TOP VIEW Clients of concierge medical practices receive more convenience, comfort and personal attention from these retainer-based physicians. Proponents of this type of service argue that these patients thereby receive better care than those who use doctors who work in traditional practices. But others doubt whether concierge practices add any value to the medical services already available to affluent individuals, especially when it comes to obtaining access to the very best specialists. Skeptics dismiss concierge medicine as more style than substance.

A growing number of primary care physicians are retooling their medical practices to target patients like Rautenberg with retainer-based services. As many as 300 primary care doctors nationwide have transformed their practices with the goal of convincing patients that they can offer a quality of care that is no longer readily available, even to those patients for whom physician access and skyrocketing medical costs are typically irrelevant.

“My time and my peace of mind are my priority,” Rautenberg says. “I have no problem paying a little bit more for that to increase the odds that I’ll get a doctor who is paying enough attention to me and my concerns and my health that he’s not going to make a stupid mistake.”

Commonly referred to as concierge medicine, this burgeoning brand of health care generally requires patients to pay an annual retainer ranging anywhere from $1,500 to more than $20,000. Many affluent patients already enjoy much of the comfort and convenience promised by these concierge practices through their long-standing relationships with their family doctors. But for those who do not, or those who require specialized care, concierge physicians offer an alternative. “This model turns every patient into someone who has instant, privileged access to his doctor—into someone who has, in effect, a personal physician ready to help at a minute’s notice,” claims David Katzman, who has a list of 50 St. Louis residents waiting to sign up for his concierge medical practice. “I can’t offer my patients dramatic new technologies, but I can, and do, give them the kind of old-line service that has vanished from the rest of the health care system.”

Most concierge doctors insist that they offer much more than convenience and access. They contend that they actually provide a higher level of medical care than a traditional physician because they can operate profitably with fewer patients. Thus they can afford to spend more time with each patient. “This is the way that they are enlisting patients: by presenting them with the logical argument that more time equals better outcomes,” says John Connolly, founder of Castle Connolly Medical, a New York research firm.

Yet some critics of concierge medicine question whether increased access necessarily equates with better and improved outcomes. “You may be able to provide the appearance of better health care, but I personally believe doctors have to see a larger number of patients in order to keep their skills sharp,” says Christopher Barley, a Manhattan specialist in internal medicine who serves as primary care physician for “a few thousand” patients. “The risk is that if all you’re doing is routine physicals for a handful of generally healthy patients, you’ll lose your edge and you’ll be bored. And that’s a recipe for disaster.”

Concierge care enables patients to essentially purchase a value-added relationship with a health care provider. Unless individuals are fortunate enough to have a long-standing rapport with a family physician and the access that comes with it, Katzman explains, “they walk into a doctor’s office and, bingo, they are just like everyone else: a run-of-the-mill patient sitting in a crowded waiting room, waiting to be seen for nine minutes by the doctor who is supposed to be in charge of their health. And no one likes that feeling.”