The Wonders of Concierge Medicine

Video Chapters & Transcript:

[Music] Well, howdy folks. Welcome to yet another edition of Smarter Money Matters with me, your wealth doctor, Jeff Camarda, our super CFPs, Anna and Lou. And today we’re honored to be joined by my personal physician, Dr. Al Castile uh who’s going to tell us about the wonders of concier’s medicine which is something that may be particularly uh interesting to uh uh to our audience and I’ve known may I call you Al? Is that okay? You may call me Dr. Al. Dr. Al. Okay. You can call me Dr. Jeff. The Dr. Al I’ve known probably 25 years. He’s the guy that first told me to start taking statins back in probably 2002 some something like that. Of course, I was young and strong and ignored his advice, but I wish I hadn’t because it could have made a really big difference for me. So, with no further ado, Dr. Al, please tell us about your practice, how you morphed into uh into Conro’s medicine and what it’s about and and like that. First of all, Jeff CFP, thank you so much for inviting me today to the show and I just want to share some great experience. I’ve been a family physician, board certified for 31 years. I trained locally at the University of Florida and it was a great town to live in to raise my child in and I stayed here in Jacksonville. So I’ve been here for 31 years plus my three years of residency. Um I’ve been and as a gator too. So the game I like it. I love that. So unfortunately we didn’t do very well last weekend but we’ll make up for it. Better better than expected. So in family medicine, what’s happening is that throughout the last two decades, family physicians are having to see more and more and more patients on a daily basis just to make ends meet, just to pay rent, just to pay malpractice insurance, just to pay their payroll for their employees. And of course, as we have to increase the number of patients that need to be seen per day, each patient gets less time face to face with their physician. So it’s become kind of a patient mill as it were. Unfortunately, it’s not our intention. We never mean it to be, but we can’t survive without seeing a bigger number of patients. So, let me see if I had this right. You know, Jesse, from a business standpoint, in order for a traditional physician to be able to, you know, have a a viable business, they’ve got to crank so many patients through the door that none of them really get the kind of care you’d like to give. Is that right? Correct. Okay. So, how have you uh are you still doing that? No. Well, what was the epiphany? What was the light bulb? The epiphany is the group MDVIP approached me and they said, “How would you like to spend more time with your patients with a smaller volume of patients as opposed to the 2,000 patients and deliver more deliberate customized individual care?” And the solution was to get into concurge medicine or what’s called individualized customized medicine whereby the patient will have direct access to the physician. The patient has the physician’s phone number. They can text, they can call 24/7 no matter what location of the patient, no matter what location of where the doctor is. Even if he’s on a boat diving in the Caribbean, even is on a boat diving in the Caribbean, which I have been in the past and was able to respond to many patients. He actually did to me two weeks ago. There you go. And with this model, the patients don’t wait weeks to get an appointment with the physician. The patient needs a specialist and you refer them to a specialist. The patient doesn’t wait weeks to months to get into the specialist because I have direct access to the specialist. And I will request through text or phone call, can you see this person a little quicker than a month from now? And usually within a week that patient will be face to face with the specialist. So how do you go about the selection? There’s so many specialists out there. I know you know not medical people really have a hard time discerning the quality. How is it that you select your cadre of specialists? My cadre of specialists come from a track record. Three decades in the business, three decades referring, getting feedback from the patients themselves, telling me how good they are, what were the pitfalls, what were the uh detractions and me selecting the group that performed the best, had the best outcomes, was most polite to the patients and where the patients came back and their satisfaction level was extremely high. Okay, so that’s how I select. So survivability is important. Incredible. service and customer service is still number one in my book. Absolutely in any business I think in any smart business. So tell me what and I don’t mean to you know you serve your time Lou or Anna please feel free to dive in. Uh Al’s a charismatic guy so um but he’s happy to take your question. Tell me what the demographic of your practice looks like. Is it across the board age wise? They tend to be older sicker folks or healthier folks. My demographics of my patient is a little bit older patient above the age of 40 that is tired of the runaround, tired of the can’t see my doctor for 3 weeks when I’m sick today, can’t get an appointment, can’t get to the specialist. So the age group is roughly above the age of 40 up until the end of life. It doesn’t matter how complicated they are. It doesn’t matter the number of medications or the conditions that they suffer from. We are still able to handle them. And because they may have a larger group of coorbidity um diseases, sicker people, we have an hour, we have a half an hour, 45 minutes, an hour and a half if necessary to sit with the patient because we don’t have the time constraint of having to see 25 to 30 people a day. It’s a smaller group of people, but you have more time for them. So you work similar number of hours but the patient leaves with the amount of care that they require not the time that you only have for them. Yeah. It’s not a I also as you know use Mayo quite a bit and which is which is an institution I guess like most institutions but I’m really impressed by the personal touch and accessibility