Once only wealthy patients subscribed to concierge medicine, in which primary care doctors receive a retainer in exchange for offering special services such as house calls.
Now the concept is expanding to a middle class market, as more patients worry about access to health care and doctors look for alternatives to the bureaucratic hassles of private practice.
Some concierge doctors accept only cash. Others accept insurance, but charge patients a membership fee. That allows them to limit the number of patients they see at a time when primary care doctors routinely have thousands of patients on their books in order to make ends meet.
The American Academy of Private Physicians estimates that 3,500 U.S. doctors practice some form of concierge medicine.
A leading company in this market, MDVIP of Boca Raton, aims to provide an option affordable to middle-class consumers. Physicians affiliated with the group accept private insurance and Medicare, but also ask patients to pony up an extra $1,500 a year. One third of that goes to corporate headquarters; the rest goes to the doctor and helps pay for preventive services that insurance won't routinely cover.
Gerry Wise is among 2,000 patients who recently learned her Clearwater doctor is joining MDVIP. The Largo woman likes her doctor and worries about finding another. But $1,500 is a lot of money, and she doesn't really want a fancy physical.
"I do have a lot of questions and I am vacillating right now," Wise said.
Her physician, Greg Silver, said most patients seem receptive.
"People are wanting information about it, because in this area it's something new," he said. "It's also part of a movement in primary care that's really about personalizing health care."
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MDVIP prefers the term "personalized preventive care" to describe its approach. It now has about 380 doctors in 28 states, including five in Tampa Bay.
The model is a response to long-standing problems in primary care. Between dwindling reimbursements and costly administration, many doctors are choosing large-group or hospital practices over solo private practice. A smaller number are affiliating with groups like MDVIP.
Patients get an "executive-style" physical, including extensive bloodwork, an EKG heart screening, exercise screening and nutritional counseling.
"Our point is to be able to provide a choice for patients for preventive care and to enhance patient-physician relationships," said MDVIP president Darin Engelhardt.
Doctors who join MDVIP still own their own practices and tend to make the same money or a slightly more than before, he said. In 2008, median salary for primary care doctors was about $185,000, according to Medical Group Management Association.
Two years ago, Dr. Alan Smith, a family physician in St. Petersburg, joined MDVIP. Smith became frustrated in a practice that had grown to 2,500 patients.
"I felt myself being drawn more away from the intangibles that were so attractive to me and being drawn more into this vortex of HMOs and insurances and all of this negativity that I never wanted to be a part of," he said.
With just over 400 patients today, he has the time to coordinate their care with specialists and help manage chronic conditions like diabetes. Sometimes, he even makes house calls.
"I love that if something happens during the middle of the night I can call him," said Bob Riner, a patient of Smith's. "It's kind of going back to the way physicians used to be."
Since his insurance carries a $5,000 in-patient deductible, Riner believes the $1,500 annual MDVIP fee is worthwhile if it keeps him out of the hospital.
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Dr. John Santa, director of the Consumer Reports Health Ratings Center, warned that more care is not always better care.
"Consumers should be vary wary of the souped up, high-tech, 'Boy, do we have a bunch of tests for you' approach.
"You get in big machines that hum and the lights go off and they look really cool," he said. "But the results that they give often can be confusing, misleading, lead to further tests, even treatments and procedures that don't work."
Five years ago, the MDVIP concept lured Dr. David Brecher out of a Pinellas practice that had grown to 3,000 patients. He determined that he could run a viable MDVIP practice with 300 patients. But Brecher got only 240 willing to pay the annual fee.
Eventually, he left MDVIP and private practice to work for Suncoast Hospice. Still, Brecher praised MDVIP as a good alternative for doctors fed up with administrative hassles and having to rush patients through.
Brecher cautioned that some patients simply wouldn't warm up to paying an annual fee.
"I had some folks who said, 'Sorry, I can't pay you but I wish you the best,'?" he said. "I had some people who said, 'Here's the check now.'
"I had some people say, 'How could you do this, you've been my doctor for 20 years?'?"
Letitia Stein can be reached at firstname.lastname@example.org or (813) 226-3322. For more health news, visit www.tampabay.com/health.