More doctors gravitate toward boutique practice
Fed up with long hours and limits on fees, they aim to offer a more personal approach — at a price
Concierge medicine is expanding as more doctors — and patients — tire of assembly-line primary care, opting for something more personal, and pricey.
The numbers are still very small — a survey commissioned by a congressional agency last year identified 756 concierge medical doctors in the United States, up from 146 in 2005. And Florida-based MDVIP, a company that helps physicians set up these practices, said it will add six new MDVIP doctors in the Boston area this year, increasing its physicians statewide to 16.
But even a tiny number of doctors leaving traditional offices for boutique practices — out of thousands of primary care physicians — is enough to make some health care industry leaders nervous. They worry that more doctors will follow as insurers and government payers cut fees and hem in providers with regulations. And when even one doctor makes the switch, there are substantial side effects, leaving hundreds of patients to scramble for a new physician.
Concierge doctors care for a small number of patients who agree to pay an annual fee on top of insurance — $1,500 to $1,800 in MDVIP’s case — in return for fast, unlimited access to the physician and to extra services like a comprehensive wellness plan. Patients also enjoy more leisurely appointments than the 15-minute visits that are now standard for most primary care doctors.
MDVIP’s expansion has upset leaders at Newton-Wellesley Hospital, after two extremely popular internists affiliated with the hospital told their patients this month that they are joining MDVIP and closing their traditional practices, in which they each care for 3,000 patients.
Under the plan, Dr. William Holgerson and Dr. Edward Legare will dramatically shrink their workloads, each caring for about 600 patients who are willing to pay the $1,800 fee — which compensates for their lost income from seeing fewer patients. The large doctors’ group to which they still will belong, Newton-Wellesley Primary Care, is hiring two new doctors for the patients Holgerson and Legare leave behind.
Holgerson, who turned 62 yesterday, said he couldn’t imagine practicing into his 70s with the existing pressures; most weekdays he arrives at the office at 6 a.m. and goes home after 7:30 p.m., not to mention the numerous weekend hours spent completing paperwork.
“I could provide the kind of care I’ve always wanted to provide with more time,’’ he said in an interview last week to explain his decision. “I want to emphasize patients’ health and not just deal with acute issues.’’
Legare, 48, was not available for an interview.
Many of their colleagues, however, have been critical of concierge medicine, saying doctors who open these practices strand thousands of patients in a system where primary care access already is tight and foster a two-tiered medical system, one for the well-off and another for everyone else.
“I understand it might be the answer for them,’’ said Dr. Thomas Lee, president of Partners Community HealthCare, a large physician organization that includes doctors affiliated with Newton-Wellesley Hospital, “but it’s not an answer for the health care system. If too many of our physicians do this, it’s just going to make primary care access that much more challenging.’’
While Lee said the number of concierge practices “is ramping up,’’ he does not believe it will become a widespread trend among doctors, largely because most patients cannot afford the fees. But others are not so sure.
Newton-Wellesley Hospital surveyed about 170 of its primary care doctors last year, and half said they had considered becoming concierge physicians. The hospital has started a “master clinician’’ program, which pays some doctors to mentor younger ones and provide longer appointments for challenging patients.
The pressures on doctors have only intensified. The state’s mandatory health insurance law means even more people with coverage are seeking doctors. Insurers are squeezing payments to doctors, and regulators and insurers are pressing providers to make care less expensive.
“It’s hitting home here at Newton-Wellesley,’’ said Dr. Leslie Selbovitz, chief medical officer. “As health care reform matures, doctors are questioning whether they want to be part of the new world order.’’
The decision by Holgerson and Legare hit especially hard because they both have leadership roles at the hospital — Holgerson is medical director of a joint physician-hospital organization and Legare is a trustee — positions hospital officials will now review.
MedPac, the Medicare Payment Advisory Commission, which advises Congress on Medicare issues, paid for a study last year on “retainer-based physicians’’ because of concerns that Medicare patients could be left without doctors.
The study identified 25 concierge doctors in Massachusetts, out of thousands of primary care physicians. Researchers interviewed doctors who said they were “mentally and physically drained at the end of their day’’ and that becoming concierge physicians relieved that stress. Some said they were making more money, too.
If 600 patients pay a $1,800 fee, that comes to $1,080,000. MDVIP keeps one-third of the total for helping the doctors run their practices, leaving $720,000 for the doctor to pay salaries and other expenses — on top of reimbursements from insurers for standard office visits and exams, which generates more revenue.
Lee said that the doctors who end up becoming concierge doctors “are physicians so liked and respected that their patient panel grew to a number that was not consistent with a life with family and friends.’’ He said he himself was guilty of asking Holgerson and Legare to take on new patients, even though their practices were full.
Holgerson said he knew of no good way to cut back on his patients without making a dramatic change.
There are no data on the growth of patients in concierge practices, but one person who recently made the switch, Luigi Schena, says he is pleased.
A chief financial officer for an environmental clean-up company, he had been a patient in a very busy practice for 15 years, but he said he did not feel he was “getting the attention I wanted from my primary care doctor. They were just trying to bang out as many patients as possible,’’ he said. A co-worker suggested Dr. Harold Solomon, one of the first MDVIP doctors in the Boston area. Schena joined his practice three months ago.
Greg Goostray, 45, a financial services executive, joined Solomon’s practice two years ago. Solomon called him with test results from his Florida vacation, checked in on him every day when Goostray was home sick for a week, and talks to him a length about putting his high-stress job, which has caused anxiety attacks, in perspective.
“He’s not like a psychiatrist but he’s damn close,’’ Goostray said.
Dan Hecht, chief executive of MDVIP, said that patients are very satisfied with the extra service, with about 92 percent of patients renewing their memberships last year.
During a MedPac meeting on the issue in September, however, one commission member, Dr. Ronald Castellanos, a urologist in Florida, said he sees concierge patients referred by their doctors, and many have unrealistic expectations of the rest of the medical system. “As soon as the come in the room, they want my cellphone number,’’ he said.
Liz Kowalczyk can be reached at firstname.lastname@example.org.