The Association of U S West Retirees



'Concierge Medicine' - Take It or Leave It
Laguna Beach Independent


February 2, 2009

Dr. Frank Rose in his Laguna Beach office.

More primary care physicians are embracing "concierge medicine," where patients pay an annual fee to guarantee access to their doctor, and giving their patients an ultimatum, pay to stay or find another doctor.

Some doctors switch to this kind of practice on their own while others join a concierge doctor network, such as MDVIP.

MDVIP-affiliated doctors limit their practices to a maximum of 600 patients. In exchange for $1,800 annual fees, patients receive 24/7 access to their doctor, a thorough annual physical, and express scheduling and office visits.

Laguna Beach physician Frank Rose prefers the Marcus Welby approach. "I like to spend time with my patients," said the Dana Point resident, who gives patients his cell phone number. Even so, his stress has diminished because patient visits are more productive.

Some opponents of concierge medicine view the business model as an extra level of bureaucracy atop managed care medical insurance. Dr. Bill Anderson, who runs the Sleepy Hollow urgent care facility downtown, wrote recently in a weekly ad, "if you have a real doctor in a private practice and not a managed care medical plan, you get the same service, minus the frills. Your doctor or an associate is available by phone 24/7 and they coordinate emergency and hospital care when you need it. So what's the big deal?"

Staff photos by Ted Reckas Dr. Jorge Rodriguez in his Newport Beach office.

Jane, a seven-year Laguna Beach resident who asked to remain anonymous because of the personal nature of her disclosures, said that she and her husband like the concierge-style approach.

Their doctor conceded he was "terrified" that patients were not receiving the care they needed because of time constraints imposed by a large practice. Under the concierge model, he cut his roster to 300 patients, who pay $2,000 a year.

Jane considers the expense well worth it. She and her husband have already benefited from expedited services. When a routine exam revealed a questionable growth, her doctor was able to schedule an MRI within two days. The doctor called her on a Saturday to give her the results.

When her husband's physical revealed plaque in his arteries, their doctor argued with their medical insurer for tests not typically covered. He also provided a detailed roadmap for suggested lifestyle changes.

"I think if you have the privilege to do this," explained Jane, who is 62 and a senior analyst for a California university, "it makes a lot of sense when you get older and you get vulnerable. In our minds, as we get older, we can use the money for a vacation, or we can pay for a doctor who is there for us when we need him."

The annual premium for an employer health plan covering a family of four averaged $12,700 and $4,700 for single coverage last year, estimated the National Coalition on Health Care.

Dr. Bernard Kaminetsky, MDVIP's medical director in Boca Raton, Fla., said their doctors provide a "wellness intervention program." A company study in 2005 shows that patients in MDVIP affiliated practices were admitted to the hospital at lower rates than non-MDVIP patients.

Rose uses a 30-minute office visit to learn what's going on in his patients' lives, a mirror into their physical wellbeing. He can learn details not possible in the five to eight minutes required to keep up with an insurance-driven clientele.

Laguna Beach resident Dr. Jorge Rodriguez, who practices in Newport Beach, is moving to the MDVIP network. "Medicine is becoming very volume oriented," he explained, adding that in the usual model a doctor must see 25 to 30 patients daily, limiting personal contact to 10 minutes or less.

"For me, I didn't sign up to practice medicine like this," he says. "Unfortunately I started practicing 25 years ago when it was different. I have seen the change, and it's very disheartening."

His 2,100 patient load will eventually be reduced to 450 or 500. He figures he will work just as hard but spend more time on each patient.

Rodriguez regrets that concierge medicine only helps a limited number of people. Ideally, he'd like to see a national healthcare system that embraces the concept of preventive medicine.

In the meantime, Rodriguez has chosen to help those he can under the current system, including himself.

John, a 20-year Laguna Beach resident, who also wished to remain anonymous because of the subject, quit his doctor after he switched to a concierge model. "I said to myself it doesn't seem worth it," he said. He found another doctor with comparable qualifications to take him on for no other fees. "I'm very happy with the new doctor and very glad I've saved $3,600," the fees for himself and his wife had they stayed with the original doctor.