Boutique Medicine      The first time I heard about MDVIP, I was having dinner with friends in Boca Raton, Florida. My friends were discussing two Boca Raton physicians who had started a unique type of practice where they planned to limit the number of their patients by charging an annual fee of $1500 per patient. This practice would enable physicians to offer VIP medical care.      To say the least, I was surprised to learn about this new approach to the practice of medicine. But before I offered my opinion, I knew I needed to do my homework on what I knew would become a very controversial subject.      I found that doctors in many cities had instituted this new type of practice called boutique or concierge medicine in response to increasing frustration over not having the time to dispense a personal and thorough type of medical care. In Boca Raton, Boston, Phoenix and Seattle several medical groups began significantly limiting the number of patients in their practice, from thousands to 600 in Boca Raton, 300 in Boston and 50 in Seattle, while charging annual fees of $1500-$20,000. Boutique medicine is currently being considered in New York, California, Illinois, Texas, Maryland and Virginia.

Patients accepting this type of additional charge are told that they can expect amenities that they have been unable to receive in the past. While these amenities vary from practice to practice, they include: same day appointments, physician availability (24/7/365), comprehensive annual physical exams, email and cell phone access to the doctor, internet access to medical records, annual nutrition and physical fitness assessments in patient’s homes or health clubs, home visits, private reception and examination areas replete with heated towel racks, marble showers and personally monogrammed robes and accompaniment to emergency rooms and referred specialist’s offices.      Physicians who practice this “membership fee” type of medicine argue that by charging an entry fee they can have a limited and small number of patients, and thus be able to spend much more time withtheir patients at each medical encounter. Physicians who have begun this type of practice insist they are not necessarily making more money but rather are finally practicing the kind of medicine they had always hoped to practice. Gone are the huge numbers of patients in the waiting room, the limited time spent with each patient and the inability to attend to their entire needs.      While I can understand why some doctors in this country are resorting to this type of practice, I am saddened that our health care system has come to this. I am saddened to think that we have come to a time in medicine where patients have to pay a substantial membership fee to get what many of us went into medicine to give as a routine practice.      Boutique or concierge practices may be a solution for an individual doctor and wealthy patients, but it is not a solution for our society. If large numbers of physicians were to limit their practices to only those who can afford these additional thousands of dollars, who will be left to take care of the many who cannot pay? What will this say about our compassionate profession? We do not need a medical system in which physicians charge extra for compassionate, personal, thorough and expert medical care. We need an environment in which our healthcare system provides funds that allows physicians to treat every patient with compassionate, personal, thorough and expert medical care.