You might think it's a pain to be a doctor that makes house calls, but these doctors love it.
"Concierge doctors," as they're known, are private doctors that charge patients an annual fee of anywhere from $1,000 to $25,000 per year for more personalized service.
That fee doesn't replace health insurance; patients pay that fee to the doctor and still maintain health insurance to cover the cost of tests, hospitalization, specialists, etc.
Most doctors see 2,000 to 4,000 patients per year, while concierge doctors see only 50 to 500, which means they can spend more time with their patients and offer a better quality of care.
“It’s medicine in the ideal,” said Steven Gallo, a Chicago physician with the concierge network MD2, who went from seeing 4,000 patients a year to just 50. “It’s the doctor you dreamed of being when you became a doctor.”
With waiting rooms already overcrowded, and health-care reform threatening to flood them with even more patients, more patients are choosing to pay extra for a concierge doctor and the personalized service they offer.
Robert A. Simon, a forensic psychology consultant in San Diego, said the reason he signed up with a concierge doctor is for the ability to get appointments quickly and spend more time with the doctor.
"When I see my physician, I get time — I'm not rushed in and rushed out," Simon said. "I'm in my mid-50s with some normal medical issues that accumulate as you get older. He can take the time to discuss. It's a more holistic approach."
The annual fee covers unlimited visits to the doctor (so no co-pays) and with the higher-end practices, it even covers tests and lab analysis. Plus, patients get 24/7 access to their doctor by phone email or text, can get same-day appointments, longer appointments and yes, even housecalls. Some practices even offer Skype visits with the doctor.
They Make House Calls
When you're paying an annual fee for top-notch medical care, you do have the right to have your doctor make house calls — or in the case of busy executives, office calls — but interestingly enough, most concierge doctors say their patients still prefer to come to the office.
The doctors are also reachable — directly — to the patients 24/7 but most concierge doctors say their patients don't abuse the privileges.
“If anything, it’s the opposite,” Gallo said. “I’ll get a call on a Monday morning from a patient and I’ll say — why didn’t you call me with this over the weekend? They’ll say, ‘I didn’t want to bother you on the weekend.’ And I’ll say, ‘That’s what I’m here for!’”
That’s partly because when you can spend that kind of time with your patients, you become a close family friend and there’s more respect. Plus, Gallo said, it’s the peace of mind patients have knowing they have direct access to their doctor at all times.
“They always know they can get me. They’re not going to have to wait. They know if they call at 7am on Monday, I will answer the phone and see them.”
Daphne Goldberg, a concierge physician with Total Access Medical in Philadelphia, said most of her house calls aren’t because the patient demands it but because of the patient’s condition — maybe it’s a mom who’s just given birth or an elderly person who has trouble walking.
Not Just for the Wealthy
Some concierge doctors cater to the wealthy — people who can afford, $15,000 or $25,000 a year. But not everyone is wealthy — particularly with the concierge practices that charge only $1,000 or $1,500 a year.
The level of service varies with the price: When you’re in the $1,000 to $2,000 range, you may get the test at your doctor’s office but the lab work will be billed to your insurance. On the higher end, the tests and lab work are all done in house. And, for a house call, doctors charging less than $2,000 often bring just the basic tools like a stethoscope, flashlight and blood pressure tester.
At MD2, where the annual fee is $15,000, the doctors bring a “car kit,” which has medicines to treat patients for everything from infections to pain, check their oxygen and pulse. They also carry IV fluids and a kit to draw blood. Plus, they give each patient a travel kit, that includes a variety of medicines they may need in case of an emergency and a booklet that describes what to do. Step 1 is, “If you’ve opened this book, you should call your doctor.”
Some concierge doctors will also drive the patient to the hospital if necessary.
Gallo recalls an 80-year old woman who was dizzy and having a heart arrhythmia, an abnormal heart rhythm. He drove to her house, diagnosed her and then drove her to the ER. The family was so impressed with the level of service, the woman’s son later joked to Gallo, “Do you want to drive her home or should I?!”
Emails and Grocery Shopping
Kevin Kelleher, a concierge doctor with Executive Healthcare Services in Reston, Va., said a typical day for him involves seeing zero to six patients (compared to the 30 that most doctors see in a day), handling probably 10 to 30 new emails from patients, handling 20 to 40 patient-care coordination emails with staff, researching sub-specialists for newly-diagnosed cancer or other uncommon problems and sending 5 to 20 follow-up emails to patients about test results.
