Doctors Cady Brown, Ryan Brown and Katie Kinsel of Downtown Drs. Brown focus on individualized patient care and “an upbeat philosophy” at their family practice. Photo provided by The Scout Guide
There was a time when you knew your doctor and your doctor knew all about you.
Now, it seems, you’ve got to prepare a list of things to talk about because you have less than 15 minutes to address your concerns before being cycled out the door. But a new trend in medical practices is working to restore the doctor-patient connection.
Called concierge healthcare or concierge medicine, the concept is simple – for a monthly fee, patients have a more direct relationship with their doctors who, in turn, are more in tune with their patients’ care. The monthly fee ensures patients can get appointments with their doctor the same day, in some cases, and the doctor is involved in all aspects of their care.
“It’s health care in a sort of a white glove primary care experience,” said Laurie Preston, marketing and public relations manager for Marshall Lifestyle Medicine in Lexington. “Same-day appointments are common rather than unusual, and you have access to a provider 24/7 for immediate intervention. Basically, you are signing a membership contract to be part of this experience with your doctor. It often falls into the idea that you have immediate access and the ability to also have an advocate for you if you need a specialist or you go to the hospital for some reason.”
Practices cover regular office visits and a wide variety of services from excising cysts to treating high blood pressure to helping with weight loss goals, as well as some urgent care issues, Preston said. While a concierge practice won’t substitute for an emergency room visit (if you have a heart attack, they’re going to tell you to go to the hospital, she said), they can handle some urgent or emerging issues like treatment for a flu or a rash.
John Marshall Mullins, MD is the founder and CEO of Marshall Lifestyle Medicine. Photo furnished
“What you end up paying for is essentially the care that you’re going to get,” she said. “By taking insurance out of the equation, the doctor can care for you on a different level not covered by traditional insurance, which very much dictates what a doctor can and cannot do. When you remove that obstacle, essentially, you have a partner in your health care who is advocating for you rather than being stuck in the constraints of insurance companies.”
Although most of the concierge service is outside of typical health insurance coverage, some services may be covered depending on a patient’s insurance policy, which is something each patient should work out with their health insurance provider. But even in those cases, Preston said, members of the office staff offer one-on-one support to help navigate the process.
“Our team here holds everyone’s hand to make sure they understand what they’re going to be expected to pay for and what they’re not,” she said. “That’s the other perk of concierge care. You have a team of people who will guide you through everything. It takes some of the stress out of managing medical care.”
In its many different forms, concierge care allows doctors to reduce the number of patients they see, which theoretically allows them to better care for all of a patient’s needs. The structure of health insurance requires most medical practices to have a lot of patients to cover their expenses, doctors said. Nationally, according to the American Academy of Family Physicians, typical primary care physicians see on average three to four patients an hour, or 24 to 32 patients a day.
With concierge care practices, doctors see between two and eight patients a day and get to spend as much time with them as they feel is necessary. In exchange for their membership fees, patients get an annual physical and one-on-one discussion with their doctor about health plans and goals for the year, as well as unlimited office visits. Depending on the practice, patients can schedule same-day appointments and urgent care visits, and some doctors at concierge practices will consult with hospitals if a patient is hospitalized, even following up with in-hospital visits.
Dr. Elizabeth Elkins opened her concierge practice, Bluegrass Gynecology and Wellness, in May 2023. Photo furnished
Even specialists can offer the concierge model. Dr. Elizabeth Elkinson opened up her concierge practice, Bluegrass Gynecology and Wellness, in May of 2023. While her primary focus is gynecology, her overall focus, she said, is women’s health and women’s wellness. A concierge practice provides her with the freedom to treat the whole patient, and not just the gynecological issues.
Elkinson is the daughter of a doctor and grew up seeing a different level of familiarity between doctor and patient.
“I used to be in the car with my dad when he did house calls and I had all these amazing experiences of seeing him with his patients,” she said. “I feel like the time I spend with patients has allowed me to get to know people on a different level ... The concierge model allows the gaps in health care to be filled because I have the time to ask the questions that I didn’t have time to ask in my previous practice.”
Some models of concierge care offer more direct care.
Dr. Alison Wiser, of Wiser Primary Care, offers a direct primary care (DPC) practice that is similar to concierge care and part of the “membership medicine” model. DPC practices are different from concierge care in that they offer affordable primary care without all of the hassles, overhead and administrative burden associated with health insurance-based practices. For her, opening a DPC practice has given her more direct access to her patients. Before, she said, the majority of her time was spent working on the computer instead of with patients.
“None of my friends or relatives could get an appointment with or access to a primary care doctor in a timely manner,” Wiser said. “From the physician standpoint, I felt like I was working on an assembly line rather than practicing medicine the way I had imagined.”
Dr. Allison Wiser of Wiser Primary Care offers a direct primary care practice, which is similar to a concierge practice. Photo furnished
Dr. Cady Brown, one of the doctors at Downtown Drs. Brown, agrees that concierge care offers a bevy of benefits for individu- al patients that larger practices aren’t able to offer. She and her husband, Ryan Brown, have run their Lexington practice since 2018, opening it up as a way to offer individualized attention to their patients.
“We wanted to take better care of patients and felt we weren’t able to do this in a high volume practice,” she said. “In a high volume practice... we saw patients suffer from the pressures of an overburdened system: not being able to get an appointment when they were sick, not getting their questions answered, not being known by their doctor, being sent for tests and special- ists, when really education and reassurance would have been the better care.”
Now, she said, patients have a closer relationship with them as doctors and get more personal care. As doctors, she and her husband are able to spend more time tailoring the patient’s care to their particular needs.
“It allows for time to focus on wellness, not just illness and mental health, in addition to physical health. It allows people to be seen efficiently in the office and not have long wait times,” she said. “It allows for patients to be seen and heard.”