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More Primary Care Doctors Switching to Concierge Care

Above: Dr. Joseph Scherger has been hired to set up an affordable system of primary care doctors on the concierge model in the Palm Springs area.

Audio

Aired 6/19/09

The effort to reform the American healthcare system could go in any one of a number of directions. A growing number of primary care doctors are choosing their own path. These doctors have abandoned traditional ways of practicing medicine, and have turned to what's called concierge care.

— The effort to reform the American healthcare system could go in any one of a number of directions.

A growing number of primary care doctors are choosing their own path. These doctors have abandoned traditional ways of practicing medicine, and have turned to what's called concierge care.

When you walk into Dr. Marty Schulman's office in Encinitas, you notice there are a few things missing.

In his concierge practice, Dr. Marty Schulman spends as much time as he likes with each patient.
Enlarge this image

Above: In his concierge practice, Dr. Marty Schulman spends as much time as he likes with each patient.

There's no receptionist. There's nobody else waiting to be seen. And in a few moments, Dr. Schulman himself comes out to greet you.

Back in one of the examination rooms, the visit begins.

Dr. Schulman: "So, how are things going now?"

Ellen Garner: "Things are going pretty good. I'm really, really happy with my job…."

Dr. Schulman and his patient Ellen Garner have time to schmooze a little bit before getting down to business.

"Now when you were here there last time we continued you on one medication, we added a different one," Dr. Shulman says. "How are things doin' with that?"

Schulman used to work in a typical managed care practice, with about 15 minutes to deal with each patient.

Schulman says it was like being on an assembly line.

"Hi how are you, what's your problem today?" says Schulman. "Oh, you got other problems? Sorry, I got someone in the next room. Come back and make another appointment. Oh, my next appointment isn't available for six weeks. Can it wait until then?"

These days Schulman gives his patients all the time they need. In fact, they can access him 24/7. Same day appointments? No problem.

For all this, Schulman's patients pay him $600 a year, plus a fee every time they come in. He doesn't accept insurance.

"So, you're paying for access, you're paying for time in the office," Schulman points out. "They can talk to me any time, refills are handled in a timely manner. For the most part I'm able to take care of things pretty quickly."

The concept is called concierge medicine. It started in Seattle in the mid-90s. Today, there are an estimated five thousand concierge practices nationwide.

Like Dr. Schulman, Dr. Joseph Scherger used to work in the UCSD health care system.

He's just been hired by Eisenhower Medical Center in Rancho Mirage. He's working on setting up an affordable system of primary care doctors on the concierge model.

"For $365 a year, we will be immediately available to our patients, we will do online communication with our patients, we'll be on the phone with patients, and we'll only see the patients whenever they want, but really as needed," says Dr. Scherger. "So the visit becomes a secondary activity rather than the only way you see your doctor or get care from your doctor."

Scherger says it's all about delivering better care. He says technology like electronic medical records and email are essential. Those tools allow doctors to help patients better manage their chronic conditions. That reduces the number of hospitalizations.

Keeping people out of the hospital is one of the keys to reducing health care costs.

Some criticize concierge care as being only for the rich. But supporters say yearly fees and visit charges don't have to be prohibitive. And they say nobody should have to wait for weeks to get a 15-minute appointment with their doctor.

Ellen Garner says the money she pays to see Dr. Schulman is well worth it.

"It's so valuable what I'm buying, the personalized health care", says Garner. "I wouldn't trade it for anything."

Dr. Scherger says the only catch to the concierge system is getting more doctors to embrace a different way of doing business.

"Changing how you work is not easy, even when it's for the better," Scherger says. "But this horse is well out of the barn, and you're gonna see it sweeping here. So, it's really a revolution that is spreading."

Kaiser Permanente has adopted part of the concierge model.

It's spent billions of dollars creating a platform where patients can go online and communicate with their doctors. Since Kaiser started the effort, it's reduced office visits by more than 25 percent.

