There’s nothing new about the way Yarmouth Dr. Phillip Frederick practices medicine. In fact, it sounds kind of old fashioned.

The doctor takes his time with his patients, talking to them for no less than 30 minutes during each office visit, and he’s available 24 hours a day, even making the occasional house call.

What’s new is how he gets paid. Instead of relying entirely on fees for tests and procedures that are billed to his patients’ insurance providers, he gets an annual fee direct from the patients, which lets him keep the size of his practice small and gives him the chance to do real preventative medicine. That kind of care can reduce hospitalizations and ultimately lower costs. It also keeps patients healthier and happier.

That’s why Frederick reports having a waiting list for his 600-patient practice, and it is why other doctors are likely to follow him and start “concierge” practices of their own.

But it also raises some important questions: If paying a doctor to keep patients healthy produces better results, why is it only available to people who can afford an annual fee? Why do most people’s doctors have to hurry through appointments without being as thorough and order what may be unnecessary tests in order to be paid for their work?

These questions are nothing new, either. Pilot programs that study the efficiency of “bundling” or paying providers per-patient, rather than per-service fees, are part of the Affordable Care Act. In Maine, 26 practices have been organized as “patient-centered medical homes” in which providers are rewarded for keeping patients healthy, rather than just treating them when they get sick.


This is a worthwhile study, but it’s clear that some people are not ready to wait around for the results.

Frederick’s practice in Yarmouth is likely to be the first of many, as consumers get increasingly frustrated with being churned through doctors visits.

Racing to cut insurance premiums by letting the low-quality insurance companies into the Maine market, as the Republican majority in the Legislature and Gov. Paul LePage did this year, is not the answer.

Patients lining up to pay more for practices like Frederick’s should show that there is value in paying a doctor to take his time.


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