Patients email Kelleher about everything from images of a rash or abnormality to urgent needs for information when a loved one is diagnosed with a serious illness. Gallo said his patients will often inquire about things they’re hearing or reading about like “Hey, should I be taking these vitamin supplements?” They also do a lot of diagnosis when patients complain of symptoms like a headache or chest pains.
These are the kind of requests that used to be bothersome to doctors, when they had to see 30 patients in a day and would have to stay late if they wanted to respond to a patient’s request.
“Now, those calls are enjoyable,” Gallo said, because he has the time to answer them.
Bernard Kaminetsky, the medical director for MDVIP, one of the largest networks of concierge doctors in the U.S. with 450 doctors in 32 states, said when doctors spend more time with their patients, they get to know them better and that leads to better diagnosis.
Sometimes it’s the intimate knowledge of a patient’s medical history or family history and sometimes it involves being part therapist.
“Our emotional problems do find a physical outlet,” Kaminetsky said.
Some of the concierge doctors in the MDVIP network take walks with their patients, go grocery shopping, do cooking classes or other seminars to be proactive about listening and taking care of their patients’ health, instead of just being reactive.
‘ER’ Meets ‘Dynasty’
Pop culture’s homage to concierge doctors, the USA show “Royal Pains,”features young and handsome concierge doctor Hank Lawson (Mark Feuerstein), who hops from mansion to mansion in the tony Hamptons section of Long Island, taking care of every ache, pain and exotic ailment of his rich and famous patients — right there in their own homes. The Wall Street Journal once described the show as “'ER' meets ‘Dynasty.’"
Gallo says in reality, they’re more like Robert Young’s salt-and-pepper portrayal of a doctor on the 1970s show “Marcus Welby, M.D.,” than the “hip guy who comes in with a lot of flash” in "Royal Pains." And, the reality is definitely more "ER" than “Dynasty,” but concierge doctors do occasionally find themselves involved in a comedic situation or drama on the high seas.
Goldberg recalls getting an email from the husband of a patient who was in labor. “She’s having contractions every two minutes and feeling a lot of pressure. What should we do?”
“If I didn’t check that email, that baby would’ve been born right there!” Goldberg quipped.
Gallo recalls his partner had a patient who was on a boat in France in the Mediterranean and was having a lot of medical problems. He really didn’t want to be hospitalized in a remote part of France, so the doctor flew to France to take care of the guy on his boat.
All in a day in the life of a concierge doctor!
Actually, international travel is quite common with concierge doctors as affluent clients tend to travel a lot.
Kelleher also made a boat visit to a family sailing in the British Virgin Islands, whose two-year old son had a worsening rash and illness.
In some cases, the concierge doctors work with doctors internationally to relay medical history and assist with the diagnosis and treatment.
Kaminetsky recalls a patient who was traveling in China and had to be hospitalized for coughing up blood. Kaminetsky exchanged digitized CAT scans with the doctor in China, and concluded that it was a symptom of an earlier diagnosis and nothing that required the patient to cut short the trip.
Raphael Darvish, a concierge doctor with Presidential Physicals and Executive Healthcarein Brentwood, Calif., has a lot of Hollywood and executive patients who often travel to exotic places. So, they try to play offense, looking up exotic diseases and conditions specific to the area their patient is traveling to ahead of time.
“We had a patient in Thailand last week who got some sort of skin rash. The patient was totally freaked out and wanted to fly back,” Darvish said. “We got him some creams so it was all good.”
Isn't That Terrible?
Gallo said people often think being on call 24/7 is, like the show’s title implies, a “Royal Pain.”
They’ll say, “You’re on call all the time. Isn’t that terrible?”
“I say, ‘No, it’s great!’” Gallo said. “It’s someone I know intimately and care about — I want to check on them.’”
Goldberg said she was sold on the idea of joining a concierge practice when she called the doctor who had offered her the job — and he answered the phone.
“He actually answered the phone,” Goldberg said. “I thought, ‘On what planet do you call a doctor and they pick up the phone?!’”
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