Faced with shrinking incomes (BMJ 2000;321:1309) and rising overheads, especially malpractice premiums, American doctors are turning to what has been called “boutique medicine”—a luxury service offering patients fast track appointments and annual check ups.
In south Florida last June Dr Robert Colton, an internist with more than 20 years' experience, started a company called MDVIP with four other doctors. In return for a yearly membership fee of $1500 (£1050; €1700), the doctors contracted to provide patients with annual physical examinations, same day appointments, 24 hour doctor availability, coordinated referrals to specialists, and online access to their medical records. Dr Colton promised to limit his practice to 600 patients.
Now similar groups are springing up in Arizona and Washington state, including one in Seattle charging families $20000 a year. Plans are afoot to franchise Dr Colton's company in New York, California, Illinois, Texas, Maryland, and Virginia. Two internists are leaving Beth Israel Deaconess Medical Center in Boston for their new practice, where patients will be charged $4000 a year on top of the medical costs covered by their health insurance.
Dr Steven Flier, one of the Boston internists, said, “We want to be able to spend more time with patients. We're desperately struggling to create a system that lets us do that within the limitations of managed care.”
Interviewed in his office in a sleek modern building in Boca Raton, Dr Colton was enthusiastic about his transformed practice. Before MDVIP, he found that the only way he could make an acceptable living was to see as many as 35 patients a day. Cuts in Medicare and in insurance company payments motivated him to charge the membership fee. Patients unwilling or unable to pay the $1500 charge were transferred to other doctors willing to accept them.
Dr Sidney Wolfe, director of consumer organisation Public Citizen's health research group in Washington, DC, said, “Boutique medicine is a predictable consequence of how badly our healthcare system is functioning.”
The American Medical Association has not taken an official position on the issue. But Dr Richard Roberts, chairman of the American Academy of Family Physicians, said, “If you have a substantial portion of America's doctors doing this, who's going to take care of everybody else? We've got over 40 million people in this country without health insurance, and another 20 million who are underinsured. What's wrong with this picture?”