For patients willing to pay, doctor is always in

Friday, Oct. 6, 2006 | 7:41 a.m.

Jerry Rakower woke up nauseated Wednesday morning, called his physician at 9 and saw the doctor before noon.

Imagine, a doctor appointment with no hassle. In today's world, that's a medical miracle.

But Rakower has become accustomed to special attention from his primary care physician, Dr. William Schofield. He pays $1,500 a year to be spoiled by his doctor.

In 2004, Schofield became one of the first of 10 local doctors - and about 130 nationwide since 2000 - to ditch the chaos of assembly-line medical care for a more personalized practice affiliated with a company called MDVIP.

The business plan is simple: The doctors handle fewer patients, seeing them more quickly and spending more time with them. For this, the patient pays the premium.

Other doctors are talking about joining the boutique practices. They have obvious benefits for both physician and patient, though ethicists warn that as some doctors reduce their patient loads to only those who can afford it, the burden of caring for the other patients shifts to other, already overworked doctors. Some critics call the trend "wealth care."

"It would be nice if everybody could get that kind of care for free," Rakower said.

The $1,500 retainer - $500 goes to MDVIP - allows doctors to reduce their patient load from about 2,500 to a maximum of 600. (If both a husband and wife sign up at full price, their children get the care for free.) The patient receives preventative services not usually covered by insurance: thorough annual physicals, wellness plans and diagnostic tests designed to detect problems early, plus same-day appointments and personal and prompt contact with doctors on the phone or via e-mail. The patient's insurance covers other, more conventional services.

Rakower, 66, praises the setup. He said he has reached Schofield on his cell phone even at 2 in the morning, and the doctor or his partner visited him daily during a five-day hospital stay.

The boutique practices illustrate several problems with health care and pose some of their own, according to Craig Klugman, assistant professor of bioethics at UNR. Doctors are attracted to the scaled-down, service-oriented practices because insurance companies are reducing reimbursements and requiring them to take on huge patient loads. Most insurance providers expect physicians to spend no more than eight minutes with patients, Klugman said, and that includes time for paperwork.

"The physicians aren't able to have the relationship with patients they wanted to because of (the level of) care dictated by insurance companies," Klugman said.

But the downside, especially in Nevada where there is an acute shortage of physicians, is that "you now have a situation where you are removing doctors from this very small pool of available doctors," Klugman said.

Schofield was working 16-hour days before joining MDVIP and said he was still unable to provide the care his patients needed. He was on his third marriage. Things needed to change. Schofield compares his former practice to the classic episode of "I Love Lucy" where Lucy and Ethel are working frantically and still falling behind on the chocolate factory's assembly line. How his life has changed. This afternoon, Schofield, 46, sits tranquilly at his desk. His waiting room is empty. The sound of trickling water comes from a wall-mounted water feature behind him.

Schofield's patient load shrunk from 2,600 to 530. MDVIP's transition plan ensures patients are transferred to other doctors if they don't want to pay the retainer. Schofield said the patients who did not join MDVIP were able to transfer, if they desired, to two doctors nearby who had less-established practices.

"I feel like I've just found time to be a better doctor," he said.

Dr. Larry Allen wants the same for himself. The pressures of his conventional practice were so great - 12-hour days plus weekends to care for his 2,500 patients - that he had gained weight and was considering quitting medicine altogether.

Allen complained too that he was reimbursed by insurance only when he dealt with sick patients even though prevention is a vital part of medicine.

"We spend a lot of time arguing with insurance companies, justifying preventative work," he said.

Allen's practice is about to shrink to the 200 patients who have signed up for MDVIP, and may grow to a maximum of 600. The other patients will be referred to doctors in the same building with less-mature practices.

There are about 1,300 primary care physicians in Clark County.

Dr. Don Havens of the Clark County Medical Society said overall health care will not suffer by a few doctors opening boutique practices.

The $1,500 annual price tag is a significant barrier to most patients, Havens said.

"There are people who can afford it and would pay for priority access where they can get in and out," Havens said. "Currently that's a very small number."