Your Medical Future Now

Doctor on Call

Healthcare providers nationwide are as frustrated as you are by crowded waiting rooms and rushed appointments that have to be scheduled weeks or even months ahead. Many are reinventing their practices to offer more patient-friendly care. Here, innovations that may be coming to your town.

In 2006 Robin Merlino, a primary-care doctor in Fairfax, Virginia, left a four-physician practice with a patient load of 2,000 to form a new concierge, or boutique, practice with just 600 patients. For $1,500 a year, her patients are guaranteed same- or next-day appointments that begin on time, an annual 2-1/2-hour physical, a secure personal Web site through which they can review their medical records, and 24-hour phone access to the doctor, who schedules appointments with specialists when necessary. Such concierge practices have sprung up across the nation. At her old office, with ever-larger numbers of patients to see each day, "I wasn't able to treat people the way I was trained to," she says.

One of Dr. Merlino's patients, Kimberly Arnold, a 44-year-old Christian missionary, says the care she gets is worth the extra fee, which costs less than her annual cable bill. Dr. Merlino isn't just efficient, notes Arnold, she's also attentive, making follow-up calls to check on patients' progress. That enhanced relationship is a major draw of boutique care. "Patients want someone who cares," says Edward E. Goldman, MD, chief executive officer and founding partner of MDVIP, the for-profit company that advised Dr. Merlino.

Boutique medicine promises a closer relationship with the doctor and a focus on prevention. But the hefty fee -- typically $1,500 to $2,000 yearly per person, though it can go as high as $15,000, according to the Government Accountability Office -- doesn't cover prescription drugs or most therapies, lab tests, and other treatments beyond the annual physical. So patients must have additional health insurance that will pick up the tab or be able to foot the bills on their own.

Though Dr. Goldman cites unpublished data from MDVIP's 19,739 member patients showing this model of care reduces hospitalizations, no one has proved whether it actually helps patients' health. Some experts also note that luxury care makes healthcare less accessible to less affluent patients.