An Iowa physician who was bothered by the rapid-fire pace of treating patients has started a new family practice in West Des Moines that’s among the first of its kind in the state. 

The biggest distinction: Concierge Medicine Iowa will serve just a few hundred patients, rather than the 3,000 to 4,000 that typically support a family medicine practice. Patients of Dr. Trae Ingram will have same-day or next-day access for appointments that last an hour if needed. And instead of accepting health insurance, Ingram charges an annual flat fee, or retainer, for unlimited access to his services, including consultations by cell phone. 

Although it’s still a rarity in Iowa, the practice model known as concierge or retainer-based medicine has grown significantly in many other parts of the country. According to the latest statistics from Concierge Medicine Today, about 12,000 physicians nationwide practice some form of concierge medicine. However, Ingram is one of just a dozen or so doctors who have embraced this concept in Iowa, according to the publication.  
 

‘A paradigm shift’ 

“I was happy in my previous practice, which was just traditional family medicine,” said Ingram, 41, an Iowa native who previously practiced in a multi-specialty group in Clinton. “But as things got more paperwork-intensive and it became such a grind to practice traditional medicine, I became more drawn to this style.”  His patients vary from a woman who comes in weekly for followup on a weight-loss plan, to others he sees monthly or just once a year. 

“My goal is that instead of a medical issue disrupting your life, I try to have it fit into your life,” said Ingram. At last count, his practice had 44 patients and is “rapidly growing,” he said. 

“It’s a paradigm shift; I don’t want you to come in if you don’t want to or have to come in. If you have another sinus infection or your allergies are acting up again, I’m not going to make you come in if you just need a prescription called in. So we’re using technology to expedite health care and cut out the inconveniences.” 

The biggest growth in concierge practices has been in the “snowbird” states of Florida, California and Arizona among the baby boomer population, but members of Generation X are beginning to consider concierge medicine for its convenience and affordability, said Michael Tetreault, editor-in-chief of Concierge Medicine Today.  

 Iowa, along with other rural states like Vermont, Idaho, Maine and Vermont, have been the slowest to adopt concierge medicine, he said. 

 Nevertheless, “I think the rural areas will be very accepting of this,” he said. “The doctor in (Andy Griffith’s town) Mayberry didn’t ask, ‘What kind of insurance does Opie have?’ or ‘Is Aunt Bea on Medicare?’ It might be slower in Iowa, but if physicians say they’re providing an old-fashioned level of delivery I think it will be adopted very quickly if doctors market it in the right way.” 

Overall, the number of physicians practicing concierge medicine has been growing between 15 and 20 percent annually, Tetreault said. In addition to primary care doctors, concierge medicine is also beginning to catch on more with specialty practices. 

Once considered a service for the ultra-wealthy who could afford to pay tens of thousands of dollars a year for a personal, on-call physician, concierge medicine has become more mainstream in recent years. According to survey data collected by Concierge Medicine Today, more than 60 percent of concierge medicine practices charge less than $135 per month. And though some do have a cash-only policy like Ingram, the majority accept health insurance and Medicare. 

Focus on prevention 

For patients ages 18 to 34, Ingram charges $125 per month; the cost increases to $200 per month for those 35 and older. He prices care for families on a case-by-case basis. “I like to make it affordable for families, because they’re the ones who really get the benefit from it,” Ingram said. “They’re shocked by how convenient it is to be able to call and come in. I’ve got several families with three or four kids that come in. You can’t beat it from a mom’s standpoint.” 

Although Ingram doesn’t accept health insurance, most of his patients have health coverage, whether it’s their plan at work or an individual catastrophic plan. “The idea is, if you need an MRI of the knee or you need to go in the hospital, it’s covered. What we’re doing here is separate from insurance. The only crossover is that you can use your health savings account to pay for it.” 

Patients also are paying for the prevention piece that concierge medicine provides, Ingram said. 

“I just sit down with patients and figure out what their goals are. We look at their lab work and health problems and make a plan. We have time to do the prevention side, where in traditional medicine the time for that is pushed out a little bit.” He has next-door access to a lab in the medical office building if a patient needs blood drawn for testing; lab costs aren’t covered by his fee, however. 

Ingram, who is married with four children, also finds his new practice provides a better work-life balance. Also, his wife handles the front desk. 

“This is ideal for me because I can adjust my schedule a little better,” he said. “Being at soccer games is important. If it’s convenient (for the patient), I can see them earlier in the day or later in the evening, even. I try to do exactly what the patient wants.” 

Ingram plans to add a nurse when his practice gets a little larger. And although he currently has a solo practice, he has room for another physician if he finds someone who is the right fit in the future. It takes the right type of doctor to practice concierge medicine, he said. 

“It’s a service business and you have to really want to take care of the patients and almost treat them like family.”

By the Numbers

More than 80 percent: Percentage of concierge doctors who accept insurance

Top 4 specialities: Primary care, family medicine, cardiology, pediatrics 

6 to 10: Average number of patients seen daily

Source: Concierge Medicine Today