Concierge physicians tout personalized primary care

Dr. Doug Pitman’s phone is always on. Whether he’s in a meeting, playing golf, on the slopes at Whitefish Mountain Resort or out of town for a wedding, he’ll answer a call from a patient (though, he admits, he’ll probably turn off his phone for the actual wedding ceremony).

Pitman works as a concierge physician in Whitefish, which means his patients pay an annual fee for 24/7 availability, personalized primary care and emphasis on holistic approaches to health. After nine years building up a portfolio of about 100 patients as the sole employee of Whitefish Personalized Health Care, Pitman is taking on a partner, Dr. Grant Nakamura, to ensure the longevity of the practice.

Concierge medicine, also known as personalized medicine or boutique medicine, is a fee-based model for primary care that has gained traction in recent years as an alternative to traditional, insurance-based primary care practices. In a concierge practice, patients pay an annual fee directly to the physician for comprehensive primary care — yearly physicals, consults, X-rays, prescriptions, referrals, lab tests and other services, short of the ER, on an on-call basis.

Some concierge practices bill for insurance, while others, such as Pitman’s, forgo insurance entirely and refer liberally to specialists, labs and pharmacists in the area.

Many proponents of concierge medicine see the model as a return to patient-centered primary care of days past, when physicians — such as Pitman’s father, who made house calls on Long Island, New York, for 35 years — devoted significant time to developing relationships with their patients.

Both Pitman and Nakamura turned to concierge medicine to address what they described as a lack of balance in their previous practices — where the demands of patient numbers, electronic medical records and insurance billing stretched their abilities to the brink and limited time with patients.

Following over three decades as a family care physician in Columbia Falls, Pitman, in 2009, was looking to pivot toward more preventative and wellness-centered care. He partnered with Signature MD, a California-based company that advises physicians on establishing their own concierge practices, to start a practice that allowed for “taking the time to listen to my patients and solve their problems while making sure they stayed true to their personal responsibility of taking care of themselves.”

Whitefish Personalized Medicine has been a “part-time practice for me but full-time for the 100 patients I care for,” said Pitman. “And that doesn’t interfere at all with my ability to see them whenever I want.”

But as he approaches full retirement in the next couple years, he was looking to find a like-minded partner to continue the practice. Fortunately, he met Nakamura four years ago through a mutual friend.

“If I had to find a clone of someone who has similar goals to be able to spend as much time as you want with patients, to form relationships with patients — Grant is very interested in that.”

At the time that they first met, Nakamura was living in his home state of Minnesota and unaware of concierge medicine, but looking to move to Montana and away from looming physician burn-out.

“My idea of primary care — I wasn’t doing it,” said Nakamura. “I wasn’t having the time to build those relationships with patients that I feel is really important to doing good health care.”

As a primary care physician in Bozeman and then Eureka, Nakamura said he was seeing “just too many patients, just doing more urgent care than doing actual office primary care.”

The stress and lack of connection with patients reached a point where he felt compelled to leave medicine. “That’s where I was getting to — the point where I said, ‘If this is what medicine’s all about, I’m not interested.’”

Now, as an onboarding partner to Pitman, he says he has time to focus on the wellness and preventative care aspects of primary care that inspired him to pursue medicine in the first place.

“For me, it’s looking at your whole life as it applies to how it affects your health — think about your diet, your activities, how much exercise you get, what kind of exercise you do, how much stress is in your life and how you deal with that. All those things are very difficult to address in a 15-minute appointment, or even a half-hour appointment,” he said.

“It’s all about wellness,” said Pitman. “And the people who join this practice are willing to pay the concierge fees to pursue wellness and to have availability and to be proactive about colonoscopies, vaccinations, cardiac risk reductions and stroke reductions.

“I solve problems more than make diagnoses ... And I think Grant shares these goals.”

Critics of concierge medicine have argued that the model pushes health care into a two-tiered system, in which wealthy patients pay for more convenient and comprehensive primary care, leaving those outside the concierge model burdened with higher insurance costs and fewer physicians.

But according to Pitman, concierge medicine is “not just for wealthy people.” Though many of his patients pay the full $1,900 annual retainer fee, with discounts for half-time residents or couples, several pay a “scholarship” rate of $1,100, judged on an individual basis.

“We’re not doing this to take a stand against what’s going on in the current medical landscape,” said Pitman, “we’re doing it to be able to practice medicine the way we want to practice it, the way it should be practiced, the way my dad did it, with house calls and spending more time with people.”

Eventually, Pitman will retire and hand over the always-on phone to Nakamura. Until then, the partners are looking forward to expanding the practice while continuing to take a personal, comprehensive approach to seeing the doctor.

Nakamura said he’s looking forward to “having a medical practice that I control ... a practice that fits my personality, rather than trying to fit my personality to the practice. That, and meeting people.”

“For my last gig in medicine,” said Pitman, “it’s just what the doctor ordered.”

For more information on Whitefish Personalized Health Care, call 270-7583 or visit www.whitefishprimarycare.com.

Reporter Adrian Horton can be reached at 758-4439 or at ahorton@dailyinterlake.com