July 29--Emma Bellotte's visit with her pediatrician was unusual -- and not only because the toddler didn't make a peep when Dr. Scott Serbin gave her shots.
The annual physical for 5-year-old Emma didn't occur in Serbin's office. He doesn't have one. It happened at Emma's house in Sewickley. People's homes have been Serbin's offices for about three years now.
"There's not anything I can't do in the home that I can do in an office," said Serbin, 53, of Franklin Park, holding the black bag his parents gave him as a gift when he graduated from the University of Pittsburgh medical school in 1982.
Serbin might be a throwback, but his approach represents a growing trend among doctors. "Concierge medicine" is a medical treatment and financial model that typically includes patients paying a flat out-of-pocket fee annually in exchange for 24/7 access to their physicians in person, by phone or via text.
A survey last year by the Virginia-based American Academy of Private Physicians showed about 5,000 concierge-medicine practices existed nationwide in 2009 -- up from 500 in 2005. The survey projected that number would balloon to 17,000 by 2012.
Serbin is one of at least three concierge physicians who practice in the Pittsburgh area. Despite the cost, patients say the extra attention they receive is worth it.
"I don't understand why you wouldn't do this," said John Kuntz, 52, an entrepreneur who lives in Collier. For three years, he has been a patient of Dr. Joel Warshaw, a concierge doctor who chooses to work from his Bethel Park office rather than do house calls.
"I can text him and get a near immediate response," said Kuntz, who pays $1,250 a year for unlimited consultations. "One time I had a rash. I took a picture of it with my iPhone, texted it to him and within a minute he wrote me back and told me it should go away within two weeks.
"It's like having a lawyer on retainer."
For busy, well-to-do parents such as Charena and Lynn Swann -- former Steelers wide receiver and Hall-of-Famer -- the convenience of a doctor such as Serbin, who will treat their two adolescent sons at home, is too good to pass up.
"We don't have to worry about going to a doctor's office where people are coughing and sick kids are playing with the same toys," said Charena Swann, 48, a psychologist who lives in Sewickley.
Patients still must have health insurance to pay for procedures such as blood work, lab tests and surgeries, Serbin said.
Some concierge doctors accept insurance. Others don't.
Serbin, Warshaw and Dr. Michelina Fato -- a Squirrel Hill-based doctor who, like Serbin, only makes house calls -- tell similar stories about how they became concierge physicians.
All three had traditional practices for more than a decade. All shared their frustrations with what's become the conventional financial structure of medicine: doctors earn more the more patients they see.
That incentive pushes physicians to see as many patients as possible every day, sometimes only for a few minutes, and results in substandard care, Serbin said. He operated a practice out of an office near Allegheny General Hospital in the North Side for 17 years before taking up the concierge approach about five years ago.
"I averaged 30 to 40 patients a day," said Serbin, who now has about 300 patients and earns about what the typical Pittsburgh-area pediatrician makes a year. It's considerably less than what he took in before, but Serbin's happier and says his work is more fulfilling.
"That hectic pace creates errors," he said. "And I witnessed a lack of compassion -- not because we doctors are not compassionate. But because we didn't have time for that."
Fato, 50, an internist who worked at West Penn Hospital in Bloomfield for 10 years before opening her concierge practice in 2006, said leaving conventional medicine "was all about the relationship I wanted to have with my patients."
"Treating someone every 15 to 20 minutes, I couldn't give the quality of care or time they deserve," Fato said.
This is the first year she has broken even, Fato said. Her husband also is a doctor -- and that's helped Fato make the transition to her new practice. She wants to cap the number of patients at 50 and has about 20 now. Fato's fee for a "young, healthy person with no chronic diseases" is $1,200 a year for an annual physical and one sick visit. Anything beyond that is $200 an hour.
Doctors carrying a medical bag and coming into a patient's home was standard into the late 1960s, said Michael Tetreault, editor-in-chief of the Atlanta-based online publication, Concierge Medicine Today.
"Look at The Andy Griffith Show. That's what our grandparents did," Tetreault said. "Medicine became government regulated and that started to end. It came in for a reason -- there did need to be some amount of administration. But now regulation and administrative tasks have frustrated doctors."
Warshaw, 44, said opening his concierge practice about three years ago is the best thing he ever did. He offers unlimited visits on a sliding scale based on age from $1,000 per year for patients under 40 to $1,500 per year for those older than 60.
"I looked at my life and realized I wasn't enjoying myself."
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