A FEW weeks ago, my wife and I were at our wits' end: our 4-month-old daughter wouldn't sleep for more than an hour at a time at night. We had consulted books and seen our pediatrician, but nothing was working. So my wife called a pediatrician who specializes in babies who struggle with sleep problems.
The next day, he drove an hour from Brooklyn to our house. He then spent an hour and a half talking to us and examining our daughter in her nursery. He prescribed some medicine for her and suggested some changes to my wife's diet. Within two days, our baby was sleeping through the night and we were all feeling better.
The only catch was this pediatrician did not accept insurance. He had taken our credit card information before his visit and given us a form to submit to our insurance company as he left, saying insurance usually paid a portion of his fee, which was $650.
A couple of weeks later, our insurance company said it wouldn't pay anything. Here's how the company figured it: First, it said a fair price for our doctor's fee was $285, about 60 percent less, because that was the going rate for our town. Then, it said the lower fee was not enough to meet our out-of-network deductible.
While we were none too happy with the insurance company, we remained impressed by the doctor: he had made our baby better and was compensated for it, all the while avoiding the hassle of dealing with insurance.
Last year, I wrote about doctors who catered only to the richest of the rich and charged accordingly. But after my experience, I became interested in doctors for the average person who take only cash. What pushes a doctor to go this route, often called concierge medicine? And how hard is it to make a living?
As to why doctors decide to switch to a concierge practice, the answer is almost always frustration.
"About four years ago, one insurance company was driving me crazy saying I had to fax documents to show I had done a visit," said Stanford Owen, an internal medical doctor in Gulfport, Miss. "At 2 a.m., I woke up and said, 'This is it.' "
Dr. Owen stopped accepting all insurance and now charges his 1,000 patients $38 a month.
"When I decided to abandon insurance, I didn't want to lose my patient base and make it unaffordable," he said. "I have everything from waitresses and shrimpers to international businessmen. It's a concierge model, but it's also the personal doctor model."
Dr. Owen, who once had three nurses and 10 examining rooms, said it was now just him and a receptionist. He has become obsessed with keeping overhead low, but he said that, for the first time since the 1990s, his income was going up.
At the other end of the spectrum is David Edelson, who runs a practice called HealthBridge in Great Neck, N.Y. In addition to five doctors, the practice has a full fitness center and provides the services of a personal trainer, nutritionist, acupuncturist, sleep expert and stress-management consultant.
"The current model for primary care is broken," Dr. Edelson told me. "Either I can go down with the ship, sell my practice to a hospital or take my practice in the wrong direction. Or I can develop a better mousetrap, which is more time dealing with patients and their care."
Dr. Edelson has reduced his own practice to 300 patients, from more than 3,000. Of those, 250 pay $1,800 a year for concierge services and 50 others receive scholarships. He estimated that from the combination of the membership fee for the extra services and what gets billed to insurance for typical care, he will make $600,000, and more of that will end up in his pocket.
"We're bringing in the same fees but we're reducing our overhead," he said. Fewer patients means fewer medical assistants, receptionists and staff members to deal with insurance.
But of the five doctors in the practice, he is the only one to go fully concierge. Another, William Klein, is testing the model, with 15 percent of his patients in the concierge program. Dr. Klein said he was hedging his bets because he was not sure what the new federal health care law would mean for primary care physicians.
Weren't some patients getting shortchanged by this hybrid model? He said he saw no difference in care.
"It's like paying for first class and not coach," Dr. Klein said. "Everyone is getting to the same destination, but some people have a better seat."
This approach to medicine is not without risks for the doctors and downsides for patients.
This article has been revised to reflect the following correction:
Correction: November 23, 2012
An earlier version of this column gave an incorrect middle initial for Mr. Harris. It is M., not V.
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