TRENDING on CMT Today (from 2001): In ‘retainer medicine,’ the doctor is always in.

Imagine having a personal physician at your disposal within minutes, 24 hours a day.

Out of town on business? Tied up at the office? No problem. Just call that cell-phone number tucked in your wallet. Your doctor will race to your side.

Sound like a fantasy? Not in Seattle. The city that spawned service giants such as Nordstrom and Starbucks, and new retail concepts such as Costco and Amazon. com, has begun a quiet revolution in medical care. A niche market, sometimes called “retainer medicine,” has taken root in Seattle with at least three such practices thriving and one poised to expand nationwide.

The idea started five years ago when Dr. Howard Maron, former team doctor for the Seattle SuperSonics, started MD2 (pronounced “MD squared”) with his partner, Dr. Scott Hall.

It provides concierge-level physicians’ services to a select number of patients who pay a premium for the privilege. For between $10,000 and $20,000 a year on top of insurance costs, patients are seen in spalike surroundings and have unprecedented access to their physicians. If they need to be seen by a specialist, for example, the MD2 physician goes with them to the appointment.

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The concept was so successful that MD2 opened a second practice in November with two physicians in Bellevue, and is now preparing to franchise the concept nationwide. Last week, physicians from Los Angeles were visiting MD2’s luxurious offices to get details on the MD2 touch. For about $75,000 in franchise fees, they will get a blueprint for running deluxe practices of their own, including interior design concepts.

“It’s like the Ritz Carlton,” said Duane Dobrowits., chief executive officer of MD2. Fine artwork hangs on the walls. The bathrooms are lined in marble. And for the ultimate in privacy, the doctors allow only one patient on the premises at a time.

Many of the patients who come to MD2 are the heads of large companies, who don’t want to be seen going to the doctor, he said. “Most of the patients are between 45 and 65 years old with a very high net worth — and who don’t want to wait.”

Two lower-cost versions of the same idea — Seattle Medical Associates and the Lewis & John Dare Center at Virginia Mason Medical Center — also are growing. Both recently added physicians to accommodate patient demand, and even that’s not enough. The doctors who run Seattle Medical Associates each have more than 100 people on waiting lists.

It’s likely to be a long wait. Turnover is low.

“To get in, someone has to either pass away or move on,” said Dr. Mitchell Karton, who started Seattle Medical Associates with partner Dr. Garrison Bliss four years ago. And that doesn’t always work. Some patients move away but retain their membership, coming back to town when they need care.

“The people who have chosen to do our practice are those who value the relationship with their doctor,” Karton said.

Of the three groups, Seattle Medical’s fee structure is the most affordable. At $75 a month, it’s the price of “a cable bill and a latte a day,” Karton said. Patients also must carry insurance.

At Virginia Mason’s Dare Center, the convenience factor costs an extra $3,000 a year for a single, $5,000 for a couple and $6,000 for a family of four in addition to insurance. For those fees, a patient gets the doctor’s personal cell-phone number, among other things.

Virginia Mason started its clinic in January 2000 after patients began defecting to the other two practices in town. The Dare Center now has about 700 patients, and recently added a third doctor.

“We developed this in response to consumer demand,” said Dr. Robert Mecklenburg, chief of medicine for Virginia Mason. “Patients had started hearing about these doctors who would see people at the drop of a hat, who came up for house calls. They wanted us to provide that level of service.”

Like the other two practices, the Dare doctors are on 24-hour call. And yes, they do house calls.

To some, the growth in demand underscores the level of dissatisfaction many patients have with the health care system.

“The sad thing about it is we have a medical care system that is by far the richest in the world, … yet the message is, ‘Even though we’re spending all this money, you’ve got to spend even more to get the care you want,'” said Aaron Katz, director of the Health Policy Analysis Program at the University of Washington.

Patients who enroll in these services are getting ready access and adequate time with their doctors to get all their questions answered, which is what most people believe they deserve, anyway, he said. “To have to pay extra to get that reveals how inefficient our health care system is, and how frustrating it is for everybody involved.”

Nan Isakson, a retired consultant to Swedish Medical Center‘s foundation, got fed up with her old health maintenance organization and joined Seattle Medical Associates.

“When I’m sick, I call and they get right back to me, not two weeks later,” she said. “With the HMO doctors, they had a limited amount of time and just rushed people through. He (Dr. Bliss) makes you feel he’s got all the time in the world.”

Isakson was in California recently, for example, and suffered a detached retina. “I was scared to death,” she said. Bliss made all the arrangements for her to get surgery immediately in Seattle. “My son met me at the plane, and the doctor was waiting for me. It all clicked.”

MD2 screens potential franchise applicants to make sure they understand the concept. “They have to be extremely customer-service-oriented,” he said.

Many doctors say they want to deliver that kind of service, but haven’t been able to because of the bone-crushing patient loads they carry.The typical urban doctor has between 3,000 and 4,000 patients, Dobrowits said.

Indeed, the number of patients in a practice appears to be proportional to the amount of attention each receives.

MD2 limits its practice to 50 “family units” per doctor.

“Every city probably has 100 families who would sign up for this,” said Dobrowits. He likened them to people who will pay more to fly first-class, or who put their children in private schools.

The other two practices also limit enrollment, but not so severely.

Seattle Medical doesn’t specify, but says its physicians see about one-third the number of patients they used to. Dare Center doctors carry about 300 patients each. The practice has a cross section of patients ranging from teenagers to the elderly.

“They’re not all corporate executives,” Mecklenburg said. “We have some housewives with young families who are on very tight schedules.”

Limiting patient loads is partly what draws doctors to this type of practice.

“Our goal was always to provide personal nurturing care for patients,” Seattle Medical’s Karton said. “But we found as health care changed, the volume we had to see prevented us from doing that. Now we’re able to provide personal nurturing care in a way you can’t when you’re in a big factory.

“Plenty of people need five minutes, but some need five hours,” he said. “Whatever they need, they get. Our practice allows for that.

“My feeling is every patient is my mother,” he said. “I ask myself, what would I want for her?”

SOURCE: http://www.seattlepi.com/local/article/In-retainer-medicine-the-doctor-is-always-in-1058930.php