Wichita physicians Aly Gadalla, Doug Nunamaker and Josh Umbehr are pioneers in the area’s medical community.
They are pioneers in the sense that they are practicing some form of concierge medicine.
Concierge medicine is not a new concept. But the three doctors are in the minority among their physician peers.
By all accounts, the concept is growing nationally. Its growth will be fueled by a shortage of physicians, especially in primary care, as well as a desire by more physicians to take care of fewer patients, the doctors and experts think.
And from their perspective, the Wichita doctors get to practice the kind of medicine they signed up for at medical school.
“I knew this was what I was going to do,” said Nunamaker, a former hospitalist at Wesley Medical Center and Umbehr’s partner in Atlas MD. “I’m seeing fewer patients a day and for more time. The family medicine that I went in to do, we do that every day.”
Umbehr, a family medicine practitioner, started Atlas MD in September 2010, following graduation from family practice residency. Some physicians counseled him to join a traditional family practice first, gain some experience and then ease his way into a concierge practice.
“I was too impatient,” Umbehr said. “I had this vision and wanted to do this as soon as possible.”
That vision is a practice that doesn’t accept insurance and charges patients a membership fee of between $10 and $100 a month, depending on the patient’s age. In return for the membership, patients get 24-hour access to Umbehr or his partner through the phone or e-mail, same-day appointments at the home or office, basic lab work and other services such as ultrasounds. The fee doesn’t cover specialists or hospitalizations, which is why most Atlas MD patients have traditional or catastrophic health insurance.
But the practice doesn’t just encompass people who would have the financial wherewithal for concierge medicine. Atlas MD’s patients cover a broad spectrum of incomes, including those who barely make more than minimum wage, Umbehr said.
Because the practice does not accept insurance, its overhead is low. Besides Umbehr and Nunamaker, Atlas MD’s only other employee is a registered nurse.
More than a year later, Umbehr said the practice has exceeded his expectations.
“I’m about to 350 (patients) and Doug’s probably close to 150,” Umbehr said. “At (the end of) year one, we expected to have 100 patients.”
Umbehr expects the practice to reach profitability soon, especially at the rate – 50 patients a month on average – it’s growing since Nunamaker joined full-time in July. Umbehr has put a limit on the number of patients he and Nunamaker will have, between 400 and 600.
“Our ROI (return on investment) will be growth and maintaining them (patients),” he said.
Both doctors work emergency room shifts to supplement their incomes.
“By and large we’ve grown enough it’s mainly on the weekends,” Nunamaker said about working ER shifts.
A hybrid practice
Gadalla’s approach to concierge medicine is a little bit different.
He said he operates a hybrid concierge practice. That is, Gadalla has a traditional medical practice and a concierge practice. Membership to his concierge practice is $100 a month, Gadalla said. But he also accepts insurance.
He said what his concierge patents get from him is unlimited access to his cell phone number and e-mail, and no wait times for appointments. Those patients can also schedule appointments with him on Saturdays and Sundays at no extra charge.
Gadalla, an internal medicine specialist, launched his concierge practice last year. He declined to specify how many patients he has.
“I have a handsome number, a good number of patients,” he said. “It’s growing every month.”
A growing segment
Concierge medicine is expected to continue growing over the next few years, said Tom Blue, executive director of the American Academy of Private Physicians in Glen Allen, Va.
Blue said an exact figure on the number of concierge practices in the U.S. is difficult because they don’t have to register as a concierge practice. But he said his organization, which was founded in 2003 to support the growth of concierge medicine, estimates there are about 3,500 in the nation.
The first concierge practice was launched in Seattle in 1996. That practice, MD2, is still in business today.
He said the number of concierge practices has doubled in the past year and a half and is expected to double each year for the next two to three years. The primary driver of their emergence is an “unsustainable business model” for large primary care practices that struggle with private and government health insurance reimbursement, Blue said.
But it’s also about physicians wanting to limit the number of patients they see on a daily basis. Nunamaker, Umbehr and Gadalla said the concierge practice gives them a freedom they wouldn’t have in a traditional practice.
“The average traditional practice has about 3,000 to 4,000 patients,” Gadalla said. “Imagine how rushed you are versus the concierge practice that has 300 to 400.
“Medicine should not be like the tag office … where I remember you as number 65.”