A different kind of doctoring

By Dick Hughes  

NOVEMBER 29, 2010 2:54 p.m. (4)

Seeing 40 patients a day, spending maybe 10 minutes tops on each, being quick with the prescription pad, shuffling them in and out, backing them up in the waiting room, going home exhausted, stressed out, discouraged.

That’s not why Leslie Long and Nancy Netter went to medical school, and they walked away, not from medicine but from the traditional office practice that wore them out and, as they saw it, shortchanged patients.

Long and Netter joined MDVIP, a network of doctors who limit patient load to 600, promise no-wait appointments, give 90-minute physicals, spend at least 30 minutes on scheduled appointments, stress preventative care, and are always a phone call away.

There’s a catch: each patient must pay an annual fee of $1,500 upfront.

MDVIP, which is owned by Proctor & Gamble, is approaching its 10th year and is spreading at a 25 percent annual growth rate across the nation.

Derided as “concierge” or “boutique” medicine by critics who say it exacerbates the inequity of health care between haves and have-nots, MDVIP says it is not for every patient or for every doctor but rather an alternative to traditional office practices.

The upfront fee can be a sticking point for some, but MDVIP says patients get complete annual physicals valued at $3,000 to $6,000, a wallet-sized data card with their medical history, expedited referrals to specialists and top medical centers, access to a nationwide network when traveling and, most of all, 24/7 availability of their local doctor.

For that level of quality care, said Netter, “I don’t see that $1,500 is an extravagant charge at all. A couple cups of coffee a day is what it boils down to.”

Long said, “Anyone is allowed in, whether they have insurance or not makes no difference.” And, she added, the annual fee “covers children even if they are at college.”

Long and Netter are two of four physicians in Greenville County who have joined MDVIP; four more are expected before the year is out.  No Spartanburg doctor yet has signed up.

Dr. Cheryl Sarmiento, who established the Center for Adult and Family Medicine in Greenville in 2001, said she was approached by MDVIP but decided it was not for her.  Sarmiento said she was uncomfortable with the upfront fee.

She averages 25-28 patients a day but does not feel overburdened.

“I don’t blame doctors finding ways to avoid being burned out, but for me, to avoid this, I try to meet my patients’ health needs one patient at a time,” she said.

“I try to balance my time well with my patients and at the same time try not to jeopardize my practice’s financials. Doing quality care in medicine is to change from a reactive mode to a mode that is far more preventive and rational.”

Nationwide, MDVIP says, more than 135,000 patients are being seen by 421 MDVIP physicians in 30 states plus the District of Columbia.  In a telephone interview from corporate offices in Boca Raton, Fla., Dan Hecht, chief executive officer, said the goal is 1,000 doctors seeing 500,000 patients by 2015.

As evidence of success, Hecht cites a renewal rate or 92 percent, a patient satisfaction rate of 96 percent and a study showing a reduction in hospitalization of 75 percent for patients covered by Medicare and 65 percent for those with conventional insurance.

Long, 48, a single mother with a 4-year-old son, and Netter, 43, married with sons 10 and 12, say MDVIP kept them in primary care.  Colleagues at Oak Tree Medical Center, they say they were burning out from the pressure of seeing 35-45 patients a day.

“It was more of an assembly line and not why I went to medical school,” says Netter.

In a traditional fee-for-service practice, she says, doctors are under the gun to constantly add patients to make up for lower reimbursement rates and higher overhead.

At Oak Tree, where Long practiced for eight years, she often saw 45 patients a day, spending 10 minutes “max” on any one, moving them in and out as quickly as possible and fielding up to 75 voice mails daily.

Now, Netter and Long say, they have time to get to underlying issues rather than, as Netter puts it, “just giving them a pill.” Both are writing fewer prescriptions. “That’s something I really like,” says Netter.

If a patient complained of being depressed in her prior practice, Long said, “I might have prescribed an antidepressant, but now I sit in front of the patient and in a half hour we might find a more natural way to deal with the problem.”

They said physicians in traditional practices are quick to prescribe because they don’t have time to discuss lifestyle issues that affect health: diet, drug and alcohol use, smoking, exercise, hobbies, work, finances and wide array of family matters and relationships.

Long said another benefit is that when hospitalization is necessary she “admits them, keeps up with their care during their stay and is there to discharge them.”

Netter, who started her MDVIP practice in February after 10 years at Oak Tree, sees 15 patients on a busy day, about eight on a slow day and 12 on average.

While Netter is “working as many hours as I did before,” she is “much more gratified as a physician,” is under less stress and less distracted by worry that she “missed something.”

A patient can call in the morning and be seen by noon, says Long, whose new office is staffed by two certified medical assistants, unlike her prior practice with a staff of 14, including two nurses assigned to her.

The waiting room is tiny with three chairs “because there is no wait.” Overhead is less than a tenth of the $900,000 annually of her prior practice.

Financially, Long is “taking home less here, but I’m happier.”  Once she works through startup costs of a new office, Netter expects to earn as much or “a little more” than she did before.

Of the $1,500 annual fee, physicians keep $1,000 and MDVIP takes $500 to pay for MDVIP’s 200 employees, support services, educational programs, electronic record-keeping, sales and marketing and keeping up with regulations, according to Hecht, the company CEO.

MDVIP is part of P&G’s profit-making FutureWorks subsidiary, which includes enterprises such as Mr. Clean Car Washes and Tide Dry Cleaners, but is not yet profitable because revenues are going into growth and technological upgrades, Hecht says.

Network doctors are independent practitioners. As Netter puts it, “I view MDVIP as consultants. I am not an employee of EDVIP. I’m an employee of myself.”