Mary Lou Rothman has her doctor's email and cellphone number, with permission to call day or night.
When she recently came down with a stomachache, she called the office and got an appointment within three hours.
When the stomachache turned out to be appendicitis, her doctor, Marcy Zwelling, went to the hospital with her and stayed by her side through two surgeries, the second brought on by excessive bleeding. Only after 2 a.m., when it was clear the second surgery had been successful, did Dr. Zwelling go home.
"She was practically sitting on my shoulder the whole time, her in conjunction with (the surgeon)," says Rothman, 69, who is expected to make a full recovery.
"I'm sure everyone thought, who is this person in ICU that she's got doctors on either side of her? But that's what we pay for. Our concierge (medical) service provides us with 24/7 care."
Rothman, a figure skating judge from Cypress, Calif., does pay for the VIP treatment, but it's less than you might expect. She's one of more than 200,000 Americans, from members of Congress to teachers to bus drivers, who pay their doctors up front for more personalized and attentive medical care.
While some concierge practices charge patients as much as $15,000 a year, the typical charge appears to be about $1,500 to $2,000, according to a 2010 report from the
. The fee often covers a comprehensive physical lasting more than an hour, as well as doctor's visits and an array of extras from cellphone access and wellness programs to direct involvement in specialist referrals and hospitalizations.
The fee typically does not cover hospital or specialist fees and may not include all care by the concierge doctor, so patients still need medical insurance.
Concierge medical care, which got its start in Seattle in the late 1990s and has been adopted by an estimated 1,000 to 2,000 doctors, is controversial. Some critics say these relatively small practices (doctors often see a few hundred patients, rather than 2,000 to 4,000) are elitist and could contribute to a shortage of primary care physicians.
In an email exchange, Michael Stillman, an internist at the Boston University School of Medicine and a critic of concierge medicine, called the practice a "blatant money grab" and raised the specter of reduced access to care.
"Imagine a country in which every physician took on only a few hundred retainer fee-paying patients," Stillman wrote.
"Where would people of modest and even average incomes receive their care?"
Supporters of concierge medicine say that it may encourage more medical students to pursue primary care, easing access problems in the long term, and that concierge doctors can provide free or reduced-cost service for the poor.
"Ten percent of my patients are scholarship patients," says Zwelling.
"I'm able to do scholarship patients because I'm otherwise paid. The patient I saved last week in the hospital — she doesn't pay a dime. … As (immediate past) president of the (American Academy of Private Physicians), I keep track of my friends: Everyone has scholarship programs, and everyone's proud to do it. It's part of what we do."
Patients choose concierge care for a wide range of reasons; some want a doctor who will actively manage a serious illness or serve as an advocate within the medical system. Some are drawn to the convenience of concierge care, and some like the emphasis on prevention and wellness.
"I felt like if I joined a practice like that it would force me to pay more attention to my health," says Jackson Despres, 63, a real estate developer from
, R.I., who joined the concierge practice of Lewis Weiner about five years ago and has since referred six people to him.
Rothman, a longtime patient of Zwelling's, wasn't happy when her doctor made the switch to concierge care, reducing her patient load from about 4,000 to about 400 and charging an extra fee, which now amounts to about $2,000 per year for Rothman.
But Rothman is a big fan of Zwelling, whom she describes as extremely determined — "like a dog with a bone" — when it comes to pursuing health care solutions for her patients. So Rothman signed on for concierge care, as, eventually, did her husband, Dave.
"Each year that we re-enroll in our concierge service we go, 'Ohhh, that's a lot of money,'" Rothman says.
"But I'll tell you what: It isn't any money when you've got care like this."
Zwelling took her by the hand and walked her over to the hospital for her
, Rothman said. Zwelling donned scrubs and attended the first surgery, went back to her office to do a little paperwork, then came back to check on her.
Rothman was on
, a medication that helps prevent harmful
clots but can cause excessive bleeding during surgery. But Zwelling says that in this case the surgery wouldn't involve much bleeding and couldn't be delayed so, having discussed the research on the issue and taken precautionary measures, the surgeon proceeded.
Rothman did well in surgery, but when Zwelling came back to the hospital to check on her at about 10 p.m., Rothman's
had dropped. Within 10 minutes, a test came back showing that her blood count had dropped as well, an indication of internal bleeding.
Zwelling sprang into action, calling back the entire surgical team and ordering platelets to stop the bleeding.
"She went into action like the Navy SEALs do — I mean it was incredible," Rothman's husband said.
The surgeon opened the same incision and removed the blood clots from the first surgery, Zwelling says. The bleeding had stopped due to the platelets and, moving between the operating room and the waiting room, Zwelling was able to keep Dave Rothman informed of his wife's progress.
A few days later, Rothman was home, and Zwelling, who had checked on her by phone, said she was doing great.
"I expect to have a full recovery," Rothman said, tired but in good spirits. "And (Dr. Zwelling) will keep on top of it — that I know."
What can you expect?
Concierge medical care hasn't been widely studied, so generalizations are difficult to make. But a good starting point is a 2010 study from the University of Chicago and Georgetown University for the Medicare Payment Advisory Commission. Drawing on previous studies and 28 interviews with experts, advocates and doctors, the authors reported:
The typical up-front fee appears to be about $1,500 to $2,000 a year, but fees can range from $60 to $15,000.
The up-front fee may cover all office visits with the concierge doctor, but that varies.
Concierge doctors typically offer a physical exam lasting an hour or longer with an emphasis on preventive care. That might include breathing, hearing and vision tests, electrocardiogram, blood tests, and screenings for
, depression and sleep problems.
Many concierge doctors offer longer-than-average office visits, same-day or next-day office visits and access to their cellphone number. They may also visit patients in the hospital or at home.