Finding a primary care doctor in Rhode Island may get harder. Faced with increasing workloads, some Rhode Island internists and family physicians are reducing their patient numbers.
"To take time to educate people," explains Providence internist Marc Weinberg, "you can't do it in a 15-minute visit." In November, Weinberg opened a solo practice that requires patients more than 35 years old to pay $2500 a year (younger patients pay less), in addition to their insurance. In return, Weinberg says, patients receive sick visits on demand, physicals that last up to four hours, and 24-hour phone access. While the typical internist has around 2000 patients, Weinberg plans to limit his practice to 400 or fewer.
A national company, MDVIP, is pushing a similar "concierge medicine" plan. In 2005, Providence internist Lewis Weiner swapped his 2000-patient practice for 400 patients who pay MDVIP $1500 a year.
The company keeps $500 and Weiner receives the rest for overhead and compensation. The MDVIP fee is a better, he says, than burning out or giving Botox injections to make quick money. In March, Pawtucket internist Peter Eller will become MDVIP's second Rhode Island physician, according to its Web site.
Some call this part of a dangerous national trend. "Concierge care is like a new country club for the rich," said US Representative Pete Stark of California at a 2005 hearing, "If a large number of doctors choose to open up these types of practices, the health-care system will become even more inequitable than it is today."
David Gifford, director of the state Department of Health, however, is not worried. Concierge medicine's high cost will limit its impact on primary care, he predicts, but he adds that low insurance and Medicare payments have created a primary care doctor shortage in Rhode Island.
"If you spend 45 minutes talking to someone about losing weight, their diet, diabetes, and quitting smoking," Gifford explains, "you only get reimbursed a fraction of what a cardiologist gets for doing a catheterization." Primary care physicians, whose salaries average about $150,000, according to Physicians Search, are the nation's lowest-paid doctors.
In a 2006, the American College of Physicians, a national organization of internists, pediatricians, and family practitioners, warned that without major reform, primary care "will collapse." In September, the Journal of American Medicine reported that, in 2007, only two percent of fourth-year medical students chose to be internists.
Other physicians offer alternatives. Former Pawtucket family practitioner Michael Fine proposes cutting out insurance companies. A 2006 Department of Health study found that administration and profits consume $45-$60 per person, per month, in insurance premiums. Fine suggests doctors charge uninsured patients half that to provide sick visits and annual check-ups. His company, HealthAccessRI, sets up the system for physicians.
Barrington doctor Andrea Arena, the Rhode Island representative of Physicians for a National Health Program, has "a micro-practice."
Instead of hiring staff, she and her partner at Barrington Family Medicine use a billing company and they answer their own phone. Both work part-time and together serve 600 patients. She calls concierge medicine "a systematic problem," noting, "I wouldn't fault the docs."