Growing numbers of doctors on Long Island, frustrated with seeing 30 patients or more in appointments each day, are adopting a business model that drastically reduces their daily caseload.
Long Island physicians using this model — generally known as concierge medicine — charge patients an annual membership fee to come to their practice. The annual membership fee is typically between $1,100 and $3,600 per year, doctors said.
These doctors, most of whom are primary care physicians, such as internists and general practitioners, cap the number of patients they accept at around 600, which is about 75 percent less than at standard practices. But the doctors get a guaranteed minimum income from each of those patients.
“I’ve learned so much about patients I’ve had for years, and it’s because now I get to spend time with them,” said Dr. Mark Wasserman, who converted his Miller Place primary care practice to the model more than two years ago.
Physicians share their cellphone numbers with patients, who can get appointments without lengthy delays.
“Every family doctor would love to practice this kind of model,” Wasserman said.
The model has critics. They say that if too many doctors see fewer patients, it will leave other patients out in the cold. Critics also worry it could create a two-tiered health system, where some patients get more personal care.
Covered services under the fee usually include an hourlong wellness exam, care for children up to age 26 and, in at least one case on Long Island, access to a gym at the doctor’s office.
Some concierge doctors don’t take insurance, and their patients’ treatment is generally covered by the annual fee.
Others take insurance, including Medicare. Patients are responsible for their share of a payment, as at a traditional practice.
Robert Doherty, senior vice president of government affairs and public policy for Washington-based American College of Physicians, placed the number of primary-care concierge practices nationwide at between 5,000 and 8,000.
To compare, there are 900,000 licensed physicians of all types in the United States. There is no federal registry of concierge practices, which makes it difficult to pinpoint how many exist.
The number of these practices across the country is growing around 7 percent per year, according to Concierge Medicine Today, an Atlanta-based trade publication.
The concierge market is concentrated in and around cities with high income earners, such as New York and its suburbs, said Terry Bauer, chief executive of Specialdocs Consultants Inc., a Highland Park, Illinois-based firm that helps doctors transition from a standard practice to a concierge model.
“If there are 3 million people on Long Island and about 20 million people in the New York area, there are thousands of doctors who are very good candidates to do this,” Bauer said.
Patient benefits at these practices include longer, in-depth appointments and a doctor willing to navigate insurance policies when follow-up tests are needed. Doctors on Long Island said their patients can call or text them at any time.
There are other patient benefits, too.
Wasserman spends the first Wednesday of the month with patients walking trails at Heritage Park in Mount Sinai. About a dozen patients joined him for a walk along a seven-tenths of a mile path there in early August, including Marie Dandrea, 53, of Miller Place, and her son Ronnie, 13, who has Down syndrome.
She said the extra cost — Wasserman charges $1,650 annually — “was a financial concern, but I can’t imagine anyone else watching and taking care of Ronnie. He is there at a moment’s notice.”
Rich Romero, 60, of Smithtown, another walker, said Wasserman “has been my doctor for 35 years, and I see the difference in him now, and my wellness exams are so detailed. You end up with a folder with all the details of your results.”
Dr. Daria Blyskal, a general practitioner in Sayville, makes house calls and has an extra room in her office where patients can lie down, stretch, meditate or listen to music.
“Most doctors offices are noisy, ugly and less personal,” she said. “This is more like a living room and less institutional.”
Her office also has a skin-care expert, psychotherapist and massage therapist — all of whom are patients of hers — although those services aren’t part of her practice.
“But they’re here, so patients can purchase their services if they’d like to,” Blyskal said.
High-end platinum members at HealthBridge, a Great Neck concierge practice, can use a gym at the office and a team of nutritional, aesthetics and stress-management experts, said Dr. David G. Edelson, president at HealthBridge. HealthBridge charges patients a monthly membership fee between $149 and $299 per month.
The practice also has dietary supplements on site.
MDVIP Inc., a network of about 850 concierge doctors nationwide, has 18 on Long Island, including Wasserman. Its doctors go food shopping with patients to teach them healthier eating practices, and some go biking as well to encourage exercise.
“We have a doctor in Nevada who has people come to his house to cook healthy meals,” said Nancy Udell, director of media relations at the Florida-based network.
