What’s Up, Doc? Why More Vermont Physicians Are Making the Switch to “Concierge” Practices

Michael Sakash admits he’s not the kind of patient who gets in and out of a doctor’s office in 15 minutes. The 62-year-old Stowe resident has a long and complex medical history that includes diabetes, diverticulitis, depression and substance-abuse issues. Then, in July 2012, Sakash suffered a stroke, which left him unable to work.

A few months ago, Sakash was notified by his primary care physician of more than 20 years, Dr. David Bisbee of Stowe, that he was switching to a “concierge medicine” practice. For the patients who choose to enroll, Bisbee now charges an annual fee of $1500, for which they receive 24-hour-a-day access to their doctor. He gives patients his cellphone number, accommodates them with same-day appointments and makes house calls.

Office visits are less rushed and more comprehensive — an annual physical can take two hours — with virtually no time spent in a waiting room. And, regardless of the medical reason for it, every office visit costs just $25. Despite the annual fee, which isn’t covered by his insurance policy though Blue Cross Blue Shield of Vermont, Sakash says he’d never consider looking for a different doctor.

“Dr. Bisbee knows my background,” he says. “If I need 25 minutes, he’ll give me 30 because he won’t leave until he’s done.”

To some, the term “concierge,” “boutique” or “retainer” medicine conjures up images of high-end practitioners who cater exclusively to rock stars and Park Avenue socialites. But though Sakash resides in the Stowe area, he’s no member of the 1 percent. A former school bus driver of 13 years, he was working in the maintenance department of a maple syrup processing plant in Hardwick when his stroke occurred. He now gets by — and pays Bisbee’s annual fee — on his disability checks.

For Bisbee, the son of a seventh-generation Waitsfield dairy farmer, the motivations for switching to a concierge practice a month ago were only partly financial. The 59-year-old family practitioner says he was driven more by a desire to regain his “autonomy” as a physician and get back to the basics of why he got into medicine 27 years ago.

“I do house calls, I deliver babies, I go to the hospital and the nursing home,” explains Bisbee, who’s also the medical director of a long-term nursing facility in Morrisville. (He waives his annual fee for most of his elderly patients and allows others to pay in installments.) “This is what I call a modern medical practice with a lot of old-fashioned notions.”

Bisbee is hardly alone in this desire. Increasingly, Vermont’s independent physicians say it’s never been harder for them to make a living. Faced with declining reimbursement rates, rising overhead costs, and excessive time spent filling out paperwork and obtaining insurance company pre-authorizations — not to mention the confusion and uncertainty of the shift to a more centralized insurance system — many say they face a difficult dilemma: either join a large, hospital-affiliated medical practice and become salaried employees, or leave Vermont to practice in another state where they can make more money.

Evidently, many doctors have chosen the former. A decade ago about half of all primary care practices in Vermont were independently owned. That’s according to Dr. Paul Reiss, president of a Vermont-based association, Healthfirst, that bargains to get independent physicians better rates on their malpractice insurance, equipment and contracts with the state. Today, Reiss says that figure has dropped to a third.

But some doctors, like Bisbee, have found an attractive third option: Set up a concierge practice, which dramatically reduces their “panel,” or caseload, from several thousand patients to several hundred. By charging each individual or family an annual fee, practitioners are free to spend more time as doctors and less as bookkeepers.

“I just really like the flexibility of getting back to the one-on-one, doctor-patient relationship. It feels really good,” Bisbee adds. “And I feel pretty confident in saying that these practices are going to pop up right and left now.”

Dr. Alicia Cunningham agrees. The 38-year-old primary care physician in South Burlington left a Fletcher Allen-owned group practice in February to set up her own concierge practice, which she refers to as “direct primary care.” Previously, Cunningham says she was spending more than half her time dealing with “paperwork, bureaucracy and mandates … time I could have spent caring for people.”

Since then, Cunningham has reduced her panel of patients from 3000 to 400, a limit she’s fast approaching after advertising her new concierge practice extensively in the Chittenden County market. As she puts it, “You cannot have a personal relationship and be on call for 3000 patients.

“I enjoy caring for my patients, which means being available to them and on call when they’re in trouble or have questions, and I don’t want them to be limited to a 15-minute visit,” she adds. Cunningham keeps her schedule open to see patients in her office the same day they call, and to answer their emails, texts and phone calls.

As with most concierge practices, Cunningham’s patients still need insurance to cover their other medical expenses, such as lab work, ER visits, prescriptions and hospital stays. But with all the extra time in her schedule, she’s now free to provide more hands-on care to her patients in hospitals, rehab centers, nursing homes and assisted-living facilities. As she puts it, “I wanted to get back to the way medicine should be practiced.”

find out more about the pros and cons of concierge medicine here 

About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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