DAVIS COUNTY -- "Concierge medicine," caters to the well off by providing around-the-clock health care--lower income patients, however, are generally not eligible for the care. In the past 10 years physicians across the nation have converted to this new type of boutique practice. In Utah a few physicians are practicing concierge's medicine in the Salt Lake Valley though none in Davis County, according to health care officials. Physicians practicing the boutique medicine have fewer patients and their clients pay additional fees in order to receive 24-hour access to health care. Patients who have the money to pay the additional fees associated with the practice will experience less crowded reception areas, same-day to next-day appointments, 24-hour access to the physician's pager, cell phone or home phone, house calls, possible accompaniment to appointments with specialists, preventive care on wellness advice and programs, spa-like amenities and free check-ups.

Many local health officials, however, are wary of the practice. Allen Freestone, M.D. with Cope Family Medicine in Bountiful questions the new trend in medicine.

"What do the physicians do with the other patients who don't want to practice the concierge medicine," said Freestone. "Will they receive appropriate care somewhere else?"

Not all patients can pay for the practice. "We have an obligation to patients who are uninsured or underinsured," said Freestone. "The legal issues are not black and white. I don't see the trend going very far." While Freestone disagrees with the concierge's practice he regrets not having more time for house calls. "It is unfortunate that house calls are dying out, they aren't done like they used to be," said Freestone, whose schedule is stretched between working at the practice, the hospital and spending time at home.

Jay Jacobsen, M.D., and professor of internal medicine at the University of Utah School of Medicine, struggles with the implications of the concierge practice.

"You can think of it like a club, the people pay a fee and will be able to get special attention," said Jacobsen. "The more you pay the more service you get."

Similar to a regular practitioner, doctors who practice concierge medicine have the insurance company pay the basics, and the patient pays out of pocket for the added services. As third parties become involved (insurance companies, government) physicians are less inclined to do more for the patients, according to Jacobsen.

"If doctors feel too pressed by the current insurance system to treat patients properly" said Jacobsen, "then perhaps they should push for a change in the system rather than for a practice method that simply makes their own lives simpler and individual doctors more successful. "It misses the mark on physicians' collective goal, 'To provide more and better care for more people'.

sclarke@davisclipper.com