Boutique Medicine—

A Local Physician Takes His Practice In A New Direction

By Kaaren Valenta

Dr Robert L. Ruxin remembers the days when doctors went to patients’ homes and had the time to really get to know them and their families.

Growing up in Cleveland, Ohio, in the 1950s, the son of a pharmacist and a medical librarian, he learned about medicine and how to provide good service and quickly decided to make it his life’s work.

So when his 30-year medical practice began to be more about haggling with health plans and squeezing more patients into an already crowded schedule than in providing personalized preventative medical care, he decided to make a significant change.

On November 2, Dr Ruxin, 59, changed his practice in internal medicine, geriatrics, and endocrinology into a concierge medical practice. He is the first physician in Newtown to adopt this new concept, which is known as “boutique” medicine. In his practice, through an affiliation with MDVIP, a national leader in concierge medicine, he will have a maximum of 600 patients, each of whom will pay a $1,500 a year annual fee that will include an extensive physical examination followed by a comprehensive wellness plan.

Under concierge and boutique plans, which are offered in metro markets around the country under a variety of options, patients who pay an annual fee receive guaranteed same-day or next-day appointments, no-wait access at appointment times, longer examination times, and around-the-clock access to their physician via cell phones and pagers. Participating physicians say they have more time to devote to patient care and advocacy, along with continuing medical education and family life.

MDVIP was created by a group of primary care physicians who believed that more time with the patient translates into better care by focusing on preventing illness and promoting wellness.

For Dr Ruxin, the concept promises to bring him back to the early days of his career when he took over the practice of Dr Jean Gretch.

“I was a new doctor working in Ridgefield, and I met Dr Gretch at Danbury Hospital,” he said. “She was a remarkable woman who became a doctor after raising six children. She had her practice at her house on Castle Hill Road [in Newtown] and needed help, so I started to work there a half day each week.”

When Dr Gretch died suddenly in the late 1970s, her family encouraged him to continue her practice.

“I enlisted Dr [George] Cohen’s help and stayed in the house for several years until we found this place [at 5 Riverside Road] in Sandy Hook,” Dr Ruxin said. “At one time it had been a schoolhouse, and some of my patients told me they went to school here.”

“It was a nice family practice offering personalized care,” Dr Ruxin said. “That’s what I want to get back to. Concierge medicine is what medicine was like 25 years ago, when doctors really knew their patients and their families.”

Dr Ruxin grew up working after school, on weekends, and during summer vacations in the pharmacy owned by his father and grandfather, and has always marveled at the progress medicine has made in treating illness. “Diabetes is one of my subspecialties,” he said. “In 1975 we had only insulin and one other pill. Now there are five classes of drugs to use.

“Now we have great preventive medicine in addition to primary care,” he said. “Back then we really didn’t know a lot about many conditions. With what we now know about preventive medicine and personalized care, I felt it was time to make a change.’

Dr Ruxin spent the past four months in a transition stage with his patients. First he conducted a telephone survey to get candid feedback from his patients. “The responses indicated that patients felt the amount of time the doctor spent with them was important. They also said they wanted a practice that emphasized prevention and wellness,” Dr Ruxin said.

Dr Ruxin said that in any year, he would see about 1,500 patients and had a database of close to 3,000 names. Under his affiliation with MDVIP, he will not exceed 600.

“Most doctors [in MDVIP] don’t actually take even that many,” he said. “Most cut down by about two-thirds. Doctors need about 350 to 400 patients to break even.”

What Dr Ruxin emphasized, however, was that the new concept is not “elitist” medicine.

“Patients who do not have insurance or who have only catastrophic insurance like it,” he said. “They are used to paying for their medical expenses. They are paying out of pocket and don’t want to wait an hour in the doctor’s office. Most are hard-working, self-employed people. They have been very interested and supportive.”

The cost, Dr Ruxin pointed out, amounts to $125 a month, or $4 a day. “Stop smoking that pack a day, and you can pay for this,” he said. “More people pay more for their television or car.”

Ten percent of his patients, most of them elderly, will continue as scholarship patients, with no premium fee, he said. “Doctors used to do a lot of volunteer and charity work but with HMOs that has plummeted down in the last decade,” he said. “We are seeing too many patients too quickly. Some practices are not even taking Medicare patients.”

Dr Ruxin said he will continue to see patients who are in the middle of treatment, and give them time and recommendations to help them find another doctor if they do not opt to stay in his practice.

Unlike retainer fees charged by some concierge plans, the $1,500 MDVIP fee provides the patient with an annual executive health examination that is the equivalent of a half-day physical exam and covers blood work, an EKG, and anything else done in the office. The patient also receives a wallet-size CD that contains a copy of the report of the annual physical, test results, and other important medical information to carry at all times.

“I have always given my patients a wallet-size copy of their EKG so I know how important this has proven to be in emergency situations,” he said. “In many cases it has avoided a hospital stay.”

Once the physical exam is done, Dr Ruxin said he will have the time to follow up with his patient and put a medical plan into action.

“We are going to stay on patients’ backs to help them,” he said. “If they don’t follow up, a red flag will go up. If I refer a patient to a specialist, I will call the specialist before the visit to consult about the patient, and also call the next day to talk [to the specialist] and not wait for a letter.”

He also will be able to see his patients when they are in the hospital or nursing home.

“I was trained to take care of my patients,” he said. “Ninety percent of doctors in the area of primary care do not see a patient in the hospital. The patients see a hospitalist who may have ten to 20 patients over a period of four days, never have seen them before, and never see again. And there may be several hospitalists over those four days. I want to see my patients wherever they are.”

“My patients will have my cell phone number and I’ll answer whenever humanly possible, even if I’m vacationing in California.”

MDVIP offers travel medical services with reciprocity with a nationwide network of physicians. The company started in Florida and has the largest number of physician members there.

Dr Ruxin said patients may submit the bill for the physical exam to their medical insurance plan, which may pay something, but his office would not do the billing. Many patients may be able to pay for the fee from a flexible spending account or a health savings account. Patients are responsible for getting reimbursed from their insurance plan for tests, such as CT scans, and surgery. Regular office rates and office hours will remain the same.

Newtown resident Nicole Christensen and her husband Kim like what Dr Ruxin is offering.

“We think it is a good thing,” she said. “We decided to stay as Dr Ruxin’s patients because we like the preventive aspect of it and also the service. We like the comprehensive checkups. We talked to friends about their doctors and many aren’t happy with the long office waits. We want to go where the doctor knows you and you are not just a number.”

The Christensens own a business, The Danish Touch, in Bethel and said that had an influence on their decision.

“It is hard for us because we are a small business,” Mrs Christensen said. “We can’t go and just get any medical plan that we want. We are only in our 30s and decided that this is a good time to get a comprehensive exam to serve as a baseline as we get older.”

A graduate of the Case Western Reserve University School of Medicine, Dr Ruxin served as a lieutenant commander in the US Navy in the Department of Internal Medicine and Endocrinology at the Bethesda Naval Hospital moving to Connecticut in 1976. His wife, Becky, is a certified diabetes nurse educator in his practice. They have two grown children, Josh, a professor at Columbia University who is involved with worldwide projects to eliminate AIDS, malaria, and tuberculosis, and Lisa, a physical therapist in Boston, and two grandchildren.

“We are a family of medicine in more ways than one,” Dr Ruxin said.