Determining how many Maryland patients are affected by the trend is difficult, since no agency keeps track of boutique practices. But the state medical society and the Maryland Hospital Association think the numbers are growing.
"Doctors have nowhere to turn but to try to find a different business model," said Dr. Ronald Sroka, president of the medical society, known as MedChi. "Some people want more than their insurance company will provide, and some people are willing to pay for this additional service."
Sroka, who practices in Crofton, said that after paying salaries and expenses, he makes about $15 to $20 an hour. He said he's not sure if he can last more than another year or so, working some 80 hours a week to keep up with his bills.
Proponents say boutique practices allow doctors to increase their income while reducing hours and giving patients higher-quality care.
Insurance reimbursement rates for primary-care doctors are lower than for other specialties, Sroka and others point out. That, coupled with Maryland's high cost of living, overhead and insurance premiums, has led many doctors to take on large patient loads to stay afloat. Some are leaving the business.
In 2007, Central Maryland was the only region in the state that had enough primary-care physicians to meet demand, according to a study by MedChi and the hospital association. The statewide shortage is expected to continue through 2015.
"I don't blame them for wanting to manage their lives," Townsend said of doctors choosing boutique practices. "They have been on the treadmill. The plus side is they are still in medicine."
Dr. Peter L. Beilenson, Howard County's health officer and former Baltimore health commissioner, said he understands the frustrations of primary-care doctors. "But I have serious qualms about this trend toward concierge medicine," he said. "It's absolutely critical that we have enough primary-care doctors, and this just compounds the problem."
Charter Internal Medicine began notifying its 9,000 patients this month that starting Jan. 1, it will no longer accept private insurance or Medicare. Rather, the doctors will charge patients $2,000 a year plus $500 for each child ages 14 to 25, a plan the practice calls the "Personalized Health Care Model."
Patients are encouraged to keep their insurance for procedures not covered by the retainer, such as hospital stays, ambulance rides and blood work.