Concierge doctors said their patients have better outcomes because of the extra time and attention to detail they give them.
“In the end, I’ll save you money,” said Blyskal, who has 300 patients, does not take insurance and charges an annual membership fee of $1,089, or $99 per month. “You’ll be healthier. You can use me as often as you’d like, and there are no hidden fees and no copays.”
MDVIP, which takes a portion of a patient’s membership fee from doctors in its network, says its statistics show better outcomes for its patients than elsewhere when it comes to chronic conditions such as diabetes and heart disease. The study, published in the American Journal of Managed Care in 2012, compared MDVIP patients to non-MDVIP patients in five states where the company does business and outcome statistics are sufficiently detailed.
The study also found that patients between ages 35 and 64 with commercial insurance at MDVIP-affiliated practices experienced 72 percent fewer hospitalizations than those at unaffiliated practices.
Doctors at standard practices push back on claims of better outcomes.
“Socioeconomics are at play here,” said Dr. Eric C. Last, a primary-care physician in Wantagh who joined Northwell Health Physician Partners, the doctor network at New Hyde Park-based Northwell Health, in 2015. “People who can afford these services are, by definition, healthier. What you’re seeing is selection bias.”
Last also said that although spending more time with a concierge primary-care physician is a plus, that advantage may not apply once a patient needs to see a specialist, who generally isn’t a concierge doctor.
“It’s a false promise, because the specialist isn’t bound by the same rules,” Last said. “I’d say we are faster and better at getting a patient in need to a specialist.”
If too many doctors shift to the direct patient contracting model of concierge medicine, it could hurt health care access for many patients, said Doherty, at the American College of Physicians, which represents more than 150,000 doctors and medical students nationwide, including doctors who have shifted to concierge medicine.
“If you decide to do this, and you’re going from 2,500 patients to 500 or 700 or even 1,000, you’re essentially firing a bunch of your patients,” Doherty said. “If a practice either doesn’t take insurance, reduces its patient base or charges fees, there is a greater risk that people with less will be excluded more often.”
Doherty, however, added that “many standard primary-care practices can exclude patients, too. A practice in the Upper West Side of Manhattan probably isn’t seeing that many low-income people.”
Concierge doctors said they have patients from all economic groups.
“At the end of the day, the more we talk about affordable care, the more people will look inward, and when they decide what the most important thing to pay for is, health care is going to be at the top of the list,” said Dr. Jeff Puglisi, who operates Glenville Medical Concierge Care in Greenwich, Connecticut. “My hope is, in time, health savings accounts can be a vehicle to make it even more affordable, and employers should look at offering this as a benefit. It would be a great way to attract new talent.”
Not all physicians can successfully convert their practice.
Bauer at Specialdocs Consulting said some doctors don’t have the right patient base, or aren’t in a region that can support charging patients a fee.
“The downside for any doctor is there will be patients who can’t afford to pay the fee and will need to find a new doctor,” Bauer said. “The analysis we’ve done shows that the [concierge] model works best in areas that have at least a $70,000 household income. The average patient has $88,000 in household income. People who are older and have higher incomes are more likely to join.
“If you can’t get enough patients to make the switch, it isn’t going to work, and unfortunately that means some doctors can’t do it,” Bauer added.
Dr. Nick Fitterman was able to convert his practice in Huntington to a concierge practice, cutting his patient count from 3,000 to 600. But he pulled the plug on the model after three years, in 2006.
“I have a tremendous appreciation for why some doctors do it, but my conscience ate at me. It limited who I could see, and that viscerally felt wrong,” said Fitterman, now vice chair of hospital medicine at Northwell Health. “I had some patients who were younger who wanted to join, and I told them not to spend the money. I didn’t feel good about it, and I was taking sick patients I knew for free.”
But Dr. Jackie Orfanos, an MDVIP-affiliated primary care doctor in Plainview who charges $1,650 annually for a patient to join her practice, said her patients include single moms, teachers, firemen and policemen, and has a mix of races and ethnicities.
“I question the moral and ethical responsibility to a patient after you see 30 or 40 patients in a day,” Orfanos said. “How can you say you’ve done a good job?”