Hippocrates didn't know where the heart was. Or how it worked. Or how to save it. But the ancient Greek physician is nonetheless known as the father of medicine, his name synonymous with the oath taken by doctors promising that they, among other things, will "prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone." Hippocrates, however, was not revered because he created medicines and treatments for suffering patients, which is a science. It was his ability to connect and sympathize with them—an art.
And so here we are, nearly 2,400 years after Hippocrates's death, still trying to find better ways to connect doctor and patient. Consider that a typical primary practice has between 2,000 and 4,000 patients. On average, that means if every patient spends only one hour per year with his or her physician, it equals 58 work hours per week for the doctor. Now add to that additional research and testing, follow-up appointments, annual physicals, and billing. It hardly leaves time for eye contact.
But there is a controversial new approach changing the doctor-patient dynamic: personalized healthcare offering comprehensive preventive care to a reduced field of patients for an annual fee ranging from $1,500 to $1,800 (roughly $140 per month). At the forefront of this movement is MDVIP, the Florida-based company that has nearly 300 affiliated physicians in 23 states including Maryland, Virginia, and Washington, D.C. More than 74,000 people nationwide are MDVIP members.
One physician who has learned the benefits of MDVIP is Stephen Glasser, MD. Named a Top Doctor by Baltimore in 2001, 2002, and 2003, he was the first Baltimore-area physician to join MDVIP. He has since joined the company's advisory board.
"Before I joined MDVIP in 2003, I was seeing 25 to 30 patients every day," says Dr. Glasser. "Under the old system, time became a four-letter word. There are only so many hours for each patient, and most of that time is spent putting out fires and treating complications. Now we focus on personal, preventative care. I actually make house calls with the black bag like doctors did years ago."
Towson-based Dr. Barry Josephs has been practicing internal medicine for 26 years and switched to the MDVIP model in April 2007. "One patient came in recently complaining about his toe," says Dr. Josephs. "So we talked about the toe, then I left the room to get him some antibiotics. When I returned he told me he was upset because a close friend had just died. He was very emotional. I realized it was not about his toe. The emotional distress was why he needed to be seen.
"It's nice to have more time with each patient," he says. "What it translates to is the kind of primary care that is wonderful to give."
Perry Hall resident Ann Kennedy has been with Dr. Josephs for 15 years, and experienced the shift in patient care firsthand. "Now he has the time to go the extra mile for his patients," says Kennedy, a retired nurse. "I recently saw another doctor for some orthopedic issues. He wanted me to take a particular medicine, but hadn't done any bloodwork. So I called Dr. Josephs, which I would have never done in his previous practice. He said come over tomorrow and we'll research it together."
Some call this new approach an obstacle in the battle for universal healthcare. Often called "concierge" or "boutique" healthcare, critics believe it supports a paradigm where more money means better care, and therefore excludes lower- and middle-class people (the annual fee does not include insurance premiums). It probably doesn't help MDVIP's cause that it's headquartered in one of the nation's ritziest zip codes, Boca Raton, Florida, where you'll find the company's co-founder and CEO, Edward Goldman, M.D.
But Dr. Goldman is not another South Florida entrepreneur with an impossibly perfect tan. He has more than 30 years of experience as a family practice physician, served in the U.S. Public Health Service, and was a research fellow at the Centers for Disease Control and Prevention in Atlanta. Dr. Goldman co-founded MDVIP in 2000, hoping to create a model that allowed doctors the time to prevent illnesses, not simply wait to treat them.
While MDVIP's annual fee may seem high, it covers a number of tests that would cost much more under standard health insurance, and often requires a physician's referral. All MDVIP patients must fill out a lengthy 200-question health risk assessment, essentially a family and social history that is e-mailed to the physician before the first appointment. They also receive a series of screenings (pulmonary function testing, cognitive evaluation, EKG, psychological evaluation, nutritional evaluation, and fitness and activity status) and laboratory and diagnostic testing (blood count, thyroid, lipids, and urinalysis). The results of this examination and other critical medical information are captured on a wallet-sized CD-ROM. That information can also be accessed via the patient's own personal webpage at myMDVIP.com.
Patients are also given their physician's cell phone number, and can be referred to any doctor in the MDVIP network. Which means if you fall ill during a trip to Las Vegas, your doctor will personally call one of the seven physicians in Sin City and set up an appointment.
Perhaps most critical to Dr. Goldman's cause, physicians can spend more time with their patients. "The minimum office visit is 30 minutes," Dr. Goldman notes. "There's leisurely time to talk about everything in your life, from physical pain to being frustrated about not getting a promotion at work. The interpersonal relationship is as much a part of the healing process as an MRI machine."
MDVIP must still contend with people chastising its perceived upscale reputation. A writer for US News and World Report went so far as to call it "24-karat care." Dr. Goldman notes that when the U.S. government and insurance companies were contacted for funding, he was met with deafening silence.
"Then there are some who question our ethics," Goldman says. "I look at the ethics of an eight-minute doctor's visit. What about doctors not being able to do all they can to treat a problem and avoid a future catastrophe? How ethical is that?"
Many assume that the VIP in the company's name alludes to exclusivity. In fact, it stands for "value in prevention." Dr. Goldman is emphatic that MDVIP's focus is taking the time to prevent illnesses, not simply waiting to treat them. The statistics certainly support his mission. According to the CDC, chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States, accounting for seven of every 10 deaths and affecting the quality of life for 90 million Americans. That's more than $33 billion in medical costs and $9 billion in lost productivity. However, only 2 percent of annual healthcare spending goes to the prevention of chronic diseases.
Asked about the demographic of his patients, Towson's Dr. Josephs says, "When I look at my patient population, I see people from their late 20s to 98. I see people who are retired. I see nurses, school custodians, state employees, and teachers. This is an issue of what people want. Every day people choose to join HMOs, PPOs, and the Medicare Advantage plan. This is just another option."
"People set their priorities, and this is a priority for me," patient Kennedy says. "Every friend of mine is middle-class financially, and I must have 35 friends who transferred to his practice." She adds with a laugh, "I would sell pencils on the street corner to stay with Dr. Josephs."
Right now, there are only 24 MDVIP physicians in Maryland: seven in Baltimore, and the balance in Bel Air, Bethesda, Chevy Chase, Catonsville, Columbia, Towson, and Silver Spring. That's a small percentage of the 3,274 primary-care physicians statewide. But word is slowly getting out.
"Now I have the time to know my patients," Dr. Josephs says. "For me, it's the biggest part of wellness and prevention."