Two popular Boston internists are closing their busy practices, leaving most of their 7,500 patients to find new doctors, as the physicians open a small concierge practice that will charge individuals a $3,600 yearly fee to join.
Dr. Jeffrey Bass, 50, of Brigham and Women's Hospital, and Dr. Ronald Katz, 51, of Beth Israel Deaconess Medical Center, are the latest physicians to give up large traditional medical practices, in which doctors see a patient every 15 to 30 minutes, in favor of a slower pace and potentially higher income.
A third highly sought-after doctor who practices with Bass, Dr. Martin Solomon, 58, has decided to stay with the Brigham but to scale back to a smaller practice. He recently mailed a letter to most of his 5,000 patients asking them to voluntarily switch to another doctor in the practice.
"Unfortunately, for many, many years I've had trouble saying no to new patients," said Solomon, who added that the administrative burden in his practice has become overwhelming. "I just felt I couldn't physically do it anymore."
Access to primary care doctors is becoming a major issue for patients in Boston. As more doctors retire or dial back their grueling practices, it is getting harder to find an experienced, established physician in Boston. Fewer medical students are entering primary care -- 20 percent in 2005 compared with 55 percent in 1998 -- contributing to a national shortage of internists.
While the number of doctors switching to concierge practices is small, the change can be disruptive for patients who do not or cannot sign up. Current patients of Bass and Katz have to decide whether to pay the fee to stay with their doctor or find someone new, who may not have the same experience level or local connections. The Brigham and Beth Israel Deaconess said they have each hired two new doctors to ease the transition for patients.
Concierge medical practices, despite criticism that they shut out all but the well-off, continue to attract doctors and many patients who say the practices let physicians provide more personal care in an unhurried atmosphere.
Some of the extras Bass and Katz are promising were once considered standard parts of a doctor's portfolio, but now, most primary care doctors say they are too busy to provide them. Most notably: visiting patients in the hospital, same-day appointments, and nearly around-the-clock access to their doctor.
"I understand why the doctors are doing it," said Dr. Richard Parker, medical director of the Beth Israel Deaconess physician organization. "They want more time with patients, fewer hassles, to get paid better. But it's a symptom of the poor state of affairs in primary care; many doctors are looking for the exit."
No one tracks the number of doctors who have switched to concierge practices, but the number is believed to be several hundred nationally and one to two dozen in the Boston area.
MDVIP, a national company that helps doctors set up such practices, has 154 doctors and is about to embark on a rapid expansion, adding an estimated 1,000 to 1,500 doctors in the next five to seven years, according to president Darin Engelhardt. The company's data, he said, show that patients of MDVIP doctors spend less time in the hospital compared with patients in regular practices, presumably because of the extra attention from physicians.
Bass and Katz, who plan to open their new practice in September, mailed letters to their patients and created a website explaining the change earlier this month. Katz said his new practice, to be called PersonalMDs, will allow him "to practice a bit of old-fashioned medicine" at a "less intense and frenetic pace." He works about 55 hours a week now, he said, and sees 25 patients a day. He expects to work a similar number of hours, but see far fewer patients daily, and the practice will accept only 800. Among the services Katz and Bass will offer are long visits, "24/7 availability," a waiting room with Internet access, a yearly consultation with a nutritionist, and home visits.
Bass said he expects to have 400 patients signed up by next week, "which shows me there's a need and want." A number of his patients are doctors, he said, which "validates the model."
Doctors in these practices can earn substantially more money. Insurance still covers office visits and tests, but the extra fees paid by patients can lift physicians' salaries well above the standard $200,000 to $250,000 for an experienced, busy primary care doctor in Boston.
If 400 patients pay the annual $3,600 fee -- or $6,000 for a couple -- that would bring in between $1.2 million and $1.4 million, although overhead in these practices is very high because services are extensive.
Among doctors, concierge medicine remains controversial.
"The patients and doctors who get left behind are the ones hurt by" it, said Dr. David Ives, another Beth Israel Deaconess internist. "The patients have to seek new doctors in an already overburdened system, and the remaining doctors have to see even more patients."