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Cash for Doctors

And other ways to escape the diktats of Obamacare.

May 24, 2010, Vol. 15, No. 34 • By TONY MECIA
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With the passage of Obamacare, Forrest says he’s seeing more physicians aggressively search for alternatives, as he once did. Over the years, he’s helped a couple of dozen offices open across the country, and he’s started speaking at industry conferences about his practice. But in recent months, he’s been flooded with inquiries from fellow doctors. “Since the health care reform bill passed, you wouldn’t believe the number of doctors who have said they’ve had it and want to operate outside the system,” he says.

There’s little doubt that the new health care law is causing concern among doctors. And the frustration runs deeper than just occasional anecdotes, such as the Orlando urologist who posted a flier on his door in late March that read: “If you voted for Obama .  .  . seek urologic care elsewhere. Changes to your health care begin right now, not in four years.” The doctor’s story was linked on the Drudge Report, he appeared on Fox News, and a Facebook page devoted to him has more than 3,000 fans.

While those stories are interesting, more troubling is a survey reported in March in the New England Journal of Medicine that found that 29 percent of the nearly 1,200 doctors interviewed said they would quit the profession or retire early if the health care reform bill passed. Add to that a reported shortage of doctors, retiring Baby Boomers, and 30 million new patients who formerly lacked insurance, and the result could be disastrous.

“I don’t know how bad it’s going to be, but it’s already stretched to the limit,” says Dr. Marc Siegel, an internist practicing in New York and a Fox News medical contributor. “It can’t get any worse than this and still be functional for doctors.” 

The average doctor leaves medical school $156,000 in debt, according to the American Medical Association—some closer to a quarter-million. So anything that makes medicine less lucrative could keep future doctors out of the profession. “The government cannot take for granted that our fuel is going to be pure altruism and selflessness,” Siegel says.

Another business model that some doctors have been exploring is a “concierge” or “boutique” practice. Often, these practices combine the acceptance of traditional health insurance with an added fee, which doctors say relieves the pressure to move quickly from one patient to the next and allows them to focus on prevention, not just treatment.

There are plenty of companies following this model—with names such as Hello Health and MD2. One of the largest is MDVIP, a Boca Raton firm that has 365 member doctors and 125,000 patients in 28 states and the District of Columbia. MDVIP doctors accept and process insurance, but for an additional $1,500 a year, they give an exhaustive 90- to 120-minute physical exam and run tests that insurance often doesn’t cover, such as screening for mental or sleep disorders. They also help the patient develop a wellness plan and stick to it.

The idea, says company president Darin Engelhardt, is for a doctor to take on more of the role of a health coach than just a treater of illnesses. A typical family practice might have 2,500 patients. MDVIP doctors have only 600.

Engelhardt says the service isn’t just for the wealthy and that people in many different income ranges are patients. He also believes that by giving doctors an alternative business model, MDVIP is keeping them from leaving health care, while at the same time offering patients needed flexibility. “It’s really just a choice along the continuum of choices for health care consumers,” he says.

Before he affiliated with MDVIP two years ago, Dr. Ned Stolzberg was seeing about 30 patients a day. Now that he’s cut the number of patients in his Phoenix-area family-medical practice from nearly 3,000 to around 400, he averages little more than a dozen a day. The extra time, he says, allows him to do the sorts of things he thinks a doctor should, such as coordinating care with a specialist for a woman diagnosed with breast cancer or spending 45 minutes talking to a diabetic about nutrition and exercise. 

“Now, I can spend a lot more time working on the complicated cases,” he says. “It makes me feel like I’m being a real doctor now, like here’s what I was trained to do, and now I can do it.”

He says his patients come from all walks of life, from dot-com executives to school bus drivers and about half are on Medicare. “There are people of very modest means who find this to be a value to them,” he says.

MDVIP has continued growing in the last two years, despite the economic slowdown. Engelhardt sees more growth ahead, as the addition of 30 million uninsured Americans into medical offices is likely to further limit doctors’ time with individual patients.

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