“Concierge” doctors offer accessibility and longer appointments, following a model that provides patient-focused services
By Connie Gentry
Imagine calling your doctor and getting a same-day appointment. Imagine that doctor recognizing you and knowing your medical history because you are one of only a few hundred patients they see as opposed to one among thousands. And imagine the doctor spends all the time needed in your appointment, as opposed to the 10- to 15-minute visits that have become the trademark of overloaded traditional medical practices.
The idea of more time with patients, coupled with comprehensive medical care and referrals, are the underpinnings of the increasingly popular “concierge doctor” model. Those goals undergird the spread in Durham and surrounding communities of concierge medical practices customized for the individual that offer accessible appointments, plenty of doctor-patient time and doctors who advocate for patient wellness.
“Time is such a precious commodity,” said Dr. Deborah Ann Ballard, a primary care physician at Duke Integrative Medicine, “and the more time we get to spend with patients, particularly those with chronic, complex or multiple medical challenges, the better the outcomes. And the better we get to know our patients, the better we can recommend integrative treatments that include lifestyle factors that can prevent medical problems and promote longevity and well-being.”
The concierge model includes a monthly or annual fee – ranging from $1,800-and above per year (usually not covered by insurance) – and the promise that the practice will limit enrollment in order to deliver on their commitment. In fact, the cap on patient membership is critical to these goals – a typical primary care practice may have 2,000- plus patients per physician, according to The Physicians Foundation. A concierge practice rarely, if ever, exceeds 600 patients per doctor, so access is readily available in face-to- face, email and telehealth options.
But access is not the only, or even main, patient benefit. “The fact that we are available to our patients is really not what the patient is paying for,” noted Dr. Jessica Burgert of MDVIP/Chapel Hill Family Medicine. “The annual fee goes toward that testing/labs/ time spent in prevention and wellness at the annual visit. The increased access is just an added bonus as we have more time to spend with our patients. The benefits are time, attention, collaboration and coordination of care, wellness care, personalized medicine, cutting-edge care, family atmosphere, the entire staff knows the patients, [the] intimately, comfortable and welcoming environment and so on.”
The annual fee at CHFM covers a wellness and prevention program that entails an extensive evaluation including comprehensive lab work, cardiovascular and peripheral vascular evaluation, agility testing and an assessment of body mass composition. The results of the tests are reviewed during an in-depth, 90-minute appointment with the doctor, which initiates the proactive physician-patient relationship that the doctors hope to establish.
“We review in detail the patient’s health history, the testing results, and health and wellness goals,” Dr. Jill Lambert of MDVIP/CHFM explained. “We also have access to a toolkit of resources aimed at cancer early detection, [a] food-sensitivity evaluation and brain health. Instead of simply making a diagnosis and prescribing a medication, we also consider dietary and exercise measures that would benefit our patients, and we make recommendations on reputable acupuncturists, chiropractors, massage therapists and physical therapists.”
The customized-health care model is in sync with the paradigm shift in how we think about health care. For decades, medical advice was sought almost exclusively as a solution to sickness — you called the doctor because you were sick. But we’ve become increasingly more proactive about our health and seek health care that can provide a pathway to wellness and better living.
Similarly, many doctors have become frustrated and disillusioned with the demands of practicing medicine in an environment that requires as much attention be given to administrative details as patient care. These new health care models are gaining traction as a result. In exchange for a smaller practice, the doctor builds stronger relationships with each individual.
In October 2016, Dr. Todd Granger opened Primus Internal Medicine, a direct primary care practice off Hwy. 15-501 in the part of Chapel Hill that lies in Chatham County. He’d been in traditional primary care practices since 1993, first in Siler City and then back in Chapel Hill, having completed his residency at UNC and served on the faculty at the UNC School of Medicine.
“I was in two fantastic practices, both in terms of colleagues and patients, but I [prefer to] spend a lot of time with patients, which means I was always running behind,” Dr. Granger said. “Good medicine takes time.”
While he is quick to assert that good health care was being delivered in his former practices, typical 15-minute time slots do not “reflect the reality of what is needed in internal medicine, where appointments should be 30 minutes or more,” he said. “I wanted to be able to practice in a way that allowed me to do that, so I looked at other practices and reimbursement models. The direct primary care model was attractive to me because it was more affordable for patients.” As an example, the monthly membership at his practice is $75, half the cost of the $150 monthly fee at Duke Integrative Medicine, which more closely follows a concierge model and resides in a healthful and tranquil setting where members have access to a range of holistic services, from nutrition to yoga to acupuncture. The fee at CHFM is also $1,800 annually, but dependent children younger than 25 are seen as well at this practice without paying an additional fee if their parent is an enrolled member.
CHFM was started in 1975, operating as a traditional insurance reimbursement model; in 2008, the practice transitioned to the concierge-like” MDVIP model. Dr. Burgert and Dr. Lambert assumed ownership of the practice in July 2020, eager to embrace the “value in prevention” mantra that the acronym denotes.
“We have prospective patients fill out extensive intake questionnaires that cover everything from their sleep history to their medical history to their beliefs and value systems,” Dr. Ballard said, “and we go over it [with the patient] in our first meeting, typically lasting one hour.”
Though practices vary in their health approaches, one thing remains constant: a smaller patient load allows for more face time. At the family practice where Drs. Lambert and Burgert worked for 10 years prior to joining CHFM, they each had a panel of more than 1,000 patients. At MDVIP practices, patient panels top out at a maximum of 600 per doctor, and the CHFM practice still has room for new patients, with initial appointments typically scheduled within a week. In the two practices where he spent the first half of his career, Dr. Granger’s patient panels totaled 1,800 to 2,500 individuals. His current direct primary care model is designed to handle 400 to 440 patients, and he has a few open spots, giving his patients easy access to same-day appointments and enabling him to keep the door open for additional members.
The smaller practices allow time for customized wellness plans for each patient which is a lot of work, but it’s “joyful work,” said Dr. Burgert.
“We also do a lot of educating, compiling articles and informational handouts they can use as a road map for the year,” she added. “Some patients get their annual wellness assessment, and we don’t see them again for a year; others come back in for any number of reasons. We also do a lot of correspondence with our patients via email and text, or [on the] phone.”
CHFM and Duke Integrative Medicine participate in select insurance plans, and the annual fee can be paid using the patient’s health savings account or flexible spending account. As a direct primary care provider, Primus doesn’t participate in insurance plans or Medicare, but Dr. Granger’s patients can use their Medicare coverage or insurance for prescriptions and health care services performed outside of his office.
“At least half my patients are older than 65, which is the nature of internal medicine,” he said. “The main reasons they give for doing this [fee-based] model are the access and the amount of time I can spend with them, which is gratifying to me. The things I find attractive about direct primary care, they find attractive as well.”
Many direct primary care family practices allow unlimited visits, but internal medicine patients tend to be more complicated and have more chronic conditions, so the annual fee at Primus includes a yearly physical, similar to the wellness and prevention assessment at CHFM, as well as three office visits. If a patient exceeds that number of visits, they pay a flat $40 fee, much like an insurance co-pay.
“When we emerge from the pandemic and social isolation,” Dr. Lambert added, “we want to begin offering quarterly seminars on fitness, nutrition and community resources [as well as highlight] some of the talents of our members.” CHFM is planning an upcoming event with a local historian to take their members on a hike across UNC’s campus and discuss the roots of the community.