Comments

Avatar for user 'jwaddle'

jwaddle | June 19, 2009 at 9:23 p.m. ― 5 years, 2 months ago

You completely omitted the other side of this story. My family doctor changed to concierge service and he went from 3000 patients down to less than 600. What happens to the other 2400 patients that are left without a family doctor? Multiply that figure by the number of doctors changing to concierge service and what do you have? A crisis in available caregivers is what you have. If I wanted to continue with him it would have been an extra $150 per month for me and an additional $150 per month for my wife. That would be in addition to the regular fees. I'm sorry but I can't afford another $300 a month for a doctor. My doctor tried to justify his action in several ways but the bottom line is that it is all about money. None of his justifications added up to any significant additional benefit for me and my wife. The doctor stressed that now he could provide more preventive care but unfortunately that would not be preventive care for me or my wife because we were thrown under the bus to satisfy his greed.

$150 per month for a year multiplied by the 600 patient load equals over $1,000,000. That's $1,000,000 before he ever sees a patient.Of course the concierge company, in this case MD-VIP gets their share for blowing up the doctor's ego and proselytizing him into their scheme. MD-VIP target doctors that they see as the best and most successful and give them a sales pitch that is too attractive to resist and frames it in such a way as to ignore, minimalize and rationalize the negative aspects of the program. In my opinion it violates the primary hippocratic oath, "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone... But I will preserve the purity of my life and my arts." I was his patient and I was harmed by his action.

In my attempts to get another doctor, my firsteffort was met with the reply, "I'm sorry but we are not taking any new patients." The second was met with, "I'm sorry but we don't take your insurance, (Blue Cross???)." The third attempt was met with this reply, "I'm sorry but we don take any patients over 65, (I'm 69)." It has been almost a year now and I still don't have a new doctor.

That's my experience with concierge service so needless to say I was less than satisfied by your glowing but conceptually flawed and less than objective reporting.

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Avatar for user 'jwaddle'

jwaddle | June 19, 2009 at 9:30 p.m. ― 5 years, 2 months ago

My comment above had more that the limit of 3000 characters so I need to post the rest of it in this, a second comment.

As a side note I am a member of KCRW and now rarely listen to KPBS as I consider KPBS to be one of the worst public radio stations in the country and with your reporting of this story you more than lived up to that very low standard. I might add that The San Diego Union Tribune is one of the worst major city newspapers in the country so the pair of you are a great match. A note to Gloria Penner; Bob Kittle is an incompetent, pompous, arrogant, ignorant ass and having him in or anywhere near your studio does you and yours a gross disservice. If he is the best you can do for your Editor's Roundtable then you deserve the miserable reputation that you have. I'm sure you do not see this the same way I do because you are too busy kissing the asses of the power brokers above you and too busy getting your asses kissed by the sycophants below you. You have so much potential but that potential is mercilessly unrealized and routinely squandered by your lack of professionalism and your conservative narrow minded approach to community service. You have an outstanding facility that is inadequately and very poorly used and it is no surprise that your boring and unimaginative pledge drives fail is such pitiful way. You could lead the way in San Diego but instead you choose to go along with a minimum of effort and to not make any waves that might rock your boat. There is one word that best describes San Diego, it's media, newspaper, radio, TV, it's culture, It's art and music community, and that word is mediocre. The one thing SD has going for it is the weather. That's the only reason I stay. As you continue to ignore the reality of the world around you I wish you luck in your severely insular environment.

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Avatar for user 'Housedoc'

Housedoc | June 21, 2009 at 6:16 p.m. ― 5 years, 2 months ago

There are other options besides being totally in or out of the public system, or for making the public system more efficient and responsive. For example, physicians can use an online service such as www.housedoc.us for routine office communications, instead of the phone or having the patients come into the office. In addition, some physicians may choose to offer on line consultations for a fee, which the patient can take advantage of on occasion. These services add considerable flexibility to the current system.

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Avatar for user 'freejoe'

freejoe | March 12, 2010 at 3:49 p.m. ― 4 years, 5 months ago

jwaddle, excuse me but it seems Dr Scherger is talking about $365 a year, far cry from MDVIP $1,500. For this small fee, they are offering things that 90% of PCP do not offer patients. Before people start whining about the primary care physician, they should try to live a while in their shoes. Most make a fraction of what specialist earn and work far more hours and under far more stress. Also, I seen nothing here where Dr Scherger is saying he is limiting practice size to 600 patients or sending anyone away from care. You have the facts on MDVIP, but a far off on what is being stated here in this article.

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