By Peggy Mika
Special to Delaware Business Times

Concierge or membership medicine is a growing trend among primary-care providers. The physicians who practice this style of care say it energizes primary care in Delaware by letting them practice medicine in a meaningful way again. The doctors we spoke with had been seeing 3,000 to 5,000 patients in their practices.

They saw 24 to 50 each day in seven- to 10-minute-appointment windows. They were discouraged; some were considering leaving primary care or retiring.

Membership medicine includes several models including DIRECT primary care, boutique, concierge and others. With membership medicine, patients pay an annual fee, which gives them 24/7 access to their primary-care physicians via phone, email, text, video chat and office visits. Physicians are able to limit their patient panels to about 600, provide extended patient visits of 30-60 minutes, and build stronger relationships with their patients. Some practices accept private insurance and Medicare; others do not.

"It's too good to be true," said Dr. Nicholas Biasotto who, after 37 years as a primary care provider in New Castle County, converted to membership medicine three years ago. Biasotto had 4,000 patients and was seeing 50 a day. "I felt like I was shortchanging them," he said. "I liked what I was doing, and did not want to retire, but I was burnt out."

MDVIP, a national network of primary care doctors who see fewer patients so they can focus on delivering personalized medicine, helped with the transition.

As part of the $1,650 annual membership, MDVIP affiliate practices offer what Biasotto calls a "toes-to -nose" wellness physical. "We find things we never would have because I can spend time discussing the results with my patient. We talk."

Dr. Uday Jani with Shore View Medicine in Lewes has a similar story. He had about 2,800 patients and treated about 25 to 30 a day. He hit a wall the day he saw a patient with multiple medical problems - obesity, high blood pressure, diabetes - for an annual visit. Jani asked if there was anything new, and the patient said "˜no.'

"As I started to walk away, I thought, "˜He needs more.' I went back in and we talked."

Specialdocs helped Jani convert to a membership practice. The health care consulting firm is dedicated to transitioning traditional medical practices to personalized, concierge medicine models. Jani has about 300 patients and sees about 12 a day. "I work about the same hours but have more time with each patient. I even make house calls," he said. Specialdocs membership fees average $2,000 annually.

Jani had regrets about patients who could not pay the fee, which is common, according to Specialdocs CEO Terry Bauer. "They have spent a lifetime building a practice, and they feel like they are abandoning their patients. The doctors who succeed are the doctors who feel like they are not serving their patients well," he said.

In addition to longer patient visits, Jani says he now has time to advocate for his patients with insurance companies and have meaningful consultations with their specialists. Jani has studied integrated medicine and functional medicine, which helps him uncover root issues behind symptoms and chronic conditions.

Dr. Bruce Sokoloff, with Total Access Medical (TAM) in New Castle County, had some of the same sentiments as Jani. So he joined TAM in 2004, trimmed his patient panel from about 3,000 to 320 and turned all of the management functions over to TAM in return for a salary and bonus. TAM is a group of six Philadelphia-area practices, which Richard Stamps founded in 2003 after witnessing firsthand the "deficiencies" of the current model with his own son. TAM limits member patient panels to 600, and promotes executive physicals, wellness plans and lifestyle counseling.

Sokoloff practices functional medicine too and often spends nights and weekends investigating symptoms and finding solutions for his patients.

"I feel like I help people who cannot get satisfaction in traditional medicine," Sokoloff said. "Here, we take care of you. We are accessible, we spend time with you, and you get good service."

"Dr. Sokoloff is thorough, systematic and a good listener," said a longtime patient who, along with his wife, transitioned to Dr. Sokoloff's membership model. "In his previous practice he seemed as frustrated as we were about the time constraints around appointments."

Patients of other membership practices have similar comments.

"I felt relieved and cared for," says Rita Wilkins of her first visit with Dr. Kimberly Nalda, who opened a direct primary-care practice in Wilmington, Rekindle Family Medicine, in January 2016. Wilkins went in with a skin rash and talked with Nalda for 90 minutes. "It was like going to confession. I never experienced that before! There are things I'd been hiding from my own doctor, that I shared with her."

Nalda switched to the direct primary care model after 10 years in a traditional practice, sometimes seeing 28 patients a day. "I felt like I was abusing my patients," she said, because she was rushed and often felt pressured to order unnecessary tests.

So, she researched direct primary care, took money from savings, got a loan, studied up on how to run a small business, bought some office furniture on Amazon and opened Rekindle. Today, she has about 250 patients and wants to grow to 500 to 600. Her staff consists of one certified medical assistant, and they see about eight patients a day.

Her monthly fees are based on age, and range from $20 for children to $100. In-house tests and procedures, including stitches, IV fluids and biopsies, are included. She has negotiated direct-cash prices for her patients with imaging practices (MRIs for $300 rather than $1,500) and labs, and she buys medicines in bulk and sells them to her patients at cost. She estimates that 75 to 80 percent of her patients have insurance, but some are uninsured.

These physicians believe they are practicing better medicine because they know their patients better. Many of them work fewer hours for comparable income even though they are on call 24/7. While patients can call anytime of the day or night, they don't abuse the access. "They know me, don't want to be disruptive, but, when they do call, it's rare and important," Nalda said.

"I love the idea of free-market medicine," she said, adding she hopes membership medicine will entice medical students - who value an old-fashioned approach - to become primary-care providers.