Concierge medicine offers personalized care, but not without controversy

More and more patients are forking over cash for medical services not usually associated with health care plans — physician accessibility and personalized attention.

Concierge medicine, sometimes called boutique medicine, is a business model in which patients pay an annual retainer — separate from the cost of medical services — to their primary care physician for enhanced care. This may mean direct access to the doctor via telephone or e-mail, additional preventative care, and/or more time with the doctor, as concierge medicine practices are usually capped at a much smaller number of patients than conventional providers.

The concept is relatively new, having taken off as a trend about 10 years ago. The Society for Innovative Medicine Practice Design, a professional organization for concierge and other direct care providers, reported an increase in membership from 200 in 2008 to 5,000 in 2009.

The growth may be attributable to patients dealing with the frustration of being rushed through appointments (on average, individuals get less than 20 minutes with their doctor at each visit), and the inability to obtain care when they need it.

A 2009 survey of 1,162 physician appointment wait times (including those in San Diego) conducted by Merritt Hawkins & Associates found the average ranged from 15.5 to 27.5 days, depending on the specialty.

Doctors, too, have been receptive to the new approach.

"It's no secret that reimbursement by insurance companies and Medicare has dropped over the years," said Len Jurkowski, M.D., a family practitioner in La Jolla who, after 27 years of traditional medicine, changed over to a concierge medicine practice 2 1/2 years ago. "Physicians are left with very few choices. You can either try to see more people to remedy that model or you can try to provide care in a smaller model where you see fewer patients."

Cost/benefit analysis

"Concierge medicine is essentially when a physician limits his or her practice size," explained Pamila Brar, M.D., an internal medicine doctor from La Jolla who launched a boutique practice in January. "It allows patients to get access to care in a way that is convenient and works around their schedules."

For $2,500 a year, Brar's patients can contact her virtually any time of the day or night. Instead of caring for 3,600 patients, as was the case before she transitioned to concierge medicine, Brar plans to cap her practice to roughly a tenth of that.

Brar said she made the change because "I felt that I wasn't able to be there for my patients when they needed me. It's a frustrating way to practice, and it doesn't allow you to develop relationships."

The new model not only allows Brar to spend more time with each patient, but she can participate in their care directly by coordinating referrals and follow-up testing, making house calls, discussing patient issues with specialists, and even accompanying patients to other appointments.

Recently, Brar noted that one of her elderly patients was having trouble walking. She recommended getting new shoes but discovered that the patient did not have anyone to take her to the store. Brar ended up going with her patient to Foot Solutions and picking out new shoes.



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