The Orange County Register - Thursday, March 16, 2006

A really private practice

So-called concierge doctors charge an annual retainer so they can spend more time with a limited clientele.

By COURTNEY PERKES

There's barely a need for the waiting room in Dr. James Strebig's office anymore. The comfy chairs and magazines don't get much use.

Keith Sanders, 51, walks in for a routine checkup. He's immediately called into the examination room.
A medical assistant offers Sanders coffee as Strebig takes a seat.

THE DOCTOR IS IN: Dr. James Strebig talks with Keith Sanders, 51, of Irvine during a checkup
at Strebig’s Irvine office.

The appointment feels leisurely. Strebig asks about Sanders' upcoming move, takes a blood-pressure reading and accepts a compliment on the office's new hardwood floors.

"I'm in the Four Seasons of health care," says Sanders, a vice president of sales for a roofing materials company. "It's magnificent."

Last year, Strebig cut his patient load by about 90 percent and joined a small but growing number of doctors who charge patients an annual retainer for so- called concierge or boutique practices.

The trend has been in play for a couple of years. And, while it hasn't revamped health care - yet - it also isn't going away.

For a price, typically $1,500 a year, patients are treated like customers. They receive same-day appointments without a wait, their doctor's cell-phone number, and comprehensive physicals that emphasize prevention and lifestyle coaching. Most of the practices still accept Medicare and private insurance.

"Patients are paying to keep this practice small," said Strebig, who has practiced in Irvine since 1994. "It's more personal."

A CHANGE OF PLANS: Dr. James Strebig says he used to see as many as 24 patients a day, treating
1,850 different patients in 2004. Since switching to a retainer practice, he has a clientele of 230 and
one recent day saw six patients.

The retainer model was born out of frustration with the hurried nature of modern medicine. Doctors complain that they must see more and more patients to keep up with rising costs and diminishing insurance payments. Sick patients feel resentment when they can't get appointments or when doctors are rushed.

Nationwide, about 300 doctors have opened retainer practices, with a handful in Orange County. The idea also has a corporate model, Florida-based MDVIP. The company, which helps doctors transition their practices and collects a portion of the annual fee, has one affiliated doctor in the county and will add a second next month.

Some health-care watchdogs worry that the trend will create inequities in care based on income. They say all people should be entitled to quality, thorough care. Lawmakers have asked federal officials to monitor concierge doctors and have expressed concern about patients who lose their doctors to others who agree to pay the retainer.

But those with retainer practices say restoring control to doctors and patients is a small step toward fixing the system.

Contrary to expectation, most people who pay for concierge doctors aren't wealthy. They tend to be in their 50s and 60s and value attentiveness and promptness.

"The average office visit today is down to eight to 10 minutes of face time between doctors and patients," said Dr. Edward Goldman, co-founder of MDVIP. "You can address what's going on at the moment, but you can't address a comprehensive approach to early detection and prevention of disease."

Dr. Garrison Bliss, president of the association for concierge doctors, called the Society for Innovative Medical Practice Design, said he thinks the model can help spur systemic change. He envisions a combination of insurance and cash payment that encourages consumers to find the best possible care at the lowest prices.

For instance, Bliss, who practices in Seattle, charges patients $95 a month. And in a departure from the typical model, he accepts no insurance. The fee covers all their medical expenses in his office, from X-rays to pregnancy tests.

"It's care without a middle man," Bliss said. "It's possible to do this much less expensively."

Sanders had been a patient of Strebig's for about 10 years when Strebig decided to convert to an "exclusive practice" as of January 2005. He sent letters to every patient, regardless of their health histories, inviting them to join. For the majority who chose not to, he offered help finding another doctor.

With a daughter in college, Sanders was reluctant at first to join. But he didn't want to lose Strebig and decided to give it a try.

He was sold after the first visit.

"There weren't a bunch of sick people in the lobby," said Sanders, who lives part time in Irvine. "I was the only one. I don't have to sign in. I walk in and can't even grab a magazine."

Strebig, 48, thought hard about his decision. He didn't want his patients to feel abandoned, but he was growing miserable.

The year before the switch, in 2004, Strebig treated 1,850 different patients. He saw up to 24 patients a day, most in 15-minute intervals.

"Some days I found myself saying I wanted to quit. That's how bad I felt rushing from room to room."

He now has about 230 patients and has set a limit of 300. On a recent day, he saw six patients.

He no longer worries about spending five minutes saying hello. Standard appointments last 30 minutes, and Strebig allots two hours for physicals. He prepares detailed medical reports for his patients and gives them a wallet-sized CD with their complete medical history.

"I've taken the rush and congestion out of the practice of medicine," Strebig said. "I love coming to work. I'm happy all over again. I wish all physicians could do this."

Strebig declined to give his salary but said he's earning more and going home much earlier. Weekend and late-night calls from patients are rare.

He's spending proceeds on an office remodel of warmer paint colors and new furniture.

And fewer chairs in the waiting room.