SAN FRANCISCO -- After practicing medicine for 25 years, Dr. Jeffrey Duckham almost was ready to hang up his stethoscope.

The high cost of maintaining a solo family practice, coupled with low reimbursement rates from insurers, required the Silicon Valley doctor to maintain a roster of 2,500 patients to stay in business. He couldn't give people the time he thought they deserved -- or that his training taught him they needed, he said.

"Our whole office staff felt it was becoming more and more like a treadmill," said Duckham, 56.

Patients still need insurance or some other way to pay for additional medical expenses like medications, hospital stays and visits to specialists. Taylor, who follows the $1,500-a-year MDVIP model, has about 460 patients on his roster and sees eight to 12 a day, down from the 25 to 35 patients he saw in his old, conventional practice. His overhead consists of his small office in a chic Marin County loft, a receptionist and a physician's assistant.

Concierge doctors say longer appointments give them the time to focus on illness prevention and early detection they never had when they had to deal with HMOs and managed care plans.

Napa Valley Register | Doctors once reserved for rich say fee-based system helps all their patients

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