Gene Blythe  /  AP
Dr. Gary Berliner examines patient Wesley Reece of Dawsonville, Ga. Sept. 15 at the Chestatee Emergent Medical Center in Dawsonville, Ga.
updated 9/18/2005 6:33:17 PM ET 2005-09-18T22:33:17

The words atop the tiny white building on the road to downtown Dawsonville say “clinic” but it might as well advertise a medical buffet.

Inside, Chestatee Emergent Medical Care is brimming with patients, each one signed on to a gutsy program that charges clients a flat annual rate of $500 for unlimited visits. Some complain of fevers, and others wilting in the heat need IVs. And through the summer, Dr. Gary Berliner has been busy with a steady influx of patients plagued by a nasty infection.

Like an all-you-can-eat deal, Berliner’s patients can visit as often as they’d like without an appointment for checkups, X-rays, lab tests and even minor surgery.

These types of medical offices, often called boutique clinics or concierge medicine, have been offering flat fee care for years to affluent patients willing to pay thousands of dollars in annual fees for the ability to walk in to a doctor’s office whenever they’d like. But Dawsonville is no metropolis or well-to-do suburb. It’s a hilly rural outpost an hour north of Atlanta — an underserved community where Berliner says reliable health care is needed most.

He and co-founder Dr. Dan Francis hope their clinic, which is soon expanding to a half-dozen locations throughout north Georgia, will start a trend in rural America.

More accessible care
By offering affordable health care to the masses — not just the elite — they say they are helping cut hospitalization rates and providing the neediest with at least a partial answer to their insurance woes.

“It’s not a difficult calculation,” says Berliner, taking a brief break from his schedule to talk in a vacant examination room. “The average person takes four visits to the doctor each year. Two thousand people represent 8,000 visits. That’s one million bucks. You can completely run this clinic with that money and still handle the walk-ins.”

The boutique trend started in the Seattle area, where the MD2 clinic charges more than $10,000 a year for home-delivered prescriptions, immaculate offices and personalized robes and slippers. Since the clinic opened in 1996, different forms of the care have sprung up across the country.

“There’s not one way to do it. We’re all trying to provide better and more accessible care to patients,” said Dr. Douglas Tilt, who opened up the Camellia Medical Group on the campus of the University of Alabama-Birmingham in 2003.

Tilt’s clinic has 212 patients — many of the school’s biggest donors — who pay an annual fee of $3,000 for care that includes 24-hour access to a doctor who makes house calls.

While some urban doctors have jumped at the chance to make more money while seeing fewer patients, as boutique doctors often attest, Berliner says few rural physicians have approached him about following his lead.

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Some patients are slow to sign up, too.

His Dawsonville clinic has 500 patients on the flat-rate plan but can take 2,000. The docs can’t handle all cases, such as the patient who chainsawed his hand while clearing debris in the aftermath of a particularly brutal storm. Emergencies like that and major surgeries are referred to a hospital.

Many of the patients also have health insurance or are covered by Medicare to cover the costs of any medical treatment beyond the clinic. Some of the insured patients have opted for the boutique clinic approach to avoid having to hassle with the bureaucracy of insurance companies.

However, a few neurotic patients also have tried to game the clinic’s system, visiting a few times each month until Berliner has to warn them not to abuse their service. Berliner said no one has abused the system again after receiving a warning.

Country club medicine
Critics argue the notion of boutique clinics is a prime example of the ailments of the nation’s medical system, which they say triages health care by the patient’s ability to pay rather than by need.

The Georgia clinic’s $500 fee may seem reasonable, but it may be out of range for many rural residents, said Aaron Katz, the director of health policy analysis at the University of Washington. Berliner, however, says his fees are less than many pay monthly for rent — even gas — these days.

Dr. John Goodson, one of the most vocal opponents of boutique care, said he fears fragmenting services will worsen a health care crisis that he says robs Americans of the hard-earned privilege of medical care.

“Everybody is coming up with their own kind of country club. Some have extremely high entry fees and are what they call the best. Some have low entry fees. You pick your price,” said Goodson, an associate professor at Harvard School of Medicine and an internist at the Massachusetts General Hospital.

“For somebody who’s got nothing, if you have a choice between that and thousands for health insurance, it’s a good choice,” he said. “Of course if you’re stuck in hospitalized care, you’ve lost your bet.”

It’s a risk some patients are willing to take.

Kurt Krattinger was the clinic’s fourth client when the business started in 2002. Since then, he’s made countless visits to treat the strange wounds inflicted while on his landscaping business. “It’s saved me so much time and grief,” he said. “I would never have gone for treatment if not for this.”

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