For an Annual Fee, Physicians Give Extra Care

Tons of snow smashed down the peak in Val d’Isere in the French Alps, sweeping up everything in its roar, including Andrew Gitkin of Manhattan Beach.

He was skiing with a friend and two guides in February when an avalanche tossed him over a 30-foot cliff and half a mile down a slope. “When I finally came to a stop,” he recalled, “I was ... completely buried.”

Gitkin, a 34-year-old hedge fund manager from Manhattan Beach, remained conscious and put his avalanche-survival training to work. Miraculously, his companions were unhurt and came to his rescue with the help of a homing beacon he was wearing.

At the mountain first-aid station, a French doctor on duty spoke no English but tried to schedule him for surgery the next day at a French hospital.

It was a scary situation: Gitkin didn’t understand the doctor, the physician’s diagnosis, the extent of his injuries and what was in store for him at the hospital. But he had a solution: His girlfriend called his doctor in Southern California, and things changed dramatically.

Having access to reputable healthcare in a strange place is a vital issue for travelers.

With that in mind, American Express Co. offers its cardholders a medical referral service of physicians whom it has screened as well as emergency translators. Hotels often have a list of local English-speaking doctors and can help arrange for medical care.

“We have a house doctor who is on call 24 hours a day,” said Joshua Gardner, concierge manager of the Four Seasons Hotel London. It is fairly typical of high-end hotels such as the Four Seasons to have house doctors, he said.

In Gitkin’s case, the call went to his personal physician, Albert Fuchs in Beverly Hills. He was reached immediately on his cellphone. But not everybody can get that kind of service.

Fuchs was there for Gitkin because the doctor is one of a growing number of internal medicine specialists practicing concierge medicine.

Concierge, or boutique, practices typically limit the number of patients to no more than 600. That contrasts with as many as 3,000 in a traditional health maintenance organization or preferred-provider organization medical practice. Fuchs plans to limit his growing practice to fewer than 400.

Fuchs arranged for Gitkin to be transported from France to New York for treatment and had specialists at a top orthopedic hospital waiting to treat him.

“Within 12 hours I was back in New York,” Gitkin said, where he was treated for shoulder injuries.

Doctors in concierge practices are available to patients through a private cellphone number 24 hours a day, seven days a week.

“Having access on a real-time basis to your doctor and not a proxy for your doctor like an answering service ... is an incredibly valuable service,” Gitkin said.

The concierge concept is gaining traction with busy professionals, especially those like Gitkin who travel frequently on business and for pleasure.

“Our fastest-growing segment is corporate executives,” said Dr. Edward Goldman, chief executive and co-founder of Boca Raton, Fla.-based MDVIP, a network of concierge healthcare practices.

Founded in 2000, it has 116 affiliated physicians serving 40,000 patients, an average of fewer than 350 patients per physician.

That kind of personal attention comes at a price. The MDVIP physicians charge $1,500 to $1,800 a year, which includes telephone access at all times, same-day appointments and, in some cases, house calls.

Fuchs, who is not affiliated with a network, charges $2,400 a year. That includes an annual in-depth physical. Insurance typically does not cover the annual cost; many companies pick it up for their employees.

Patients and their insurers are still billed for a variety of services and referrals, including, at MDVIP, office visits. Fuchs does not charge for office visits.

Patients in the practices generally fall into two categories.

“One is busy, successful executives who want their care around their schedule, not my schedule,” Fuchs said. The other is retirees with multiple medical problems who are frustrated with the Medicare system.

Concierge health is not without controversy. The American Medical Assn. is concerned about the consequences to existing patients or a practice being converted to a concierge practice.

It requires doctors to make clear to patients in a concierge practice what their fees do and do not cover. The AMA has issued ethical guidelines on concierge practices, finding that they are acceptable so long as such ethical considerations are addressed.

Some critics deride the whole idea of concierge medicine. They say it is healthcare only for the rich, or “wealth care.” They also worry that doctors will abandon care for the needy at a time when fewer physicians are going into internal medicine.

Fuchs disputes that. He notes that he donates his time two afternoons a month at the Venice Family Clinic’s Simms/Mann Health and Wellness Center in Santa Monica, something he would be unable to do if he had 2,000 patients.

“I can give back my time to those who can afford absolutely nothing,” he said.

For patients who can afford the service, having a doctor readily available while traveling offers peace of mind in a chaotic travel climate.

It is comforting, Gitkin said, “to know that a doctor who knows you best is just a quick phone call away.”

James Gilden can be reached at james.gilden@latimes.com.