Docs: Patients say 'concierge' care is worth the extra cost

Drs. Alan Sheff and Robin Merlino were about to quit primary care.
Each was attempting to care for several thousand patients in a busy group office, seeing 20 to 25 patients a day, and losing ground financially. Both were only in their 50s, but ready to leave medicine.
Today, each sees about 10 patients day. Appointments are set no more than a half-hour at a time. And Sheff and Merlino are happy about being family doctors. Their patients are happier, too, even though each one pays $1,500 a year for the privilege of being a patient. Patients also must pay for other services and lab tests up front, but get help from the doctors in submitting insurance claims.
Sheff, six years ago, and Merlino, less than two years ago, joined a national network of physicians who agree to limit their practice size and guarantee a certain level of care for an annual fee. The network, called MDVIP, is one of several formed to help physicians organize limited, but still profitable, practices. Some 5,000 American doctors are thought to be working under such arrangements.
"Before, I rushed from exam room to exam room, I felt like I was on a treadmill or roller skates all day long," Sheff said. "Now, with 500 patients, I'm as busy as I want to be. And my patients are happier too, they didn't like the old ways any more than I did."
"In the old traditional practice, I might wait an hour, hour-and-a-half for an appointment. Now, I seldom have a wait," ," said George Nemcosky, a retired Montgomery County, Md., teacher who has been a patient of Sheff's for more than a decade. "This is a special relationship, I can call or e-mail Dr. Sheff and I know he'll get back to me that day.
"Sure, the annual fee isn't cheap, but I appreciate his approach, I know that if you don't have your health, you're not going to enjoy the other aspects of your life."
A Scripps Howard News Service review has found that access to primary care is deteriorating across much of the country, driving millions of people outside traditional family practices, or leaving them without care. And frustration with insurance rules and assembly-line is prompting thousands of doctors like Sheff and Merlino to dramatically change how they work.
Merlino became a solo practitioner when she joined MDVIP, leaving a group she'd helped found in Vienna, Va., in 1983.
"There were doctors in my group willing to take on the patients who didn't follow me over," Merlino said. "The transition was painful, but patients come and go all the time in medicine -- they move, their insurance changes, they get mad at you.
"I really can't imagine practicing the way I used to. I love being in a small office and being able to give this type of care, with no more in-and-out appointments, time to listen and focus on prevention."
"She is definitely less stressed, she makes you feel as though you are her only patient,'' said Elise Steinfeld, a dental office administrator from Fairfax, Va., who Merlino has had in her care for 19 years.
"In her old office, most every visit was three hours. Sometimes I went to another doctor outside her practice so I didn't have to wait. Now, I know I'm going to be seen in five minutes and not be rushed out after 10 minutes. It's really more a Dr. Marcus Welby type of practice, very homey feeling."
Sheff's revolution was more complex. He remains the chief executive of both a four-doctor MDVIP clinic and a traditional practice with 10 more doctors in three clinics, one adjacent to the concierge office.
Although independent, the two practices do share a billing service and doctors can cover for each other if necessary. But there's a waiting list to join the MDVIP practice, while the traditional practice has younger doctors still accepting new patients.
Sheff says his workday is bit shorter -- maybe by an hour.
"The real difference is, on the way home in the car, I'm not asking myself, what did I miss," he said. "There's not that unsettled feeling. I leave knowing I've done the best by every patient."
Both doctors talk fondly about "catches" they've made in their new practice that might not have happened when they were so rushed. Merlino has found several patients with a rare iron processing disorder, hemochromatosis, by running an extra blood panel. She's found a recurrence of breast cancer in a patient who came in because of breathing problems.
Sheff had been seeing one patient in his 70s for at least 10 years.
"The first time he came into the new practice for a physical, I heard a soft heart murmur that turned out to be life threatening -- and it wasn't new," he said. "Was I any better or smarter a doctor that day? Not really, but there's something about slowing down and taking your time that makes you a better doctor."
Yet there is criticism for concierge care, too, that the practices widen the gulf of health between the well-off and the poor, that each doctor who has limited his or her practice to 600 or so patients are thus not caring for several thousand others that they might otherwise.
Dr. Thomas Bodenheimer, a medical professor at the University of California-San Francisco, said the services "are rarely available to lower income patients, and if the approach were widely adopted, the primary care workforce would become grossly insufficient to care for the entire population."
"It's like saying that because people live on Park Avenue, there are homeless people in New York," counters Dr. Bernard Kaminetsky, medical director of MDVIP. "This is one of many models of care in this country, and it's serving a group of patients well. The fact is, if they weren't practicing this way, most of the doctors in MDVIP would be lost to medicine entirely."

(E-mail Lee Bowman at bowman(at)shns.com. Distributed by Scripps Howard News Service, http://www.scrippsnews.com)