Give the doctor a checkup before ordering a house call

The new breed of 'concierge physician' aims high-priced services at the well-off. One is on probation with the state Medical Board.

By David Lazarus

He refers to himself as Dr. House Call. In glossy brochures mailed recently to thousands of well-to-do households from Malibu to Brentwood, he said he was seeking to be a "caring, old-fashioned Marcus Welby kind of good doctor without the office hassles."

Dr. House Call -- a.k.a. Dr. Herbert Rubin -- is an example of a small but growing trend in medicine as physicians cut themselves free from insurance companies and enter into direct relationships with patients who can afford more personalized healthcare.

He's also an example of why people may want to shop around before inviting a so-called concierge physician into their homes. Although his brochure doesn't mention it, Rubin is on probation with the Medical Board of California for accusations that include gross negligence, incompetence and insurance fraud.

"Accusations have been made," he told me over coffee the other day at a Pacific Palisades restaurant near his home. "I absolutely deny them. They were all false."

No one knows precisely how many concierge practices exist nationwide. Neither the American Medical Assn. nor the American College of Physicians keeps such data, but healthcare professionals peg the number at fewer than 1,000 and growing as doctors seek alternatives amid rising costs and cutbacks in reimbursement by insurers.

In most cases, a concierge physician chooses to limit his or her practice to only a few hundred patients, rather than the usual 2,000 or 3,000. Patients may pay the physician an annual retainer that can run as high as $15,000 or an hourly fee of hundreds of dollars, on top of whatever costs may accrue as a result of treatment.

Critics of concierge medicine point out that such practices generally target the wealthy and create a tiered system whereby people who can afford it get first-class medical treatment, and everyone else gets what they get.

Proponents say concierge physicians offer a legitimate service and charge only what the market will bear.

The American Medical Assn. says what it calls retainer practices "are consistent with pluralism in the delivery and financing of healthcare." However, the industry group also warns that such practices "raise ethical concerns," particularly if they "become so widespread as to threaten access to care."

"All patients are entitled to courtesy, respect, dignity, responsiveness and timely attention to their needs," the association says.

Rubin, 67, has been practicing medicine since 1975. Much of that time was spent in Beverly Hills, where he focused on gastroenterology, or matters related to the digestive system.

Rubin said he decided around 2000 to stop dealing with insurers. They were more trouble than they were worth, he said, and interfered in his dealings with patients.

In 2006, Rubin said, he concluded that it was time to retire from medicine. "It stopped being fun," he said. "I loved the patient-care part. But all the rules, regulations, restrictions -- I didn't want to do it any more."

But after a year pursuing other interests, Rubin said he missed practicing medicine. He saw that many physicians who shared his frustrations with the healthcare system had turned to concierge practices.