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The foyer at Evolutionary Healthcare has been used for book signings and art shows, and at least one couple has asked to exchange vows there. But it doesn't take a formal occasion to discover this is no ordinary medical office- just a hello, as in "Hello, Carol Osborn speaking."
A doctor answers the phone. Evolutionary indeed.
Of course, that's a freebie (the office manager was busy). Other perks at the private practice - appointments that start on time and last as long as necessary, house visits, weekend consultations, cell-phone access - carry a price, $1,800 a year, not covered by any health plan.
The concept is called concierge, or retainer, medicine, and, after 10 years of being confined mostly to the Northeast and Northwest, it has arrived in Utah. Osborn and fellow physician Phil Haggerty opened their Salt Lake City practice in December and, according to the Florida-based company MDVIP, three other doctors in Salt Lake and one in Park City are exploring the idea.
MDVIP, a national group representing concierge physicians, enlists doctors and provides technical support. It receives a portion of each retainer fee.
The doctors are part of a growing segment who are disillusioned by a health care system that conspires against the Marcus Welby-style of medicine they long to practice. Doctors must see more patients to offset shrinking Medicare and insurance payments, causing longer waits, shorter visits, grumpy customers and, says Osborn, an erosion of empathy.
Slashing caseloads and making up the lost income through retainers is a way off the treadmill of traditional medicine, a means of regaining control, says Haggerty.
"I feel like I've gotten my soul back," Osborn adds.
But critics find no comfort in a model that turns health care into wealth care. The system is already too stratified, they say, and any innovation that makes standard aspects of care into special services only the well-heeled can afford is no paragon.
Even one of Osborn's loyal patients, Anne Milliken, says concierge care is "almost Faustian."
Rep. Pete Stark, a Democrat from California, calls it "a new country club for the rich."
"The danger is that if a large number of doctors choose to open up these types of practices, the health care system will become even more inequitable," Stark told a joint economic committee chaired by Utah U.S. Sen. Bob Bennett. "The wealthy will pay for exclusive access to quality care, and everyone else will continue to have inferior access to primary-care physicians and basic medical advice."
That was April 2004. Today, MDVIP has double the doctors (126) and triple the patients (40,000) that it did then. Add Haggerty, Osborn and the 140 or so other doctors who belong to the Society for Innovative Medical Practice Design and you can't help but wonder: Is concierge care the future of primary-care medicine and, if so, is that a good thing?
Since its debut in 1996, retainer medicine has taken several forms. Some practices operate on a cash basis. Others, such as Evolutionary Healthcare, still participate in Medicare and insurance plans.
Most doctors restrict their caseloads to no more than 600 patients, compared with the 2,500 patients most internists manage, and charge clients $1,500 to $2,000 a year in retainers.
The fees entitle patients to services not covered by health plans - deluxe physical exams, alternative medicine, nutritional counseling and wallet-size CDs containing a patient's medical history and test results - as well as same-day appointments and other conveniences.
"If someone is smoking a pack of cigarettes a day, they're spending more than the cost of our program," says MDVIP's Darin Engelhartdt. "And nobody says smoking is elitist."
Osborn, too, struggles with the wealth care label. She has served as medical director of the Wasatch Homeless Healthcare Program and is a frequent team leader for Interplast, the first humanitarian organization to provide free reconstructive surgery in developing countries.
She believes the concierge model will free up doctors for such community service projects, and that the increased focus on preventive care has the potential to lower health care costs by reducing hospital stays.
Some medical professionals question the ethics of the model. But Jay Jacobsen, professor of internal medicine at the University of Utah and chief of the school's Division of Medical Ethics, says it is rash to single out retainer docs or label them.
"We don't level that charge at people who choose medical specialties like dermatology and opthamology who see a small number of high-paying patients in controlled environments," he says, adding he understands the frustrations of over-extended doctors.
"But we say our highest duty is serving patients, not ourselves and while we are talking about people not having to wait to be seen in a doctor's office, there are 45 million [uninsured] Americans who don't have the luxury of an appointment. I would feel better about the idea of boutique medicine if I lived in a country where everybody got what I consider to be a very high level of medical care."
Milliken says she struggles with that, too. The 56-year-old freelance writer for public radio is the type of patient who, when given the choice, always picks the generic drug, ascribing to the theory that more expensive doesn't necessarily mean top-rate. But having a doctor on demand is worth every dime, she says.
"It's something my husband and I really talked about," she says. "There is a fallout. Not everyone can have this kind of care." Milliken remembers watching TV shows such as "Dr. Kildare" and "Marcus Welby, MD," where patients seemed so safe and the doctors so dedicated. That's how she describes her relationship with Osborn.
"She's a good doctor and a good citizen, and we have a philosophy of looking at the world the same way. I trust her. I can talk to her about everything and I don't feel like I'm taking up all her time because there are too many people in the waiting room."
So far, Osborn and Haggerty have about 50 retainer patients and 400 or so nonretainer clients between them, and unlike some boutique doctors, they do not discriminate when it comes to health services, just access and convenience.
And yet they acknowledge that a regular patient receives some of the same perks by default - such as the no-waiting waiting room.
The foyer is open and airy, with exposed ceiling ducts and bamboo in the floors. The furniture is sleek, leather, contemporary. And the art hanging on the walls is the work of Kathryn Lindquist, a former university professor who followed Osborn from her previous practice at the U.'s Madsen Health Center.
Lindquist, who does not pay a retainer, says she has never had to wait more than a couple hours to have a phone call returned.
"She is interested in the whole me, not just an isolated medical incident," Lindquist says of Osborn.
But the artist isn't sure she would be willing to pay another $1,800 a year for such lavish attention. "It would be hard to give it up," she says, "but that's a lot of money."
What is concierge medicine?
Doctors restrict caseloads to no more than 600 patients and charge clients $1,500 to $2,000 a year in retainers. The fees entitle patients to such services as deluxe physical exams, same-day appointments that take as long as necessary, alternative medicine and weekend consultations.