Over the last few weeks, Dr. Brooks Wilkins' patients have been running him ragged, trying to get in to see him one last time.
Wilkins is not retiring. He's downsizing - and going upscale.
Starting Tuesday, Wilkins will treat only patients who pay an annual fee of $1,500 to remain in his new MDVIP practice.
MDVIP, which refers to both Very Impressive Physicians and Very Important Patients, is a national organization of doctors who aim to provide more personalized, preventive care for a select group of patients willing to pay a premium for the service.
Wilkins is the third doctor in Raleigh and the fifth in the Triangle to make the transition to MDVIP, part of a national trend toward "concierge practices." There are fewer than 10 such doctors in North Carolina and several hundred nationwide. Participating doctors trade in their thousands of patients for 400 to 600.
"I'm really excited that this will allow me to drill deeper on important health issues with my patients," saidWilkins, 60.
In exchange for a $1,500 fee on top of their regular insurance coverage, VIP patients are guaranteed more time with the doctor, an extensive annual diagnostic exam, and a cell phone number where the doctor should be available night or day. In addition, VIP patients get a compact disc with their permanent medical record and access to a network of other MDVIP doctors while traveling.
Dr. Bernie Kaminetsky, medical director for MDVIP, said a lot of doctors, like their patients, feel dissatisfied with the mill-like atmosphere of modern medicine - one patient after another all day long.
"It's like that famous 'I Love Lucy' episode in the chocolate factory," he said. "The chocolates on the conveyor belt keep speeding up, and you just can't keep up."
Getting to know patients
Dr. Mitchell Hardison, who became Raleigh's first MDVIP doctor almost a year ago, said he had grown so disillusioned with medicine under managed care that he contemplated early retirement until his wife told him about the Florida-based "concierge practice."
"I used to spend perhaps 10 or 15 minutes max with each patient," said Hardison, 57. "I worked from 5:30 in the morning until 8 at night, and I always left with items undone on my desk.
"There were phone calls I couldn't return. There were a lot of things that I worried were falling through the cracks. It was not the way I wanted to practice medicine."
Now, Hardison spends at least half an hour, often more, with each patient. There are some patients he has treated for more than 20 years whom he's only really gotten to know and understand over the past 11 months.
Hardison said he even makes house calls to patients too ill or infirm to come to his office near Rex Hospital.
When MDVIP really helps
Some patients are thrilled with the change.
Jack and Toni Davis became believers in early November, when Jack had a large blood clot in his leg. His symptoms showed up late on a Saturday night, and the Davises finally called Hardison before dawn on Sunday.
"He answered the phone himself," Jack Davis said. "He said 'I want you to get to Rex. A wheelchair will meet you at the door.'"
Hardison then guided the Davises through Jack's hospital stay and directed him to specialists as needed.
Because of the extensive exam Jack had undergone at the MDVIP transition, Toni Davis said, Hardison knew her husband's medical background in detail.
The Davises plan to sign up for a second year with Hardison later this month.
Haves and have-nots
Some patients were not happy to receive the MDVIP letter from their doctors.
Janet Jester of Raleigh said she was outraged when she received notice from Wilkins a few months ago.
"I've been his patient for 20-some years," she said. "Now I have to pay $1,500 to remain his patient?"
She said she and her husband, both in their 60s, have always been very satisfied with their care. But they cannot afford the $3,000 to go VIP as a couple. It's the principle that really galls her.
"I really like Dr. Wilkins, but I told him, 'I think you're creating an elitist class of people,'" Jester said. "They have a separate waiting area for VIP patients. I think they're again dividing the haves and have-nots."
Gopal Sreenivasan, a medical ethicist at Duke, studies disparities in care. He said that for people who believe that everyone should have access to the same level of health care, the concierge model might be viewed as an insult.
But the truth is, he said, "there are differences in access to health care. Our health care system is really a patchwork of care based on what people can afford."
Michelle Piette, 57, another of Wilkins' longtime patients, thinks the shift to premium practices was inevitable.
"I have to admit, when I got the letter and saw the $1,500 fee, I was, like, 'Holy mackerel!' " she said. "But even looking at the cost, it's a choice I had to make. Having someone who knows me and stays on top of things is important to me. I take health care very seriously."
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