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Concierge doctor raises concerns

August 17, 2008

I appreciated the cautionary piece, "Before the house call, give doctor a checkup" (Consumer Confidential, Aug. 10), about Dr. Herbert Rubin, a physician advertising concierge medical care who has been placed on a probationary license by the Medical Board of California and had to surrender his New York medical license for questionable patient care and billing issues.

The piece serves as a reminder to all of us to check the credentials of those we trust with the health of our families.

I am a physician and clinical social worker. What is most worrying to me about Dr. Rubin's house-call service is the bundling of medical and nonmedical services for vulnerable patients delivered on a private-pay basis in a setting where there is little regulatory oversight or accountability.

David Wallenstein, M.D.

Westwood

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I sincerely hope the Consumer Confidential column steers many prospective patients away from Dr. Herbert Rubin. By reducing his practice to a few hundred people, he fancies himself a modern-day, warm and wonderful Marcus Welby who can be ultra-responsive to his chosen ones.

The fact that he is on probation with the Medical Board of California -- and denying it -- is disturbing enough. In fact, he seeks to feather his own nest by accumulating only well-heeled patients who pay him obscene rates directly for personalized service.

With millions of citizens uninsured or under-insured, what the market should bear is single-payer healthcare.

Suzanne Harris

Los Angeles

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I'm a physician and have been interested in concierge or boutique practices for several years. My practice is not such a practice. Your article is dead-on about checking out a physician before trusting your life to him or her.

However, this was presented as an article about concierge practices. Checking out a doctor's credentials is easy, standard operating procedure and in no way specific to concierge doctors or practices.

Concierge practice is a far more interesting story. Any doctor who successfully transitions to this practice style will provide far better care to far fewer patients. The doctor will earn far more income and improve his or her lifestyle with regard to job stress, job enjoyment and dollars and cents.

Most of the concierge doctors will be among the best physicians because they're the only ones who can pull it off. Few people will pay $1,500 to $15,000 per year to a loser doctor like the one in question.

John M. Spine, D.O.

Erie, Colo.

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The argument that concierge medicine is elitist and unethical is without substance.

We already have a two-tiered healthcare system. In our present fast-food model, physicians contract with HMOs, PPOs and other third parties, as opposed to working directly for their patients. They do not treat the uninsured. These doctors have simply agreed to "ration care" to their patients in return for a steady stream of referrals from the third parties.

I opened one of the first concierge practices in the country eight years ago in Tucson. I've just authored the first book on the subject, in which I address the ethical issues. We have somehow come to accept that our current system is the ethical gold standard by which we compare concierge medicine. If the current third-party system is ethical, please call me unethical.

Steven D. Knope, M.D.

Tucson

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