by Marty Cook
Posted 4/21/2014 12:00 am
Updated 5 months ago
Parents trying to get their children bathed and to bed can relate to Sarah Lewis’ dilemma.
Her 2-year-old son was playfully romping in the tub when he head-butted mom, splitting her lip open. It wasn’t the blood or pain that concerned Lewis so much as it was the potential headache of getting after-hours medical treatment.
The cut seemed serious enough for stitches but was a trip to the emergency room worth it? She had three children to get to bed and she and her husband had jobs the next morning and, well, who wants to spend two hours in a waiting room when the injury might not even need to be dressed?
Fortunately for Lewis, she didn’t have any stress about a busted lip. She called her personal physician, who looked at a texted picture of the injury and met Lewis at her office.
Forty-five minutes after her bouncing boy bonked her, Lewis was back at her Greenbrier home, two stitches in her lip, with her children to bed and relaxing in front of the television.
Lewis’ personal physician is Amy Beard, a former emergency room doctor who has gone into private practice. Not just any kind of private practice, though, because Beard is one of a handful of Arkansas doctors pursuing a new model of medicine commonly called concierge or direct primary care medicine.
Lewis and her family are Beard’s patients and pay a monthly fee for the doctor’s unlimited, 24/7 service. A child with a cough, a husband with a fever, a mom with a cut — Beard treats them all whenever the need arises.
“It has been an answer to prayer,” Lewis said. “She has saved us two ER visits. I would pick up cans on the side of the road to pay for it.”
Beard’s practice, Hippocrates Health & Wellness, doesn’t force patients to such drastic measures to make their payments. Beard charges $100 per month per adult, plus $30 per child, so a family of five can get unlimited primary care for $290 a month.
Tom Blue, the chief strategy officer of the American Academy of Private Physicians in Richmond, Va., told Arkansas Business that there are about 5,500 concierge doctors nationally and the practice is growing at a rate of 25 percent a year. The count is a well-educated guess, Blue said, because not every concierge-type doctor has to publicly announce or register his or her practice.
Blue said the concierge model is growing in popularity. In Richmond, the first doctor started in 2002 and now there are 28, Blue said.
Beard said she knows of five concierge doctors in Arkansas, and Blue said he would theorize there were a few more who haven’t gone public.
“There are a lot of states where it is picking up steam,” Blue said. “Once doctors succeed, others will quickly follow. Once it catches on, it quickly spreads.”
Concierge medicine has the reputation of being for the rich, but Beard and others said that’s not the case.
“My fees are less than some people’s cell phone bills,” Beard said.
Beard said a medical service like hers allows patients to get less — and cheaper — health insurance from their employers or third-party companies for major issues like catastrophic injuries or illnesses. Because concierge doctors such as Beard don’t bill insurance, there is little overhead or wasted fees.
More importantly, Beard said because she has a reduced number of patients she can spend more time with each patient, resulting in better care and better health.
Beard started her practice in October 2013 and has built up a patient list of about 150 with a goal of 300. That’s a welcome switch from her years as a resident in family medicine when she had to see 40 or more patients a day.
“You can’t provide good health care in five minutes,” Beard said. “We are much more complex than a cow. I didn’t like seeing 40 patients a day. I don’t know what they were getting, but it was not health care.”
John Furlow of Fayetteville had a similar epiphany. Furlow was in internal medicine with the Fayetteville Diagnostic Clinic for 13 years before opening his private office in October 2013.
Furlow said he researched the idea of being a personal physician — he uses the term direct primary care physician — for three years before making the jump. He had an advantage Beard did not because he had 2,000 patients at FDC, some of whom have followed him to his private practice.
“I’m doing it the hardest way possible,” Beard said. “I’m building from scratch. A physician already established would have a much easier time doing this.”
Lewis said she found out about Beard’s practice when her sister went to a ribbon cutting for Beard’s Greenbrier office and returned with a brochure. Beard has offices in Greenbrier and Conway and also has “a la carte” services for diet planning, hormone replacement and massage therapy.
Like Beard, Furlow has monthly membership plans, ranging from $60 to $100 depending on age, and he also has a pay-as-you-use-it basic plan. And, like Beard, his office staff is two: the doctor and a manager.
Beard said more office personnel means more patients are needed to justify and pay for them. The bare-bones operation — Beard or her husband-office manager answers the phone — means almost no overhead or superfluous expense.
“If you cut out the behind-the-scenes documentation, the doctor can spend more time with patients without the headaches,” said Furlow, whose patient list is approaching 500. “There’s no insurance to file. Direct primary care gets away from insurance that is expensive.”
Mark Williams of Your Personal MD of Mountain Home said concierge physicians can drastically improve a patient’s health because they have the time to give a thorough examination. Williams, who used to work in a clinic before going solo in 2010, said the current medicine model is like an assembly line, where doctors can see patients for just a handful of minutes.
Many times, patients are seen by a nurse practitioner rather than a doctor, Williams said.
“It was a cattle farm, and I do personalized care,” Williams said. “Thank goodness I’m not in the rat race.”
Williams said concierge care is focused on the patient, not the insurance company or the doctor’s overhead.
“I went into medicine to spend time with my patients,” said Williams, who said he had about 175 patients. “I was serving the insurance company’s needs instead of my patients’.”
All three personal physicians said giving patients more attention and personalized care is actually a money saver. Instead of treating whatever symptom is presented during a two-minute consultation, Williams said, a one- to- two-hour visit can help determine how to treat the underlying root problem.
“Most people tell me that’s the kind of doctor they want,” Furlow said. “It has been an absolute joy to practice medicine. Patients want information. It goes back to when your doctor was your doctor, and he took care of you.”
Furlow said several of his friends in the medical community have reached out to him to find out how he is doing — “They call me and say, “Hey, let’s get lunch,’” Furlow said — and Beard is looking to expand her office with another doctor to handle the increase in patients she is expecting. Williams wants to open branch offices of his corporation in other regions of the state.
“It’s going to be the wave of the future,” Williams said. “Once a patient gets a taste of this, they’re never going back. It’s a totally different type of medicine.”
All three doctors said they have made house calls as part of their service and each routinely receives phone calls and text messages from patients with health questions. Beard said she made a home visit because a patient was regularly complaining about allergies and other symptoms, and that home visit helped solved the question of what was causing the problem.
That wouldn’t have happened if she only had two minutes in an office with a patient, Beard said.
“I have no regrets,” Beard said. “I get late-night calls, and I don’t mind at all. That comes with the job. I’ve been on call 24/7 since we opened. It saves a lot of money and time.”
The questions Furlow gets from other doctors are about finances: Can a doctor survive on his own with a reduced patient load and no insurance to bill?
“It works, but physicians are notoriously risk adverse,” Furlow said. “I was willing to take the risk and just do it. I finally just pulled the trigger.”
Williams said most doctors are in debt from the expenses of medical school and the grind of residency. He said he tells interested doctors that going concierge is not a quick fix and it will take a while to break even, but the other benefits compensate.
“A happy doctor is a better doctor,” Williams said.
Beard started her medical career later in life after starting as a dietician. When she began her residency, while moonlighting as an ER doctor, she was told she would never get rich and would need antidepressants after a few months.
It was that gloomy outlook that spurred Beard into the new model.
“After getting beat up one night — not literally — I came home and said I can’t do this anymore,” Beard said. “I really wanted to be a family medicine doctor. This has been a blessing. I wake up every day and I’m happy.”