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Growing up in coastal Texas, Dr. David DeAtkine skimmed the waves as a surfer and skimmed the pavement as a skateboarder, but he refused to apply the same technique to his medical practice.

"In the summer of 2003, I had 4,300 active patients," he says. "I was seeing 150 new cases each month and adding on the order of 1,500 patients a year. I felt like I was still doing a good job but if it went further, I would be 'skimming the surface' of thousands of patients rather than doing a really good job with a smaller number. I was thinking there had to be a different way."

So DeAtkine, a St. Vincent's-based internist/endocrinologist, began seeking alternatives to his 40-patients-a-day routine. He discovered that a concierge practice might be just what the doctor should order. (The concierge model advocates reducing the number of patients in a practice so that more time can be spent developing meaningful doctor/patient relationships.)

In the process of researching the concierge concept, DeAtkine learned about MDVIP, a national company that helps physicians establish and maintain concierge practices. He contacted the company, and the idea of establishing his own concierge practice began to take shape.

"I spent a year in discussions with them and almost launched the practice in the fall of 2002, but decided to give it a little more time," DeAtkine says. "After another year, I decided to announce that I was starting a concierge practice in the fall of 2003."

DeAtkine was the first physician in Alabama to join MDVIP and the first endocrinologist in the country to start a concierge practice. Patients that join his practice, he says, pay $1,500 a year for an hour-and-a-half visit called a wellness/prevention planning physical.

"We sit down, and I completely go through the patient's medical history and learn about their history, their family history, vaccinations, dietary habits, exercise habits — everything possibly pertinent to their health and their family's health," DeAtkine explains. "Then we do a complete physical, including lab work and EKGs.

"All this serves as a foundation for us to really get to know the patient and not only be able to address current medical problems but to look ahead and say, 'What can we do to help this patient live well and enjoy themselves for the next 30, 40 or 50 years?'"

But the benefits don't stop there. Every patient has DeAtkine's beeper number and can page him day or night, 24/7, except for when he is out of town. On those occasions, he hands off his beeper to another physician.

In addition, complete medical records are downloaded and provided to the patient on a wallet-size CD. Patients can also log onto a Web site and look at encounter notes or send e-mails to DeAtkine.

But giving this level of care requires limits. Instead of 4,300 patients, DeAtkine now has about one-tenth that many and plans to max out at about 450. He sees only eight to 15 patients a day as opposed to the dozens he used to see and is able to spend 30 minutes to an hour and a half on routine visits.

"I'm able to do some things that I've been trained to do but have never been able to do because I didn't have the time," he says. "The (healthcare) system does not reward doctors for spending time with patients, for thinking about patients, for taking on the more difficult, more problematic, more demanding patients. What the system does reward is the doctor who pushes people in and out of his door all day long.

"But I want to be clear that I'm not trying to disparage other doctors. The system requires them to see patients this way; otherwise, they don't make a living. The system is broken. My solution was simply to step out of the system."

The biggest criticism DeAtkine has received since launching his concierge practice is that it smacks of elitist medicine for the hyper-wealthy.

"I absolutely repudiate that," he says. "It boils down to $125 a month. I'm not saying that's inconsiderable, but most people spend that on their hair, or cell phone or cable TV. Yes, I have some wealthy people in the practice, but it's actually more diverse than it was before."

A graduate of Rice University and the University of Texas Southwestern Medical School, DeAtkine completed his residency in internal medical at Duke University Medical Center. His wife, Anne, is a radiologist at Shelby Baptist Medical Center. The DeAtkines have two children.

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