their doctor, wallet-sized CDs with their medical data recorded on it and other services.

They also get a doctor with only 600 patients, compared to about 2,500 at a traditional practice. MDVIP promises same-day or next-day appointments that last as long as the patient needs.

Kaminetsky said dashing between 25 and 30 patients each day at his old practice left him dissatisfied because he only had enough time to treat people who were sick instead of providing preventive care.

"Because of the nature of a smaller practice it means I have more time to spend with patients and delve into problems," Kaminetsky said. "I think one of the advantages of having fewer patients is that I have more time to appreciate those subtleties and nuances which can translate into big differences in terms of clinical decision-making and patient care."

John Goodson, an associate professor at the Harvard Medical School, calls the concierge practices "country club medicine" and says it sends the wrong message.

"You still have this concept that you have to be a member of a club to get the health care you deserve," he said.

If firms like MDVIP are the Cadillac of health care, then MD2 (pronounced "M-D-Squared") is the Bentley -- offering unlimited access to patients who can afford it.

"Imagine if your brother, your father, or your mother was a physician and you became ill, that's what we provide," said MD2 partner John Moses.

Each MD2 doctor treats no more than 50 families, Moses said.

"What that means is that our physicians have all the time necessary to provide complete access to their patients, extraordinary care and service, and home or office visits," Moses said. "We're able to offer total privacy because it's highly unlikely that we would ever have more than one patient at our office at any given time."

The offices don't have waiting rooms (or much waiting) and patients are encouraged to call their doctors directly when they need to talk to them. If a patient needs to see a specialist, the MD2 doctor will help find the best ones and even go to the appointment.

Moses said MD2's style of care costs a family of four about $24,000 a year. That fee would cover all doctor visits and any other services the office provides, such as X-rays, but outside treatment -- an MRI, for example -- would cost extra.

About 76 percent of the concierge doctors surveyed in a Government Accountability Office report issued last year said they billed health insurance companies for covered expenses and almost all said they would accept Medicare patients.

MD2 has offices in Seattle, Washington; Bellevue, Washington; and Portland, Oregon. A fourth office is scheduled to open next year in San Francisco, California, and the company plans to expand into other major cities, Moses said.

Goodson said he is concerned that concierge medicine is worsening the shortage of internists, which he said was already at a crisis.

"It's really sapping the workplace dry," he said. "What that means is that everyone else who decides to remain in mainstream practice shoulders the burden."

But Kaminetsky said he might not be treating patients at all if he had not made the switch.

"That question is predicated on the presumption that if I weren't seeing the 600 I'd still be seeing the 2,600 and that's a flawed premise because many doctors are becoming so disillusioned that they quit primary care altogether," he said.

The American Medical Association does not track the number of concierge doctors because the practice is fairly new -- MD2 opened the first concierge practice in 1996 -- and because of the small number of doctors involved.

Rick Kellerman, the president of the American Academy of Family Physicians, said the number of concierge doctors is still too small to have much of an impact on the health care system.

"To me the underlying issue on this is why physicians do this" Kellerman said. "And I think it's because people are just so frustrated and exasperated -- particularly in primary care practices -- by the amount of paperwork, the amount of hassle and payment rates that don't reward for the services provided by primary care."

"There's a lot of physicians that think about it, but not very many have signed on to do it," Kellerman said.

The GAO report found that in 2004 there were just 146 concierge physicians in the United States. Most were clustered in the Northeast, the Pacific Northwest and in Florida.

Two-thirds of the 112 concierge doctors who responded to the GAO survey said they had begun practicing that type of care since 2003.

MDVIP says the 130 doctors now in its network treat more than 40,000 patients.


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