by Barrett Seaman –
Jessica Sullivan’s two-and-a-half-year-old twins, Teagan and Clare, were due for a checkup. Rather than pile into the car and then sit for an hour or more in a crowded waiting room filled with sniffling kids and impatient parents, they stayed home. The doctor came to them.
Nitin Gupta, MD FAAP, arrived at their Dobbs Ferry home, where he spent an hour and 15 minutes examining the two girls. After he left, he texted Jessica with a tailored action plan designed specifically for each girl to maintain their health going forwards. There would be no bill for the examination. They were covered under a contract with Dr. Gupta that cost the Sullivans $125 each per month for any and all medical services, 24/7, including house calls like this. Before signing up with Dr. Gupta, Jessica had compared the projected costs with her family’s high-deductible insurance policy and concluded that it might be 50% more expensive, “but it was incomparable in terms of convenience.”
Katie Wilson had a similar experience, though she took her daughter to Dr. Gupta’s Dobbs Ferry office. “She had been tugging at her ear. I picked her up at day care at 4:02. We were in his office at 4:20.” He diagnosed her earache and handed Katie a prescription—“all within an hour. I probably wouldn’t have gotten in to see our old pediatrician until the next day. By the time I woke up the next day, I had a text from him asking how she was.”
Dr. Gupta, 40, is a board-certified pediatrician trained in gastroenterology at Cornell Weill. A Berkeley undergrad who went to medical school at St, George’s in Grenada, he has been an ER doctor at Brooklyn Hospital Center and an Urgent Care physician at PM Pediatrics. Married and a father of a boy and a girl, he made the switch from group and hospital practice to become a “concierge” doctor — the first pediatrician to do so in New York State, he said. He takes no insurance and there are no co-pays. Instead, he charges a flat monthly fee for his services, whenever and wherever needed. Children under a year old cost $150; children ages one through four are charged $125, and those five and over cost $100.
If he took insurance, he explained, his overhead, including back office staffing, would run around $350,000 a year. As a concierge doctor, he said his overhead is just $50,000. He doesn’t need many patients to break even and said, “I’m trying to keep my patient volume down.” Doctors who carry insurance must see thousands of patients to cover their costs. For them, the average time spent with any one patient is about seven minutes.
Current state law does not allow him to sell prescription medicines, and his patients’ families would still have to pay separately for hospitalization or treatment by specialists. “But with time to manage my patients, there is less need for specialists,” he says.
“Concierge” practitioners constitute a small fraction of the 300,000-some doctors nationwide that practice family or primary care medicine. According to Bret Jorgensen, CEO of MDVIP, a company that has aggregated some 950 such physicians, there are about 5,000 nationwide. Very few are strictly pediatricians; for the most part their patients are in the 50 to 80 age range. They see an average of 300 to 400 of them, versus 2,000 for the typical primary care doctor. The payoff is a renewal rate of about 90% and a reduction in hospitalizations for their patients of between 70 and 80 percent. Their numbers are continuing to grow, said Jorgensen.
Frustration with the current system of paying for health care plays a large part in the shift to concierge medicine. Insurance reimbursements keep shrinking; deductibles keep rising. To cope with the repayment deficit, many doctors, labs and hospitals inflate their bills, which only adds to the problem. Both doctors and their patients are caught in the squeeze. Some families cope by postponing or skipping needed healthcare. As for the doctors, said Dr. Gupta, “Physician burnout and physician suicide rates are at an all-time high.”
“I burned out seven years ago,” Gupta confessed. “My father was dying and I was flying back and forth from New York to San Francisco every other weekend. After my dad died, I considered leaving medicine altogether.” Instead, he took time off, left New York and took up practice in Caribou, Maine. There, he said, “I was surrounded by a community of people who viewed each other as neighbors, and neighbors were considered family. There were stories of doctors coming to the hospital in any way possible. Some were picked up on a snowmobile; others came in on skis and snowshoes. I remain inspired by those doctors, and that’s why I want to do house calls for my neighbors.”
For most parents seeking a good pediatrician, the mention of “house calls” is about all they need to hear. As Joanie Lester-Gill, whose son is a patient, put it, “Who wants to go sit in a doctor’s office with all those sick kids?” One Sunday in October, she was with her son at a surprise birthday party when he began to exhibit breathing problems. She called Dr. Gupta, who arrived with a nebulizer machine and examined him in the trunk of their SUV – in time not to ruin the surprise.
Julia Laspina, who took her then five-month-old to Dr. Gupta when he was in a traditional practice in Rockland County, said he saved her daughter’s life by diagnosing bacterial meningitis and getting her hospitalized immediately. She was devastated when he moved across the river, but when he called to tell her that he was going to set up a concierge practice, she signed on immediately, saying, “I, of course, would follow him to the ends of the earth.” She had only to drive across the Mario Cuomo Bridge from her home in Pomona so that her daughter could spend more than an hour with him in his Dobbs Ferry office.
Concierge doctors rely heavily on social media and word of mouth to bring in new patients. Dr. Gupta had only about a dozen as of Thanksgiving but plans to have no more than 400 tops. Ashlee Keane, a medical assistant studying to be a licensed nurse, heard about him through the doctor she works for. “He’s bringing back old school medicine,” she said, “which is a great idea.”
Dr. Nitin Gupta’s website is www.rivertownspeds.com. For those seeking information on concierge doctors in general, there are a number of regional and national networks including MDVIP, whose website is www.mdvip.com.