Even in recession, personalized health care in demand

Thanks to patients who still value their health in hard times, the recession has barely slowed the growth of concierge medical practices, which charge hefty membership fees for highly personalized care and around-the-clock access.

From Seattle, where the movement began in 1996, to South Florida, where its largest concern is based, physicians with boutique practices say they are losing far fewer patients for financial reasons than they had expected. While some new practices are not filling as quickly as they might, they continue to attract a steady flow of patients willing to pay thousands of dollars for the privilege.

The practices typically charge at least $1,500 a year, with the most elite services asking $25,000 or more per family. The fees cover a thorough physical exam and enable physicians to limit the number of patients they see so they can provide premier service.

Doctors give patients their cellphone numbers and schedule leisurely same-day appointments with no waiting. Some make house calls, though patients still need health insurance to pay for hospitalizations and specialists.

Most of the 20 physicians and executives interviewed said a small number of patients had decided not to re-enroll in recent months, citing lost jobs or devalued portfolios. They tend to be like Susan Schwartzman, a book publicist from Yonkers, N.Y., who said she had given up her concierge doctor because of declining income, but only after first canceling her gym membership and swearing off restaurants.

For the most part, however, boutique practices have shown resilience. Doctors said the recession seemed to have reaffirmed the importance of health care to their patients. With jobs scarce and stress at a peak, many may see a link between continued health and continued employment. And with savings depleted, they recognize that assiduous preventive care may help them avoid costly chronic conditions and hospitalizations.

"It's the old penny-wise, pound-foolish thing," said Dr. C. Scott Molden, who practices internal medicine in St. Louis with MDVIP, the largest consortium of fee-based doctors. "I tell people, 'You cannot afford to not be in my practice. You cannot afford to be sick, even with insurance.' What I'm offering is to keep people out of hospitals."

Critics of concierge medicine consider it elitist and say it has widened the already significant class disparities in U.S. medicine. They also say it has exacerbated the shortage of primary-care physicians by leaving more patients to be treated by a shrinking pool of doctors.

Dr. Thomas LaGrelius of Torrance, Calif., who leads the Society for Innovative Medical Practice Design, a professional association of concierge physicians, estimated that there were 5,000 such doctors in the United States, out of an estimated 240,000 internal-medicine physicians and related subspecialists.

The company is privately held and does not release detailed membership data, but Darin Engelhardt, the firm's president, said renewal rates among its 100,000 patients had remained at its usual level of 93 percent a year during the recession. Each MDVIP doctor is limited to 600 patients, who each pay $1,500 to $1,800 a year.

"I'm happily able to report that we have not seen any adverse impact from the economy," Engelhardt said.

Peter Hoedemaker, the chief executive of MD2, a concierge medical provider based in Bellevue, said the company had been pleasantly surprised by patient enrollments at its new office in Chicago. The five MD2 practices, each with two doctors, charge $25,000 per family and limit each doctor to 50 patients. About a dozen openings remain in Chicago, Hoedemaker said, far fewer than projected, and the group is looking to expand to New York City.

Many of the doctors boasted of their ability to keep patients out of emergency rooms by intervening by phone for conditions like diverticulitis or an abnormal heart rhythm. They said their deep knowledge of their patients helped them detect subtle changes and danger signs.

"A close personal relationship with a physician is not something that's easy to find anymore," said Dr. David Elliott, an MDVIP physician in Phoenix. "People find it valuable."