uh that your practice offers which is I really haven’t found anywhere else. And you have a pretty big team you know including your students. What do you employ? Maybe 12 people something like that. I have full employees about seven people. Okay. And I have students from either University of Florida, Florida State University and Nova Southeastern University that rotate through the office in family medicine. And on the off time we lecture, we give them homework. Co coincidentally, tomorrow I’m lecturing at Nova Souththeastern University on cardiology case studies to try and share some of the knowledge I’ve gained in three decades. And let the young guys know the know the good stuff. That’s right. the inside track and inside track. What’s not to do, what not to do. So, you have you have a physician’s assistant, you have a PA and yourself, correct? And then I guess you have some nurses or what’s the rest of your team? I have my medical assistants, I have my check-in person, checkout person, an office manager that coordinates and oversees the whole team, allowing me to do more clinical care and not having to deal with, you know, what insurance companies asking me for X paperwork. We got people for that. So, tell me, you know, do you do much with tele medicine or that sort of thing? Tele medicine became extremely popular during the co years. Of course, I was always skeptical about tele medicine because I simply can’t examine you. The doctor needs to put a stethoscope on your chest and you can’t do that with tele medicine. Yeah, some things are simple. Some things are just oral history. A diagnosis can be made or a rash can be shown on a picture or a video. But the true true diagnosis a physical exam should be performed before the right diagnosis assessment is done and that is very uh has shortcomings in tele medicine. Sure you I mean you can you can talk when you really can’t touch. So the uh um now in terms of your patient base, what sorts of personalities I guess are even aware of you because I think there’s still a lot of our clients, a lot of our you know viewership, you know, which including some pretty affluent people that probably haven’t heard of us before. Um so what come what is your patient complexion look like and how do they find you? They find me usually on the web. If people go to mdvip.com and they look at doctors near me, I’m in the Orange Park area. My practice phone number is 904-2158400. Very easy number to remember. And people can come in. When’s your book coming out? That’s very good. You like that? 2158400 is an easy number. But patients can call, sit down and actually put me through an interview for nothing. They can call, set up a time with me. They can sit face to face with me and ask me about my philosophies, my experiences, what my thoughts are on certain current ideas of medicine. and they can interview me before you even select me as their physician. Well, speaking of interviewing, I’d like to Lou and Anna have the the opportunity to ask you some questions. But before another out, Megan, if it’s okay with Ashley, you can put that phone number up on the screen of compliance prison. Okay. So, Lou, why don’t we start with you? You know, because you’re, you know, you’re of Canadian bent as I recall, which has a a radically different health care system than here in the US. Um is this something that you find uh you know new and refreshing or absolutely I mean this is this is you know I’m learning this is this is brand new for me so I haven’t heard of this before but um it’s refreshing it’s good and when you say you know patients have to take away three days well back in Canada you know that’s that’s nothing that’s about three months is kind of the the average minimum but um but regardless kind I have a kind of two-part question so you talked about your team um is there another physician in your group and so if I was the patient if I called you would would I be directly talking to you or do I talk to your let’s say assistant and then kind of you know if we need to depends what your needs are. For example, if you have a clinical question, you would text me to my cell phone. The patient has my cell phone directly to my pocket which is with me 24/7 like most people are with their iPhone today. And you would actually text with me directly and you may have a need or a want. If my staff can handle it, I may direct them to call you back and let you know what’s going on. If you need a clinical question, I will call you as soon as humanly possible. I usually respond within minutes. Excellent. And you would be able to communicate directly with me. Now, if you just need a refill, you need a referral to somebody, I’ll get my staff to work on it. Actually, not not to interrupt you, but I I ema I texted you this morning, asked for refills at 858, and he responded at 859. That’s a true story. You know that not a plug, but that’s just, you know, that’s the way I’m dedicated to my patience. That’s what God put me on the earth for, to be a doctor, to be a family doctor to families. And I live for that. And I will still live for that. And I’ve got maybe 15 more years of practice in my life, maybe 20, depending on what God decides for my for my brain and my health, but I love what I do. Anna, what questions do you have for Dr. Al? So, Dr. Al, um, you know, for your patients, do they have to select like a certain health care policy to work with you? Do you like take different insuranceances or like how does that work? So my MD VIP individualized patient will still have insurance. The usual customary insurance processes are being followed. There is a co-ayment. I’m sorry. There is a bill and a charge to your insurance company. And we take most insurance companies that are out there. We take the Blue Crosses, the United plans, the smaller plans. And we’re very very wellversed in all the plans. There are some select plans that are really not very good that don’t cooperate with the primary care doctor. They don’t cooperate very well with the specialist and that’s on a case by case basis. They would have to call the patient would have to