Episode 2 | Concierge Medicine - Your Healthcare Fast Pass

[00:00:00] And to see your private doctor is unfortunately not feasible for most people to spend quality time with them. You don't get quick appointments. You don't get to ask all the necessary questions. So Born was concierge medicine for those people that valued A relationship with their physician. Hi, and welcome to the Lumida Legacy Podcast.

I'm your host, Justin Gilder. On this podcast, we'll explore how to achieve and plan for a long, healthy life, as well as how to prepare for the inevitable and unforeseen through estate planning, insurance, and end of life decisions. We'll talk candidly with experts who advise high and ultra high net worth clients.

So you can learn how to apply their strategies and tactics to your own longevity and legacy planning.

Hi, Ian, Dr. Rusinov. It's great to have a conversation with you. I've been really looking forward to this one. [00:01:00] I am personally contemplating. Whether I should start finding a concierge doctor, and then I realize I don't even know what concierge doctors do. I'm the son of a physician. Unfortunately, my father passed away about 14 years ago, so I couldn't call him up and ask him what his take on it is.

But maybe you can enlighten me and just start at the very beginning, first principles. What is concierge medicine? Yeah. So thank you so much for having me, Justin. I really appreciate it. Concierge medicine essentially is a relationship what's really missing from medicine these days, really in the primary care world is a relationship.

So concierge medicine came about probably 20 years ago or so. Medicine has changed over the years. It's very dominated by insurance companies. Doctors and patients can't spend a lot of time together. They get lost in the shuffle. And to see your private doctor is [00:02:00] unfortunately not feasible for most people to spend quality time with them.

You don't get quick appointments. You don't get to ask all the necessary questions. So BORN was concierge medicine for those people that valued a relationship with their physician. Okay. And so take us back to your start. What led you to being a concierge doctor? And both professionally, but also education.

So everybody listening, understand, who you are and where your expertise comes from. Yep. I definitely have had a different path than most. So I am actually a board certified emergency medicine physician. I went to school in Brooklyn, New York, SUNY Downstate, and I did my residency and training on the Upper West Side of Manhattan at St.

Luke's Roosevelt Hospital, which is part of Mount Sinai. And I was a board certified emergency medicine physician. I graduated residency in 2005. My wife and I, we moved to Florida at that time. My first job out of residency was at a level one trauma center in [00:03:00] Fort Lauderdale, where I became the assistant director.

From there, I went to the Cleveland Clinic. Which is more of a tertiary center complex care. I was the vice chairman of the emergency department there, and I left Cleveland Clinic in 2021 to be the medical director of a company called Solace Health, which is a concierge medical practice in Solace Health has locations in New York, California, they were building Florida, I became the medical director, and my responsibility was to really grow the market.

And we have locations in Palm Beach, and in Miami, we we grew the Palm Beach market from zero members to 2, 500 members in a little over a year. So where you see the Desire to just be a part of a concierge practice and have immediate access to care and relationships with your doctors. But through that, what I formed was relationships with patients.

I never had that as an emergency medicine physician. My job in the emergency department was basically to treat in street. Diagnose and stabilize, [00:04:00] non emergency, we sent it out, follow up with your doctor, I've taken care of everything, gunshot wounds, stab wounds, car accidents, heart attack, cardiac arrest, COVID, seizures, infections, pneumonia, I mean everything, diverticulitis, acute abdominal emergencies, but when I got to Solace Health, even though our bread and butter is really more urgent and emergent care.

It was really more of a concierge care. We were a one stop shop, a do it all for the patients, members at any time. And I really found a passion for getting to know the patients and building a relationship. So it was pretty eye opening for me because for the first 16 years of my career, It was just all about, I hate to say it was all about volume, but I could see 50, 60, I once was 75 patients in a 12 hour shift, left, I felt fine, went out to dinner, went to the gym, it was routine.

And really what was missing from that in retrospect was just the time and the relationship with the patients. So at SolaceHealth, I started to [00:05:00] have that relationship giving out my cell phone, speaking to people outside of work, and just participating in our members healthcare. And quite frankly, it's a pleasure to participate in our members healthcare.

And it's different, at Solace you learn that sometimes it's a patient, in the sense that they come in, they're sick, they need urgent or emergent care, and other times they're a member, just looking for advice, just with a question, but they've truly trusted me with their help. And along that process, I met a great doctor, Dr.

Goldstein, who has a longstanding concierge internal medicine practice in West Palm Beach. She asked me to join her practice. She's a solo provider for over 400 patients. So she asked me to join her practice as her partner, which I did. And now I'm building up my side of the practice. So I've taken the lessons and the knowledge I've learned at Solace to just a new territory where now.

