At a time when a medical appointment can last less than 10 minutes and may not even involve seeing a doctor, concierge medicine is turning back the clock.
Patients get 30 minutes with their M.D. --- and that's the shortest appointment. They have their doctor's cell number and can call anytime. The doctor knows most of the patient's medical history without studying the chart. Want to talk about getting healthy? That doctor-patient conversation may take an hour or more and develop into a journey that could start with a plan for weight loss, but will delve into all the details of your family life and your work.
Even a house call is not out of the question.
For about $1,500 a year, on top of the regular charges of coming to the office, you can buy into this new model that eliminates many of the complaints that physicians and patients have about today's health care system. While it may be great for those who can buy in, some in medicine worry about what it will mean for everybody else at a time when Georgia is already grappling with a doctor shortage.
"It leaves those who can't afford it out in the cold, and I think you're setting up a system that has two tiers to it, " said Dr. Sandra Reed, an ob-gyn from Thomasville who is president of the Medical Association of Georgia, a trade group for physicians. "If you can afford to pay the doctor, you know they will be there for you, and if you can't afford that you are stuck with no doctor."
But Reed completely understands why some doctors are going concierge.
"Medicine has gotten to the point that in order for physicians to make a living they have to do the concierge practice and they can't open their doors to every patient that needs a physician, " she said. "That is the travesty of this health care system."
'Conveyor belt medicine'
Talk to any doctor in a solo or small group practice and they will tell you that practicing medicine isn't what it used to be. They say the government health plans --- Medicare and Medicaid --- cover more people than ever before but pay less than the cost of seeing a patient. Private insurers are more stingy than in the past. Demands for documentation, pre-authorization and electronic records require more time and money these days.
The result? Many doctors see as many patients as possible, day in and day out, to keep their practices afloat.
"Traditional primary care has become conveyor belt medicine, " said Mark Murrison, president of MDVIP, a Florida-based concierge medicine company. "We're less healthy than we have ever been. Patients are dissatisfied and doctors are dissatisfied."
MDVIP is a dominant player in the concierge medicine industry, which is converting a small but growing number of physician offices into these boutique practices. While a concierge is, literally, a hotel staffer who handles a guest's every need, the medical version is designed to do that for each patient's health.
The concierge model usually works like this: Ask patients to pay about $1,500 a year and cut a doctor's patient load from 3,000 down to 600 patients or less. The concierge company usually keeps about a third of the patient's payment to cover services. The rest of the patient's fee pays for wellness services --- including lab tests --- that aren't covered by insurance, while also underwriting the practice. That allows the doctor to see fewer patients and still make as much money or more.
While $1,500 is out of the question for some, it's within reach for many in the middle class who spend that much every year on cable television alone.
"It's a matter of where you want to put your priorities in terms of your health care, " said Tim Alderman, a 57-year-old from Marietta who went concierge when his internist, Dr. Tim Cummings, joined the MDVIP program. Alderman said he knows plenty of people making average money who spend their extra cash on Falcons and Hawks tickets. For Alderman, doing all he can to stay healthy is worth the investment.
"I'm in good health and I am very active, but I know if we want to maintain the health we have, we need to stay in front of it, " he said. "It's all about preventive care."
Alderman travels frequently for work. If he needs an appointment quickly he can get it. If he needs help while out of town, his doctor is just a cell phone call away. He didn't hestitate to call his doctor for advice when a family member was going through a crisis. And he likes knowing that his doctor isn't facing a jammed schedule of 30 patients a day.
"He doesn't have to be in a hurry, " Alderman said.
Dr. Cummings said his patients think of him as the quarterback for their health care. "I"m looking down the field --- I call the plays, " he said. While he likes that role, he also sees himself as getting back to the root meaning of doctor: a teacher.
"Seeing a patient for six to eight minutes at a time, it's very difficult to fulfill that role as a teacher and doctor, " Cummings said.
Today, he can go over everything his patients need to know in detail: what their lab results mean; how the body works; step-by-step changes they need to make to their diet and exercise routine. When he refers a patient to a specialist, he has time to call that doctor and have a conversation about the patient instead of just writing a note that is faxed to the office.
An ideal model?
Doctors on the outside of the concierge model tend to admire what it achieves, since it offers the kind of doctor-patient relationship that many had in mind when they went to medical school. They know most doctors have to see a higher volume of patients than they would like to see because of the realities of what insurers and government health plans pay.
"The days of Marcus Welby where you could sit down and talk to a patient for an hour --- that was all great and we all wish we could do that, " said Dr. Robert Jansen, president of the WellStar Medical Group. "But if you're going to make a living and you're going to pay your overhead and your staff and your malpractice insurance, you can't afford that model."
Jansen sees why doctors would find the concierge model satisfying. But he also knows it creates a dynamic when a doctor cuts a practice of 3,000 patients down to 600 at a time when Georgia already has fewer internists and family physicians than it needs.
"What happens to the other 2,400 patients?" Jansen said. "Who is going to take care of them? It exacerbates the physician shortage."
Concierge medicine is one way for some to improve primary care, but it certainly isn't the solution, said Dr. David Satcher, the former U.S. Surgeon General who now is with the Morehouse School of Medicine.
"It's another resource that's available if you have the money, " he said. "That doesn't solve society's problems."
Those behind the new approach, however, say the concierge model shouldn't be written off when it comes to offering a broader solution. Its focus on prevention avoids costly illnesses --- and they say it helps address the shortage by keeping doctors in practice longer.
"We have many doctors in their 70s going strong, " said Dr. Andrea Klemes of MDVIP, "'because they love practicing medicine again."
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