After completing rounds at two nursing homes and a hospital and watching my daughter's soccer game all on a Saturday morning, I found time to review FPM (a testimony to FPM's relevance). After reading about Dr. Forester's successful nonprofit concierge practice [“A New Model of Charitable Care: The Robin Hood Practice,” February 2008], I felt a tinge of practice envy at first.

After all, I have a practice with more than 6,000 active patients and, along with an invaluable full-time physician's assistant and a part-time nurse practitioner, work 24/7 to meet the needs of these patients while maintaining a busy personal life (with four growing children). I could replace this hectic lifestyle with one that is more relaxed and just as profitable simply by selecting several hundred “benefactor” patients who could afford to make the yearly payments a concierge practice requires, and then I would have the time and resources to provide charity care to uninsured patients as well. Yet, I would have to say goodbye to the several thousand patients who are stuck with the usual third-party payers or Medicare and can barely afford their co-payments and deductibles.

When a similar concierge practice opened in a neighboring (and I might add more affluent) community, I searched my own heart and mind to see whether I would, or should, follow their lead. Thus far, the answer has been a resounding “no.” To find my answer, I simply considered the many hardworking middle-class patients in my practice who have sought me out because of the quality of care my practice provides. It would be difficult to open a practice that excludes my friends who are schoolteachers, hospital employees, construction workers and neighbors simply because they are neither rich nor poor enough to fit into my practice model.

Perhaps as my energy level dwindles, I will reconsider. Dr. Forester's practice sounds like a comfortable and rewarding lifestyle.

The article on St. Luke's Family Practice was outstanding! What a vision! Thank you for the encouragement.