“The amount of time physicians like me spend with a patient has trended downward, and new physicians may be spending as little as eight minutes with each patient," he said. "Time is eaten up filling out electronic forms, instead of really interacting with the patient, and many of us find ourselves spending more time looking at a computer screen than we do at the person we are caring for. Also, many of the organizations that employ physicians are applying pressure to work faster, driven at least in part by a desire for more revenue.”

Becker reports that his practice has never dropped below an average visit of 15 minutes per patient visit, but to sustain it, he has paid a substantial price. “I spend two to three hours a day outside of patient care on paperwork and phone calls,” Becker told me. In order to preserve what time he has left, he has had to spend more money. His small practice has had to hire a full-time employee just for billing and coding. It also invested in a new electronic health record system, which requires maintenance and annual upgrades.

When I asked Becker if anything has gotten better over the past few years, he had to give it some thought. “Well, I guess it is making me a better typist. And I do have to admit that the electronic health record does make it easier and quicker to find some kinds of patient data.” He quickly added, “But make no mistake about it. In my mind and the minds of many of my colleagues, the loss of time and attention has harmed the individual patient at the point of care.”

So Becker is shifting to a new style of practice, sometimes called concierge or retainer medicine. With the help of a company that has been helping physicians make such shifts for over 13 years, he will cease caring for a total of 2,500 patients and instead cut back to about 600. These patients will pay an annual fee of $1,650. In exchange, they will receive a two-hour annual visit with a complete physical exam, same-day appointments, 24-hour physician phone access, and personalized, web-based resources to promote wellness.

When patients get admitted to the hospital, Becker will remain their physician, and their health insurance will still pay for much of their care. Will it make more money for physicians? Becker doubts it, but if it does, he plans to plow any additional income he might derive back into his group practice, helping to lessen the economic pressures on his colleagues.

The concierge model of practice is growing, and it is estimated that more than 4,000 U.S. physicians have adopted some variation of it. Most are general internists, with family practitioners second. It is attractive to physicians because they are relieved of much of the pressure to move patients through quickly, and they can devote more time to prevention and wellness.