Over the counter cold-and-flu remedy: $5.99.
Trip to the doctor's office: $20.
Extra time to bend your doctor's ear: $1,500 a year and up.
Primary care physicians are increasingly offering exclusivity to those willing to pay for it.
These practices, known as concierge, boutique or retainer practices, typically charge annual fees that range from $1,500 to $10,000 or more. The fee allows the businesses to prosper with a far smaller roll of patients than has become the norm under the traditional system.
Patients like the extra attention and lack of crowded waiting rooms. Doctors say they need alternatives to a payment system that forces them to cram their schedule with appointments.
But the growth comes with concerns about doctor access, particularly since a bill moving through Congress could cover millions of uninsured people and flood doctor offices with new primary care patients.
Heidi Berman pays $1,500 annually to see Dr. Stephen Glasser in Baltimore. The 38-year-old attorney said visits to her previous doctor lasted five or maybe 10 minutes.
"If you had questions, they were sort of an afterthought because the experience was so rushed," said Berman, who switched to Glasser a year ago.
Now, if she forgets to ask a question during normal office hours, she calls her doctor in the evening and he immediately calls back.
"It's personalized attention that I think ... every person is really entitled to," she said. "It's unfortunate that you have to pay for that, but for me, the $1,500 a year for that extra attention is worth every penny and then some."
The fee typically gives patients longer, more in-depth appointments with doctors as well as extras normally not covered by insurance. That can include an annual physical that delves into nutritional counseling and depression screening and provides a wider range of tests and blood work than patients usually receive. They also get after-hours access to the doctor.
Most patients still need insurance in addition to this fee, and they still pay co-pays and other coverage-related costs.
Glasser used to care for about 3,500 patients, seeing between 25 and 30 a day. He pared the total down to between 600 and 700 when he converted to a concierge practice six years ago.
He still has full days, but he traded 10-minute visits for more time with patients, including physicals that can last longer than an hour.
"Back then, you're sort of putting out the fires and treating complications and trying to keep people out of the emergency room," he said.
The number of doctors who operate a retainer-based practice is hard to pin down and is still a small slice of the roughly 326,000 U.S. primary care doctors. But organizations that help start them report brisk growth.
MDVIP Inc., based in Boca Raton, Fla., works with 340 doctors who have about 122,000 patients. It is one of the bigger firms in the business and has seen both doctor and patient totals grow by 10 percent or more every year since the company started in late 2000.
Concierge Choice Physicians in Rockville Centre, N.Y., works with 120 doctors who have converted their practices. Managing partner Wayne Lipton said there also could be a few thousand doctors who set up retainer-based practices without such help.
In contrast, a 2005 U.S. Government Accountability Office report identified only 146 concierge physicians in the entire country.
The growth in concierge care is "a reflection of the fact that we've got a very dysfunctional health care system," under which doctors are forced into a "hamster wheel" system in which they must see lots of patients just to stay afloat financially, said Dr. Lori Heim, president of the American Academy of Family Physicians, which is neutral on the subject.
But Harvard Medical School professor Dr. Stephanie Woolhandler said concierge practices are "absolutely the wrong solution," one that leaves behind people who can't afford better care.
Woolhandler, who still sees patients, says the entire system must be fixed to place more value on a doctor's time.
Some doctors try to juggle the two systems and operate only part of their business under a concierge model. Others may waive fees for needy patients. MDVIP works with physicians to find new doctors if patients can't pay the fee when a doctor converts.
Despite these options, some patients are still left with a tough search for affordable care.
Florence Day, of Sandy Spring, Ga., had a hard time getting her blood pressure under control after she lost her doctor a couple of years ago. He switched to a concierge practice and she declined to pay the $1,500 fee to stay with him.
Day, 90, lives on a fixed income and is covered by Medicare. Her daughter helped her eventually find a doctor she likes. But she's not thrilled with a system that charges an annual fee on top of the payment she's always made at the doctor's office.
"That's like putting up a deposit, you know, and I don't think that's right," she said.
Patients Paying For More Face Time With Doctors
Over the counter cold-and-flu remedy: $5.99.