I have the opportunity to grow this practice and really treat my members and patients with the time, dignity, [00:06:00] honesty, and respect that really they deserve and that I want to, provide. Yeah. That's a, it's amazing change in medicine. I can only say from an outsider's view, but I remember as a child hearing my father complain about the inability to spend enough time with his patients, even though he was in private practice for himself.

And so what is the reason that drives patients to concierge medicine when you hear them talk about their prior experience with What are some of the top reasons? Yeah and I'll just take a step back. So with my path being through the emergency department, which is again, not the traditional path, because I'm board certified in emergency medicine, even though I have now the experience and the skills to help people And, practice internal medicine.

The more traditional path is you have doctors that are trained in internal medicine or family medicine, and they've ran a busy office and they'll have patient volumes of, a census of 2, 500 patients. And [00:07:00] when you have that many patients, you can't get them in the same day or next day, you can't spend, a half hour, 45 minutes or an hour, you can't take phone calls at all times of the day.

So the more traditional route is you had one of those. Those practices, 2, 500 members, and you couldn't spend time with your patients. It just was not feasible. You have to pay the bills, the insurance companies reimburse very little. To make that happen, you had to put 5, 6 people, 6 people on your schedule in one hour.

And there is just no time to really properly evaluate. And get to know your patient. There's just no relationship at that clip. Now you will find some people that will say, Oh, I have a traditional doctor and he gives, he or she gives me their cell phone number. That may be the case for certain patients, but I can guarantee that not all patients have the cell phone.

And it's just a very different way of structuring the practice. So in concierge, You limit your practice size. There's a magic number. It's different for everybody, but it's [00:08:00] somewhere from 300 to 500, that's the range, which is the number that should allow the physician to provide ample time to their patients.

And included in that with concierge, the expectation is same day appointments or next day appointments, if it's late in the day. Access to their cell phone to ask any questions at any time of the day. Advocacy. So someone's going to be in the hospital, whether you're the admitting doctor or just you're under a different service, but you will advocate as the doctor for your patients in the hospital.

Expedited follow up appointments. We all have our relationships and preferred contacts. So when my patients need expedited appointment to cardiology, GI, orthopedics, I have my own personal relationships that I will. Ask for help or assistance or guidance or just advocate for quicker care. And that's what people are technically paying for.

It's, I often get uncomfortable even describing what it is because this is born out of [00:09:00] the, like the problems in the healthcare system. If the healthcare system in America was better, Everybody would be able to have this kind of treatment. Sadly, when people, ask me how much it is per year, or what's the membership like, I'm almost embarrassed because, I want to take care of everybody and do the right thing for my patients, but if you have too many, you can't give the proper attention that they need.

But this is a consequence of health insurance, And just like a difficult, broken healthcare system. So it sounds like terrible, but most. People prefer to go to Universal Studios or Disney with a fast pass or some guarantee that they're going to get on the rides. This is essentially in many aspects like a fast pass for your health care and ultimately, what's more important than your health care?

We both I'm sure know lots of people who spend money on vacations and houses and cars, you can't enjoy your wealth without your health. So this is a way that [00:10:00] members and that's what I guess, we'll get into the topic of longevity for those that value their health, which will allow them to enjoy their wealth.

They have to go the route of concierge medicine to get the attention and detail, the attention to detail that they really deserve. Yeah. So before we go over to talking about longevity spend a bit more talking about the current healthcare system, not just in the structure, which I think you've touched on in terms of insurance and the wait times or perhaps the volume of patients that doctors have to see.

But also, outcomes, patient outcomes, because I'm wondering whether concierge medicine is able to also improve outcomes for patients, and is that a driving force also?

I could tell you anecdotally from my time at Solace Health, we were greatly able to improve patient outcomes by offering them expedited access to appointments and to care, and just having somebody help them navigate a difficult [00:11:00] system. We've have connected in doctors, or I don't even want to say connections, we have relationships with doctors where someone, even if it's a colonoscopy, we had a patient who thought they were going in for a routine colonoscopy, and they diagnosed lymphoma.

We've had members who were in the hospital and just, They had nobody to advocate for them. They were admitted to a hospital of service. And we got involved through the Salas Health approach as a team. And we coordinated a transfer in a, like a difficult transfer because usually you need a primary care doctor involved to, to expedite and coordinate that.

But we were able to do that. So I would say that there are many health benefits to having access to concierge care. I, We're able to do quicker labs, quicker turnaround times at Solace Health. And again, that's where I came from. So I recently made this transition, but we have the ability to do CAT scans and x rays and blood work.

And we would see people with chest pain who undoubtedly would be admitted to a hospital for, you Two, three days while they're doing blood works and waiting on [00:12:00] tests we could turn that around in less than an hour and coordinate an outpatient appointment safely. So person didn't have to spend a day or two in the hospital, pick up a hospital acquired infection, be away from their family, be away from their pets.

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