Doctors offer exclusivity, but for a hefty retainer

By TOM MURPHY

Over the counter cold-and-flu remedy: $5.99.

Trip to the doctor’s office: $20.

Extra time to bend your doctor’s ear: $1,500 a year and up.

Primary-care physicians are increasingly offering exclusivity to those willing to pay for it.

These practices, known as concierge, boutique or retainer practices, typically charge annual fees that range from $1,500 to $10,000 or more. The fee allows the businesses to prosper with a far smaller roll of patients than has become the norm under the traditional system.

Patients like the extra attention and lack of crowded waiting rooms. Doctors say they need alternatives to a payment system that forces them to cram their schedule with appointments.

But the growth comes with concerns about doctor access, particularly since a bill moving through Congress could cover millions of uninsured people and flood doctors’ offices with new primary-care patients.

Heidi Berman pays $1,500 annually to see Dr. Stephen Glasser in Baltimore. The 38-year-old attorney said visits to her previous doctor lasted five or maybe 10 minutes.

“If you had questions, they were sort of an afterthought because the experience was so rushed,” said Berman, who switched to Glasser a year ago.

Now, if she forgets to ask a question during normal office hours, she calls her doctor in the evening and he immediately calls back.,

The fee typically gives patients longer, more in-depth appointments with doctors as well as extras normally not covered by insurance. That can include an annual physical that delves into nutritional counseling and depression screening and provides a wider range of tests and blood work than patients usually receive. They also get after-hours access to the doctor.

Most patients still need insurance in addition to this fee, and they still pay co-pays and other coverage-related costs.

Glasser used to care for about 3,500 patients, seeing between 25 and 30 a day. He pared the total down to between 600 and 700 when he converted to a concierge practice six years ago.

He still has full days, but he traded 10-minute visits for more time with patients, including physicals that can last longer than an hour.

The number of doctors who operate a retainer-based practice is hard to pin down and is still a small slice of the roughly 326,000 U.S. primary care doctors. But organizations that help start them report brisk growth.

MDVIP Inc., based in Boca Raton, Fla., works with 340 doctors who have about 122,000 patients. It is one of the bigger firms in the business and has seen both doctor and patient totals grow by 10 percent or more every year since the company started in late 2000.

Concierge Choice Physicians in Rockville Centre, N.Y., works with 120 doctors who have converted their practices. Managing partner Wayne Lipton said there also could be a few thousand doctors who set up retainer-based practices without such help.

In contrast, a 2005 U.S. Government Accountability Office report identified only 146 concierge physicians in the entire country.

The growth in concierge care is “a reflection of the fact that we’ve got a very dysfunctional health- care system,” under which doctors are forced into a “hamster wheel” system in which they must see lots of patients just to stay afloat financially, said Dr. Lori Heim, president of the American Academy of Family Physicians, which is neutral on the subject.