Illustration by Angela Mitchell
Imagine that you call your doctor at 2 a.m., and she picks up the phone immediately, dispenses clear advice and follows up with a visit to your home the next morning. Imagine that she spends a couple of hours checking you over, discussing your ailment and general well-being as the two of you sit in your living room. Imagine sending her an e-mail during lunch and getting a prompt reply.
Luckily, I don’t have to imagine it; that’s my life now.
My family and I have our own personal physician, Dr. Elizabeth Laffey. As a board-certified family practitioner, Laffey is available to us 24/7. She makes house calls and answers e-mail and phone calls directly. No physicians’ exchange, no smart-alecky nurses—just us and Dr. E.
Until we became patients of Laffey’s, I figured that personal physicians were only for professional athletes, the rich or Elvis back when he was really alive. I was wrong. Regular people can and do afford “concierge” physicians, who limit their practice to a select few hundred patients (rather than thousands) and offer highly personalized care.
I like to tell people that I won Dr. Laffey at a networking event. It’s true. There was a raffle for a year’s worth of Laffey’s services. I put in two $1 raffle tickets and, boom, I won a doc. Being newly self-employed and paying the outrageous insurance deductible for myself, my husband and our 4-year-old daughter, I interpreted winning Dr. Laffey’s services as a godsend. With a child who comes down with something every other week, having a personal physician has been not only helpful but a time-saver. We call with a question or send an e-mail (including the occasional photo of a rashy posterior) and get an answer within a few minutes. We don’t have to sit in a crowded waiting room full of sick patients or agonize because the pediatrician’s office is closed on Sunday. The doctor is always in.
But the real shocker was discovering that having a dedicated doctor is actually affordable.
“It’s the cost of a latte a day,” Laffey said.
Although prices here vary, they generally fall in the range of $1,000 to $1,600 per person per year. Insurance doesn’t cover the fee, but with the high deductibles most entrepreneurs and the self-employed are stuck with, having a personal physician becomes a viable option.
Only a handful of concierge or “boutique” physicians work in St. Louis. The concept began in Seattle in 1996, when MD2 opened a spalike practice and charged a retainer of $20,000 a year. Doctors frustrated by managed-care bureaucracy and the time squeeze of seeing a patient every seven minutes began to adopt variations on that model. In 2003, internist David Katzman was the first St. Louis physician to convert his practice to retainer medicine.
The second was Dr. Richard Bligh. “I was tired of the pressures of trying to see 40 to 50 patients a day,” he says. “I couldn’t give my patients what they really needed: time and education. In the typical primary-care practice, the time spent is about six minutes. There’s such a need to look at preventing problems rather than just putting Band-Aids on them. I spend 30 minutes to an hour now, and my patients have my home number and my cell-phone number.”
Pediatrician Natalie Hodge, owner of Personal Pediatrics in Clayton, switched from a conventional practice to concierge medicine in January 2005. “This is the way it used to be done,” she says, “but, until now, there has been no alternative.”
Hodge finds that working two-parent families and new moms are among those attracted to her practice. Laffey says that busy executives often seek her out.
“It’s translated into a huge gift of time,” says business owner Laura Schacht, 43, who estimates that she spent about three solid weeks sitting in waiting rooms and getting prescriptions. “I just wouldn’t go to the doctor to deal with this ‘foot rot’ I got in South Africa,” she admits. “I waited six months, and then my heel started to fall off.”
Schacht became Laffey’s patient. They first tried a natural remedy for the infection, but Schacht didn’t keep up with the treatment regimen. Laffey then prescribed an antifungal medication, and the infection was cured.
Physicians are drawn to retainer medicine for many of the same reasons patients like it: more time for visits, less stress, a deeper doctor-patient relationship and practically no paperwork.
“I went into medicine to change people’s health, but I was frustrated by the workload,” Laffey says. “It’s so much more fun now. I can actually talk to people. The number of times I’ve avoided sending people to the [emergency room] is phenomenal.”
Dr. Glenn Fox, a Town & Country family physician, finds that he has “more time to tie up loose ends.” Because he has just 300 patients and plenty of time for follow-up, Fox can make sure that his patients are getting the tests they should have. He cites the case of one patient, Danny H., whom he persistently urged to get a colonoscopy. When Danny finally had the test, it revealed a precancerous polyp that was treated before it became cancer.
“I love that kind of medicine,” Fox says. “It’s not flashy. It doesn’t make the cover of Time magazine. If I do my job right, then guess what: Nothing happens, and you’re healthy until the day you die.”
Fox, who converted to what he calls patient-supported practice in 2004, requires all members of a nuclear family to become his patients. His fees range from $180 annually for a child and $240 for a baby or toddler up to as much as $1,020 a year for those over age 65. He cares for about 10 percent of his patients at a reduced rate or no charge.
Finding a concierge physician is tricky. They aren’t listed in the phone book under a specific heading, and some limit their advertising to word of mouth, hoping to preserve exclusivity and keep from having to turn away patients once their practices are filled.
But concierge medicine is only beginning in St. Louis, and more physicians may soon join the trend: Hodge is investing $2 million to create a boutique-physician network.
“This is the new niche in health care,” she says. “There will be more and more of this to come.”
