Since concierge care debuted in the Richmond area with the opening of Partner MD in 2003, the concept has been growing in popularity. Partner MD, based in the Bon Secours Heart Institute off Glenside Drive, has expanded from one physician serving 50 patients to six doctors with about 3,000 patients. There are also at least three physicians with concierge practices affiliated with the national organization MDVIP. In another twist, doctors in two Richmond-area practices, Associated Internists and Virginia Physicians Inc., are using a concierge-hybrid arrangement that lets current patients choose whether to sign up for the service.
With each of these plans, concierge patients pay a fee, generally $1,500 or more per year, for services not covered by insurance. These include an "executive-style" physical with extensive tests and screenings, a follow-up consultation with their physician and appointments with nutritionists or exercise specialists. Concierge patients also gain access to the doctor's cell-phone number, and time is built in to the physician's day to allow for more in-depth conversations.
"The current health-care model is to wait for you to get a disease and then manage it," says Dr. Jim Mumper, co-founder of Partner MD. "Our approach is to anticipate the risk for [illnesses such as] diabetes and prevent them."
Dr. Michael Mandel of Associated Internists says the hybrid plan offered by New York-based Concierge Choice Physicians allows him and other doctors to continue serving patients who do not choose concierge care for cost or other reasons. For the participating physicians — four of the practice's six doctors — 25 percent of their time is devoted to concierge patients. "It's just really nice to be able to sit down with a patient and feel like you have put time aside," Mandel says.
Patricia Groome, one of Mandel's patients, says that because of her frequently changing work schedule at the federal prison in Petersburg, it's important to be able to reach her doctor when she needs to. Groome, 45, also says the concierge arrangement has provided her more support in her efforts to lose weight — she's dropped more than 100 pounds from her previous weight of more than 300. With concierge care, she says, "There is simply more time available for my questions."
The pressure to see large numbers of patients and low salaries relative to what specialists earn has resulted in fewer medical students going into primary care, area doctors say. That has a lot to do with the way reimbursements are structured, says Dr. Frank Bain, a Goochland County physician and past president of the Richmond Academy of Family Physicians. Bain, who does not have a concierge program, would like to see Medicare increase reimbursement to doctors, because he says insurance companies base their policies on what Medicare does.
Concierge care takes some doctors out of the mix for the general population. However, no one is seeing a mass exodus. Bain says, "I'm concerned there aren't going to be enough primary-care doctors … to take care of people the way they need to be taken care of with or without concierge care."