It takes time to heal: patients are willing to pay a premium to get it from physicians at concierge medical practices.

• Author: Martin, Edward

She drives 20 minutes from downtown. Charlotte to SouthPark, the city's second downtown--high-end retailers, high-rise offices and high-dollar houses and condos clustered around the ritzy shopping center with that name. Event planner Mary Tribble walks into one of the office buildings, stopping at a reception desk of richly inlaid wood. On the walls hang paintings by local artists. Freshly cut flowers fill a vase on a table. She and a nurse disappear down a hallway into a suite evocative of a waiting room. More flowers. More local artwork. She climbs onto an exam table covered in fresh linen. Elizabeth Perry, trained in internal and emergency medicine at three of the nation's top medical schools, takes her time. They talk, chatting about Tribble's health but also about her business and personal life. "You've been fasting?" the doctor asks. The patient nods: "Since last night." Perry laughs. "I'll bet you're hungry" She goes to the kitchen, returns with an apple, then peels it.

[ILLUSTRATION OMITTED]

A few years later, Tribble will sell her business, retiring at 50, then reemerge as chief of events planning for the 2012 Democratic National Convention. Still a patient of Perry's at Signature Healthcare, what she remembers most about that first visit was not the relaxed, hour-plus examination but a highly trained physician slicing her a piece of fruit.

Practicing medicine this way is but a sliver of North Carolina's $60 billion-a-year healthcare economy, and only about 4,400 of the nation's 600,000 doctors--a figure that includes surgeons, psychiatrists and other specialists--do so, estimates Tom Blue, executive director of the American Academy of Private Physicians in Richmond, Va. Called direct, private or concierge care, boutique medicine and retainer-based medicine, what they all promise is meticulous attention and quick access to doctors. To get that, patients pay a premium. In North Carolina, an individual membership fee is cally $1,500 to $3,500 a year, out of pocket, on top of health-insurance coverage for visits and treatments. Tribble pays about $2,700.

In 2003, Signature Healthcare PLLC became North. Carolina's first concierge practice. Nobody keeps official count, but now more than a dozen doctors engage in retainer medicine at a handful of practices across the state. Among the latest is Perspective Health & Wellness, started this year in Charlotte by Carolinas HealthCare System, the nation's second-largest public hospital network. Even doctors' views of this trend vary. A recent national survey of 900 by the journal Physicians Practice found nearly half wouldn't want to be in such a practice but don't object to those who do. But more than one in 10 question the ethics of medical care catering to the relatively healthy wealthy--though nearly that many say they're considering forming, joining or already working in one. Here's one reason why.

William Lee is settling in to catch the late news when the phone rings at his Raleigh home. He turns off the TV and picks up the receiver. A woman's voice, sobbing. "Mama died." He listens as she recounts details. He's an affiliate of Boca Raton, Fla.-based MDVIP Inc., a national direct-care network. She's his patient, as her 89-year-old mother had been for 30 years, most recently in hospice care. He searches for words. "We know," he says softly, "that she's no longer in pain or suffering the indignities of health care." They grieve together. In conventional practices, where primary-care physicians have as many as 3,000 patients and might see 30 a day, time is often too...