18 Apr More docs gravitate toward boutique practice

Boston.com | Concierge medicine is expanding as more doctors — and patients — tire of assembly-line primary care, opting for something more personal, and pricey.

The numbers are still very small — a survey commissioned by a congressional agency last year identified 756 concierge medical doctors in the United States, up from 146 in 2005. And Florida-based MDVIP, a company that helps physicians set up these practices, said it will add six new MDVIP doctors in the Boston area this year, increasing its physicians statewide to 16.

But even a tiny number of doctors leaving traditional offices for boutique practices — out of thousands of primary care physicians — is enough to make some health care industry leaders nervous. They worry that more doctors will follow as insurers and government payers cut fees and hem in providers with regulations. And when even one doctor makes the switch, there are substantial side effects, leaving hundreds of patients to scramble for a new physician.

Concierge doctors care for a small number of patients who agree to pay an annual fee on top of insurance — $1,500 to $1,800 in MDVIP’s case — in return for fast, unlimited access to the physician and to extra services like a comprehensive wellness plan. Patients also enjoy more leisurely appointments than the 15-minute visits that are now standard for most primary care doctors.

MDVIP’s expansion has upset leaders at Newton-Wellesley Hospital, after two extremely popular internists affiliated with the hospital told their patients this month that they are joining MDVIP and closing their traditional practices, in which they each care for 3,000 patients.

Under the plan, Dr. William Holgerson and Dr. Edward Legare will dramatically shrink their workloads, each caring for about 600 patients who are willing to pay the $1,800 fee — which compensates for their lost income from seeing fewer patients. The large doctors’ group to which they still will belong, Newton-Wellesley Primary Care, is hiring two new doctors for the patients Holgerson and Legare leave behind.

Holgerson, who turned 62 yesterday, said he couldn’t imagine practicing into his 70s with the existing pressures; most weekdays he arrives at the office at 6 a.m. and goes home after 7:30 p.m., not to mention the numerous weekend hours spent completing paperwork.

“I could provide the kind of care I’ve always wanted to provide with more time,’’ he said in an interview last week to explain his decision. “I want to emphasize patients’ health and not just deal with acute issues.’’

Legare, 48, was not available for an interview.

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