Oken, who has been with the practice since 1985, said the group struggled with the decision for years. The doctors finally decided this summer when Medicare announced a cut in reimbursement rates.Advocates of boutique medicine say the premise harks back to the days when family doctors made house calls and had bonds with generations of patients. That level of personalization allows doctors to focus on prevention and early detection of disease, said Dr. Edward E. Goldman, founder of MDVIP, a Florida-based company formed nine years ago that has become a leader in organizing boutique practices.
Nationwide, there were 146 doctors in 2005 with concierge practices, according to a report by the Government Accountability Office. While current national figures are not available, MDVIP alone says it has 260 doctors in 24 states and Washington, D.C., serving roughly 90,000 patients. In Maryland, 24 doctors are affiliated with the company.
Patients pay $1,500 a year and receive a wellness plan, a wallet-sized CD of their medical history and an hourlong physical with EKG and lab tests.
While some critics question the ethics of high cost of such care, Goldman argues that the current health care system does a disservice to patients.
"Traditional practice right now is totally geared toward the treatment of illness," he said. "For those patients who want what the system does not offer, shouldn't they be given the choice? When I know I am not managing your Type 2 diabetes because I only have 10 minutes and God forbid you end up blind or amputated as a result, something is wrong with the morality of that approach and the ethics."
He said the nation's health care already has multiple tiers, comprising the uninsured and those covered by HMOs, Medicare and other options. "We think this is the system that the U.S. should have for primary care, period," he said.
Dr. Joseph Zebley, a member of MDVIP, switched his Baltimore practice to the boutique model three years ago. He said he reduced his patients from 2,500 to 600 and limits the number he sees to 15 a day.
"I have more time to practice medicine, and therefore my workload is much less and my income is more," he said. "When I depended on third-party payers for revenue, I never knew if I was going to be able to make payroll."
Zebley said he can now spend as much time with a patient as required, without worrying whether the insurance company will cover the visit. "You need time to get to know people as people," he said. "You can't do that in 7 1/2 minutes."
