By Tim Bonfield
The Cincinnati Enquirer

Come March 1, patients who want to see Dr. Douglas Magenheim will have to pay a $1,500 annual membership fee for the privilege.

The unusual new policy will make Dr. Magenheim the first doctor in Greater Cincinnati to openly market himself as a "boutique," "concierge" or "luxury primary care" doctor - a small but growing trend that has popped up in several states in the past three years.

"Medicine over the years has become less personal and more complicated. My goal is to make it more personal while still providing the complex care people expect," Dr. Magenheim said. "I don't like to use the term `boutique practice,' though. A lot of those practices are all about access. This is about access and quality."

Doctors who quietly cater to the elite aren't new. Few top executives, pro athletes or star entertainers have to wait weeks or months to see a specialist.

But this concierge concept has become public enough to become a full-blown business in Florida, and widespread enough to draw criticism from some medical ethicists, lawmakers and advocacy groups.

Critics say luxury physician practices give the better-off a way to opt out of a troubled medical system, while increasing the burden on the rest of the health care system to serve those who can't afford the membership fees.

"My hunch is this is a flash-in-the-pan. If these practices really grow, my hunch is there will be legislative action to ban them," said Robert Hayes, president of the New York-based Medicare Rights Center, a patient advocacy group. "These practices raise a lot of concern. If they keep growing, there won't be room for middle-class patients who can't pay."

Dr. Magenheim compares the concept to sending a child to private school. A members-only doctor, he said, may sound elitist but it is a choice people are free to make in a market-based economy.

"It's a value decision. There have been a lot of complaints about how people have to wait too long to see a doctor. This is my answer to fix some of that," he said.

How it works

Dr. Magenheim, 41, has been an internist since 1991. For the past four years, he has been a member of the Queen City Physicians group.

He serves about 2,700 patients from an office in Madeira. On March 1, he will open shop in Norwood as a solo practitioner under the business name My Doctor LLC, seeing only those patients who have paid the $1,500 membership fee.

He will accept up to 800 patients. A letter offering membership to current patients went out this week. If Dr. Magenheim has fewer than 800 members on March 1, he will begin accepting members from the general public.

The practice offers same-day or next-day appointments - with no 15-minute or 20-minute time limits.

Dr. Magenheim promises to personally return phone calls and e-mail, day and night, weekends and holidays.

And he pledges to devote more time to patient education and other services not traditionally covered by health insurance.

Patients will still be billed for office visits, tests and other services. His office will continue accepting Medicare and private insurance payments.

Membership fees, which could reach $1.2 million a year, will more than cover the income Dr. Magenheim will lose from fewer visits.

"When Dr. Magenheim told me about his plans, I asked, `Can I write a check today?'" said Jack Leone, a 55-year-old retiree from Procter & Gamble who lives in Batavia.

After being diagnosed a few years ago with diabetes, Mr. Leone said Dr. Magenheim provided a surprising level of personal education about how to manage the disease. The boutique doctor concept has been growing in other parts of the country.

A company called MDVIP started three years ago in Boca Raton, Fla., and has since grown to include 21 affiliated doctors in seven states.

In Seattle, the Dare Center charges $3,000. Another Seattle group charges couples a $20,000 membership fee.

MDVIP predicts it will have up to 100 affiliated doctors by year's end. The group is looking to open a Cincinnati office, said Andrew Ripps, chief operating officer.

Critics say luxury practices may aggravate some of the larger problems facing health care in America. If every doctor in a city dropped half their patients to offer better service to fee-paying clients, the other half of patients would have no doctor at all.

Mr. Ripps said exclusive services won't dilute the system.

"Even if there were 1,000 doctors in the country doing this, that would be from an overall pool of about 300,000 primary care doctors. That's less than a speck of sand in the big picture," Mr. Ripps said.

From a medical ethics point of view, luxury medical practices do raise questions about equity, but starting one appears no worse than many other long-tolerated inequities in medicine.

"Physicians today choose the communities and situations in which they are going to practice. Relatively few physicians practice in impoverished inner-city or rural areas; many do not accept patients with Medicaid or those without insurance," wrote Boston-based Dr. Troyen Brennan in a commentary published in the New England Journal of Medicine.

"Since we have accepted broad inequities in access to health care in the past, it is difficult to argue that luxury practice should be prohibited."

E-mail tbonfield@enquirer.com