ORLANDO, Fla. — Bill Lear cannot remember waiting more than 20 or 30 minutes for a return call from his physician — and that was during the day, when Dr. Jason Mercer is seeing patients.After hours — including once at 3 a.m. — Lear reaches the Volusia County, Fla., doctor directly on his cell phone. Mercer also makes house calls, meets patients at the emergency room and allots at least 30 minutes for an office visit.
These and other perks come with the $1,500 annual fee Mercer charges patients. He is part of a growing trend called concierge medicine, in which doctors reduce their number of patients so they can offer highly personalized attention, 24-hour access and extensive annual physicals.
Lear’s wife also is treated by Mercer, and the Volusia resident thinks their combined $3,000 fee is well worth the benefits.
"It’s just the most amazing, most delightful feeling to have an appointment at 10 a.m. on a Tuesday, and when you arrive, you go straight in," Lear, 76, said. "There’s no waiting for hours on end to have the privilege of seeing your doctor for all of three minutes."
The movement is attracting criticism from some, who deride it as "wealth care" that will create an elitist medical system for the rich. They argue as more doctors get involved, patients who cannot afford the fees will overburden the remaining physicians in a community.
Supporters say the trend is a healthy revolt against the mind-numbing bureaucracy that has engulfed medicine. Doctors with fewer patients can devote more time to the preventive care that keeps people from getting sick in the first place, Mercer said.
A family physician, Mercer used to juggle about 2,400 patients. Now he is down to 310 and will handle no more than 600. He transitioned to concierge medicine in 2002, at the height of his frustration.
"I was leaving the house at 5:45 (a.m.) and getting home at 8 at night," Mercer said. "It wasn’t so much that the hours were long. If I had come home with a sense of satisfaction, it wouldn’t have been a problem."
"But I was ending every day with the feeling that I had left something undone."
Mercer made the change with the help of a Boca Raton, Fla.-based group called MDVIP, which has 65 doctors in 12 states, treating 20,000 patients.
MDVIP physicians are limited to a maximum of 600 patients and charge a $1,500-a-year fee to each — $1,000 goes to the doctor and $500 to MDVIP.
The company was founded in 2000 by Edward Goldman and others who saw the field emerging as doctors in Seattle and elsewhere were charging steep annual fees — sometimes $10,000 or more — and offering everything from same-day appointments to out-of-town house calls.
For joining MDVIP, the company helps doctors make the change and handles administrative issues, sometimes assisting with negotiations to get lower premiums for medical-malpractice insurance.
But the more common approach is the one MDVIP has taken: Patients pay an annual fee and get extra perks along with preventive services that are not covered by insurance. For all the usual ills and medical expenses, a patient’s insurance company is billed. People still make the same copays that go along with their health plans.
The average primary-care physician can see more than 30 patients a day, spending about 10 to 15 minutes per visit.
But critics say the approach only worsens the inequities that already exist in health care, in which people with more money and better insurance have greater access to doctors and services.
"Concierge medicine simply widens the gap between the haves and have-nots," said Arthur Caplan, a professor of bioethics at the University of Pennsylvania.
What is more, he said, patients should not have to pay to get some of the things offered in these practices.
In addition, some members of Congress, including Sen. Bill Nelson, D-Fla., have introduced legislation that would ban concierge physicians from charging Medicare. The measures have not passed, but the Government Accountability Office is investigating the concierge phenomenon. The GAO plans to release a report next year on how it could affect Medicare patients.
A spokesman for Nelson said the senator is concerned seniors who cannot afford the extra fees will not be able to remain with their preferred doctors.
The American Medical Association supports the practice, as long as doctors follow the ethical guidelines the AMA compiled last year, said J. Edward Hill, the group’s incoming president.
