Facing pressures from insurance companies and regulators, primary care doctors are turning to concierge medicine.

DR. JAY S. EDMONDS HAD BEEN PRACTICING MEDICINE FOR 30 YEARS WHEN IN THE MID-2000S, HE NOTIFIED HIS LONGTIME PARTNER, DR. CINDY LEE, THAT HE WAS BURNED OUT.“He gave me notice that he was going to go flip burgers,” Lee says. “I said, ‘Wait, let’s take six months to figure out what options there are.’”

They spent the next six months researching the options. They could join a big group, like Montage or the VA, but valued personal relationships and working for themselves. They decided to become a concierge medical office, though they prefer the term “membership.”

Lee recalls a coffee meeting with a representative of Florida-based MDVIP, a concierge medical group 1,000 doctors strong, and her initial reluctance to embrace the concept of a patient fee. “I said, ‘I can’t pay for patients having the privilege of me being their doctor, it’s not me,’” Lee recalls. “I was really anti this model until I found out more about it and what it could offer my patients.”

What it could offer was a way to shrink their total number of active patients from about 3,000 to 600 per year. It meant going from days stacked with 20 to 25 patients booked for 15-minute appointments – both Lee and Edmonds describe it as “a treadmill” – to six to 12 appointments per day. It meant 90-minute annual exams with reviews of extensive test results like EKGs, hearing tests and body composition analyses.

It meant they could get off the treadmill and do more reading, and both Lee and Edmonds describe something of a personal revelation in learning about the importance of lifestyle in controlling chronic conditions. They offer guided walks and hikes with patients, screen films about health and regularly talk with patients about things like nutrition, relationships and anxiety.

Lee says she’s changed her own philosophy: “Eat well, move more, love more, stress less. For the brain, discover more.”

“What we’ve learned is the importance of lifestyle medicine,” Edmonds says. “Many people are busy people who go to the gym for an hour every morning. But they eat like crap, stress like crazy, get hardly any sleep and have dysfunctional relationships then are shocked when they have their heart attack, and when they look up and find out they don’t have much joy in their lives.”

For the patients who are members of Edmonds’ and Lee’s practice, the increased attention and access – members get same-day or next-day appointments, and can call 24/7 – comes at a price. The fee is $150 per month, a percentage of which goes to MDVIP, responsible for managing regulatory compliance and legal issues. Nancy Udell, a spokesperson for MDVIP, declined to comment on doctors’ contracts and fee schedules. Patients and their insurance companies are still billed for appointments and services.

There are six MDVIP doctors in Monterey County – “a lot for one area,” Udell says – and others that are independent or operate with other companies.

Ten years ago, the first local doc to join MDVIP was Scott Schneiderman.

“I’ve been able to take care of patients better,” he says. “They get the kind of care they need and deserve. I get more personal and professional satisfaction because I can take care of my patients in the way I was trained to do. It’s a win-win. I wish everyone could have this model, but it’s not something government or insurance companies are willing to pay for.”

Schneiderman’s patient fee is $137.50 per month, which he views as reasonable for working-class patients.

“Ask people what they’re spending for phone bill, cable bill or lattes at Starbucks – that’s a lot less than you’re paying for MDVIP membership. It’s a personal choice: What do you value?”

Some patients, particularly younger patients, may not value access to a primary care physician, and opt instead to utilize telemedicine or a growing number of urgent care clinics. At least that’s what Dr. Jim Gilbert, president of the Monterey Bay Independent Physician Association, has observed. He says for the concierge model to work, a doctor has to already have established a reputation and trust, so he thinks it’s unlikely new doctors will get into it.

“These are different models that have different advantages and disadvantages and are responding to different needs and desires of patients,” Gilbert says. “There’s little question that concierge fees may not be in the budget of every patient.”