Boutique doctors


  • Health
  • Sunday, 19 Jan 2003

Fancy your own personal doctor who’s on call 24 hours a day, 365 days a year? Welcome to a new movement in medicine where personalised care can be available, for a price, writes ERIKA NIEDOWSKI.  

The idea of personalised care is to give more attention to fewer patients so that quality of care is not compromised. 

DR Marsha Y. Blakeslee didn’t recognise the number on the page she received one recent Friday night at home while she was changing her daughter’s diaper, but she called back right away because she knew it must be one of her patients.  

A woman on vacation with her husband in Hawaii was feeling awful, with a fever, a terrible cough and aches all over.  

Five minutes later, Blakeslee figured out that her patient was suffering from a severe case of bronchitis, so the 39-year-old doctor called in prescriptions to a Hawaiian pharmacy for antibiotics, a chest decongestant and a cough suppressant, and the woman was soon on the mend.  

Blakeslee is part of a growing movement in primary health care in the United States known as “boutique medicine” or “concierge care”, in which people pay steep annual fees –sometimes as much as US$20,000 (RM76,000) for a couple – to receive more personalised attention and day-and-night access to their physicians. With Dr Maryrose F. Eichelberger, Blakeslee opened a practice in Severna Park, Maryland., that charges US$1,500 (RM5,700) a year for individuals and US$4,500 (RM17,100) for a family of four to join the patient roster.  

Critics of the boutique movement call it elitist, saying patients who can’t afford to pay the membership fee are being left out. They also say the burden on overworked primary care doctors will only get worse if more begin seeing fewer patients and opt out of traditional practices with wide-open doors.  

But doctors such as Blakeslee and Eichelberger say they weren’t able to provide the best care for their patients under the old, rushed system. As a result, they say, their practice was no longer professionally satisfying or financially viable.  

“There was a constant sense that things were getting worse,” said Blakeslee, who has been in practice with Eichelberger since 1999. “There has been a constant, growing pressure to see patients in volume. That’s entirely at the hand of the insurance industry. That’s just not sustainable. I couldn’t tolerate the thought of shorting anyone in their health care.”  

The two doctors are affiliated with MDVIP, a Florida-based company trying to create a national network of boutique providers.  

The company has signed up 20 doctors in six states, including Massachusetts, New York and New Jersey, and is projecting to have 100 by the end of next year, said Andrew S. Ripps, its chief operating officer.  

Technically, MDVIP stands for “My Doctor believes in the Value In Prevention”, meaning that physicians aren’t just reacting to illness but trying to keep people well in the first place. But the company’s name also points to the access that a Very Important Patient gets for his or her retainer fee.  

Mary Alice D. Edwards, an 89-year-old retired religious educator from Severna Park, decided she wanted to stay on as a patient of Eichelberger’s after two years under her care. So she paid the US$1,500 (RM5,700) to join the new practice.  

“I like that personal relationship with a doctor,” she said. “When your doctor sees you as a person, it’s a little different than simply being a patient. I think the important point is giving (the doctor) a manageable workload so she is still a person and not a machine.”  

Eichelberger used to have a patient load of about 1,500 – some doctors have twice that –which required from 20 to 25 appointments a day.  

Now, she and Blakeslee will each see 600 patients, or about 12 a day.  

Patients who join get a comprehensive annual exam, including a slew of tests, a chest X-ray and an ECG. Beyond that, they are guaranteed 30-minute same-day or next-day appointments - on time. They also get their doctor’s personal pager number for use 24 hours a day, 365 days a year.  

“It removes the barrier,” said Eichelberger, 42, who was considering leaving primary care medicine and doing hospital shift work instead before she learned about MDVIP. “It lets the patient know, ‘My doctor is right in the corner with me.’”  

Return visits cost patients an insurance co-payment. If the doctors don’t participate in a patient’s plan, they will charge the equivalent of a co-payment, or about US$20 (RM76), Blakeslee said. Patients who need to see a specialist will get a referral but must pay separately for that care.  

Because boutique care is relatively new, it’s unclear whether it will mean doctors can work fewer hours for more money. Like other physicians interviewed, Blakeslee and Eichelberger declined to discuss specifics about the finances of either their new or their old practice, other than to say they couldn’t continue the old one without compromising care.  

“Our (new) situation will be better,” Blakeslee said.  

Dr Susan W. Tolle, an internist and director of the Centre for Ethics in Health Care at the Oregon Health & Science University in Portland, understands why boutique medicine is catching on – not just among patients, but among doctors, too.  

“I see the sweat on their brow,” she said of her colleagues. “I see the piles of charts they haven’t called back.”  

Still, she finds the trend toward selective care troubling. In many communities across the country, Tolle said, there aren’t enough primary care doctors, which means that boutique providers seeing fewer patients are making it harder on other doctors and the people they treat.  

“The justice-and-ethics issue is not that some people get more – that you buy a Cadillac instead of a Honda,” she said. “The result is that some people get less. I’m talking about when those individuals do not carry their share of the poor and uninsured and underinsured because they’re only doing boutique.”  

The American Medical Association’s Council on Ethical and Judicial Affairs issued a report at the group’s interim meeting recently outlining guidelines for what it refers to as “contracted” medical services.  

Dr Leonard J. Morse, the council chairman, said the report acknowledges a doctor’s right to practice such medicine but stresses that he or she still has a responsibility to serve the broader community. Under the proposed guidelines, a boutique doctor would be obligated, for instance, to treat anyone who shows up in the office with a medical emergency – even if he or she isn’t a “member”.  

The guidelines prompted such lively debate that the council was asked to revise them; the report will be reintroduced at the AMA’s annual meeting later. More boutique practices are expected to spring up before then .  

At Executive Physician Services in suburban Rochester, Dr Paul R. DiEgidio sees patients whenever and wherever they want – including their home or office.  

He offers two levels of care: “standard”, which costs US$2,500 (RM9,500) for an individual, or “platinum”, which costs US$5,000 (RM19,000). The less expensive plan gets patients his pager number; the more expensive one gives patients his cell phone number.  

DiEgidio, 42, has been to patients’ houses after midnight for emergencies. Recently, he delivered a set of crutches, a cane and a prescription to the wife of a patient experiencing knee pain so he would have them when he got off a plane from a trip to Hong Kong.  

For visits at patients’ offices, DiEgidio dresses as they dress: in a suit and tie or more casually, if need be, so he blends in. He carries everything he needs in a briefcase. Since May, he has signed up 15 paying clients and hopes to attract 100 to 300. He sees an additional five at no charge because he can afford to and has the flexibility.  

He has heard plenty of criticism about boutique care but says the arrangement allows him to take care of patients the way he wants to – and the way they want him to.  

“I think doctors should be able to do anything they want. It’s their life and their business, and to be altruistic and say they have some type of obligation here or obligation there, that’s not necessarily true anymore,” he said. “People expect of doctors things that they don’t expect of any other profession.” – LAT-WP  

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