By Kay Quinn
ST. LOUIS (KSDK) - What would you do if your primary care doctor started a new practice, and in order to stay a patient, you'd have to pay an annual fee for services? It's called concierge medicine.
Here's a look at what it means for patients who follow, and the possible impact on those who don't.
What's happening at Dr. Shari Cohen's internal medicine practice is part of a growing trend.
"I think this style really allows you to get back to the old fashioned 'let's take care of the patient,' which is really what physicians want," says Dr. Shari Cohen, a concierge physician.
At the start of the new year, Dr. Cohen left her longtime practice of about four thousand patients.
"It's becoming more difficult to take care of patients there's much more red tape and paperwork," says Dr. Cohen.
Now, she sees about 400 or so patients.
Practices like these go by several different names: boutique medicine, concierge medicine, members-only practices. Patients typically pay an annual fee and most of these practices don't accept insurance.
"The community standard is between $1,500 and $2,000, and we're right in that range," says Dr. Cohen.
The first concierge practice opened in Seattle, Washington 10 years ago. In the past year, these practices have grown 30 percent in the U.S. There are an estimated 5,000 nationwide and about 12 to 15 here in St. Louis.
Reaction from patients in Dr. Cohen's old practice was mixed.
"The patients that didn't see this as a possibility were upset about not being able to come to the new practice," says Dr. Cohen. "A lot of patients were excited about the prospect of a smaller practice and being able to get a hold of me easily."
But patients who joined the new practice now have fewer patients to compete against and much better access. They're given Dr. Cohen's cell phone number so they can call or text any time of the day or night.
"I didn't necessarily make this change because I wanted a concierge service," says Bob Klimt, a patient of Dr. Cohen. "I did it because I wanted to continue to be Dr. Cohen's patient and in order to do that I had to enlist within the concierge service."
"Even within the profession there's a lot of debate about whether this is a good thing," says Dr. Kevin Broom, assistant professor of health management and policy at St. Louis University's School of Public Health.
Dr. Broom says primary care doctors face growing costs associated with billing insurance companies along with shrinking profits. They can make up for this by seeing more patients, but that's when job satisfaction drops, concierge practices become more attractive.
"We have a shortage of primary care physicians," says Dr. Broom, "and if you have primary care physicians that essentially shrink their practice down to be able to give a relatively few people a lot of access and real good high quality care, then what happens to the rest of society?"
Dr. Broom says if practices like Dr. Cohen's remain a niche, probably not much. But if this specialty continues to grow, some believe it could have a negative impact on health care.
Dr. Cohen says while her motivation for making the change was for more job satisfaction, she was surprised that Obamacare became one of the questions she was most frequently asked.
"A lot of patients ask me that," says Dr. Cohen. "Ask me if Obamacare is an issue and the truth is the issues with our healthcare system started way before Obamacare. It was not because of Obamacare."
Dr. Cohen says she sees her new model as good for the future of healthcare, ultimately saving healthcare dollars by providing comprehensive care.