Appeal of retainer practices: Boutique care goes mainstream

Physicians are targeting middle-class patients willing to pay a fee for extra perks and more attention -- but others argue that making exclusivity more widely available still doesn't make it right.

By Mike Norbut, AMNews staff. Aug. 4, 2003.

After 11 years in hurried motion as an emergency physician, Daniel Frank, MD, decided he wanted to treat all of his patients as if they were his own family members. The Seattle internist liked the idea of starting a boutique practice -- one in which patients are charged a set fee for certain extra services -- so he could spend more time with a smaller set of patients. But he wasn't interested in following the boutique tradition of catering only to the wealthiest members of society.

So, for what he considers a reasonable price of $99 a month -- which equals about $3.30 a day -- Dr. Frank offers extended-time and same-day appointments, e-mail and easy phone access, routine check-ups that might not be covered by insurance, a wellness program and a monthly newsletter. He also offers home visits for an additional charge. The way he figures it, the cost of membership to his practice is comparable to what his patients would spend each day on a grande Iced Caffe Mocha at Starbucks.

"My goal is to make it widely available to the middle class," Dr. Frank said. "For the patients who pay that extra $99, it makes their experience unbelievably better."

Dr. Frank isn't the only physician bringing boutique practices to the masses. Boutique practices arrived on the health care scene in the last decade as a fringe benefit for the wealthy, but they have become much more mainstream in recent years. The $20,000 annual fees that were characteristic of the first practices are far outnumbered now by those that charge between $1,000 and $1,500 a year.