Want a doctor who isn't juggling thousands of patients and is willing to give you direct, anytime access through a personal cellphone number?
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"It's there because the current health-care system is broken and we actually have to pay people to talk to us. You're buying back personalized medicine, a relationship with somebody, because the current business model has weeded that out." — Art Caplan, chairman of the University of Pennsylvania's Department of Medical Ethics in Philadelphia. |
That's the allure of boutique medicine, where patients pay a flat annual fee to a primary-care doctor who caters to a smaller group of patients.
About a decade after it began, boutique medicine remains a small niche. But the number of boutique practices is growing, especially on the East and West coasts where wealthier people are apt to pay more to -- and expect more from -- their health providers, experts say.
Yearly fees vary and can run up to thousands of dollars, depending on the provider and the level of service and convenience offered. Some doctors' fees cover multiple office visits, a comprehensive exam and some tests, while others just cover a single office visit. So prospective patients need to understand exactly what a fee buys them in terms of preventive care and access and tests and what other charges, such as typical insurance premiums and co-payments, may apply.
More Time for Medicine
Reduced patient loads, higher income and more time to spend solving medical problems, instead of health-insurance issues, are what James Taylor, an internist in San Rafael, Calif., says attracted him to start a retainer practice in March of 2003.
Dr. Taylor was seeing as many as 35 patients a day but his business was struggling after a five-doctor practice he was part of disbanded. So he contracted with Boca Raton, Fla.-based MDVIP, a company that helps doctors transition to boutique practices.
Now he's winnowed his patient base to 425 from nearly 4,000 and sees "anywhere from eight to 15 at the most on a very busy day."
Such a reduction often translates into longer and same-day appointments, extensive physicals, better coordination with specialists and more follow-up as well as a greater emphasis on preventive care.
Dr. Taylor's staff of two, for example, is able to keep track of which patients taking cholesterol medications are due for blood work and call them.
"Patients are happier; I'm happier," he says. "I've got more time to devote to each problem a patient has. I feel much more comfortable and confident about what I do."
Patient retention is high, says Darin Engelhardt, the chief financial officer and general counsel for MDVIP. The company counts 40,000 patients across the nation, 95% of whom renew their annual memberships, he says. A list of participating doctors is provided on the company's Web site, www.mdvip.com.
Patients who leave the practice usually either die or relocate, says Dr. Taylor, 53, though he's quick to point out that the retainer approach isn't for everyone. "I don't think this is a solution for the entire population or for health care in general. I see this as a solution for my particular situation and circumstance."
The typical fee is $1,500 a year, though doctors in places like southern California can command $1,800, Mr. Engelhardt says. That doesn't include any co-payments or deductibles required by an insurer. Most boutique practices take and use insurance with the same paperwork procedures as other doctors' offices.
If you look at the fee as a monthly outlay, more people than simply the well-heeled can afford to join, he says. "For people who choose to value preventive care, it is a very viable choice from a financial perspective."
MDVIP requires that its 127 affiliated practices take no more than 600 patients per doctor. The company started out with six physicians at the end of 2001 and expects to have as many as 150 doctors by the end of the year, with a goal of adding 60 more in 2007, he says.
Driving Forces
Boutique medicine is driven by several factors besides doctors' desire to make more money, says Art Caplan, chairman of the University of Pennsylvania's Department of Medical Ethics in Philadelphia.
"It's there because the current health-care system is broken and we actually have to pay people to talk to us," he says. "You're buying back personalized medicine, a relationship with somebody, because the current business model has weeded that out."
Mr. Caplan and William Plested, president of the American Medical Association and a thoracic and cardiovascular surgeon in Santa Monica, Calif., agree that boutique medicine is likely to stay a niche practice.
"The economic reality and demographic reality is there aren't that many areas that will support this type of practice," Dr. Plested says.
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