notify us and ask us what do you take? Gotcha. And we would sub there is a subscription fee though, is there not? There is the MDVIP program is $2,000 a year. It is $500 a quarter, which comes out to about one Starbucks a day. As as Tom Hopkins would say, you get to let $120 stand a month stand between you and your health and the best healthcare you can get. Of course not. No. And also those of you that have health savings accounts or other facilities like that, this is a perfect application for that for HSAs. It’s completely covered and you’re getting a service that you’re not going to get, not even in the higher institutions, which are wonderful. We love the Mayo clinics. We love the Cleveland clinics. We love all the greater institutions of our country, but you’re not going to get someone to respond within a minute or two or maybe two weeks, you know? I mean, they’re all machines, you know? I pick up the phone, I call you back, I text you. I’m the one that actually responds to you and patients are loving it. I’ve been doing it for three years now and patients just absolutely love the connectivity and it brings me closer to the patient, which is what family medicine and primary care is all about, being closer to the patient. See, I’m sorry. Go ahead. Yeah. Okay. I was going to ask another question. So if you have, you know, maybe elderly um patients and they have kids or family elsewhere that aren’t local, are you able to kind of coordinate care or answer questions for their family? That’s my completely. So in answer to your question, coincidentally, coming here to this beautiful meeting, we had a patient contact me directly and it was the daughter of a patient. So, normally when a patient is older, maybe doesn’t use text, the patient’s family will text me directly just the same as if it was the patient and ask me clinical questions so I can direct them on care. Uh, there was a blood pressure issue, diuretic issue, and I was able to answer it at the traffic light because I don’t text and drive at the same time. I was able to answer the question while I’m on the road. Fantastic. This is what they want. This is what they’re paying for. They’re paying for one more thing. We provide a physical that no insurance company typically pays for. We provide a physical that’s an indepth physical with a deep dive into your blood work. And the blood work has deep dive fractionation of your cholesterol. As you remember cholesterol, coronary artery disease is still the number one killer on the planet earth. So explain fractionation because not even Mayo does that. So very good. So the fractionation of your cholesterol is not just the high number, the good number, the bad number. You can actually fractionate. They do an MRI of your blood and they can tell the size of the molecules of your good cholesterol and the bad cholesterol. The smaller the particles, the worse it is for the patient. The larger the particles, the better it is for the patient. So if a patient’s on the margin, on the edge whether or not they need medication for cholesterol, again, coronary artery disease being the number one killer on the planet Earth, we can get them to make the decision based on the size of their cholesterol particle. So if it’s a really sticky small LDL, then you definitely want to medicate. You want to medicate that because you’re preventing future cardiovascular events. It’s not just about lowering the cholesterol. It’s about preventing the events that the cholesterol causes. So, it’s very very groundroots level prevention. And you’d rather put out you’d rather prevent the fire in the kitchen than have to put out the fire in your kitchen. Something’s going to get scorched. Did he answer your question? Yeah, that’s fantastic. Good. And and as a followup to that, you know, we we our viewership, you know, extends across the country and maybe beyond. um and does our client base um and we do a lot of you know tea financial planning I guess you call it um but uh your organization is it uh um it is MVP MV is that right it’s MDVIP okay.com they’re the oldest customized individualized medicine company in the country a national organization it is a national organization you have colleagues across the country I do if you’re traveling it’s a beautiful beautiful point that people don’t know if you’re traveling in a particular city and you get sick and you need hands-on care, instead of running to the emergency room or running to an urgent care center, I can find an MDVIP doctor that’s near you and you can visit him as if you were visiting me without an issue of faith, without issue. We’re in a network. We’re in a network that you are covered. So, if you have, you know, for instance, back to Anna’s earlier question, say that, you know, a child for a client, the client’s here in Jacksonville, maybe it’s your patient, and they’re looking for a referral to a similar service in Oklahoma City, uh, that’s something you could help facilitate. Immediately I go online, go through MDVIP’s provider list, and when a family signs up for MDVIP, it’s individualized per adult. But if you have, if you’re a member, you have children under age 26, they’re covered under the MDVIP plan. They have the same exact benefit as the MDVIP parent. They can call me, they can text me, they can get things done and be seen immediately. Wow. A lot of people don’t have that. No, that’s great. Yeah. A lot of people don’t have that. People not aware that there’s individualized customized medicine and they just label it concurge care because they’re familiar with the concierge services in a hotel that they give you exactly what you need. So, and then that’s really a good analogy and a good descriptor because that’s what concurge medicine is. Customized very what do you want? You know, where do you want to go? And I’m going to take you and find the right solution rather than putting you in a box and shipping you down the way. Right. And when you look at the cost versus the actual benefit, it’s no question. It’s health. Nobody wants to spend time as an inpatient in the hospital when it could have prevented could have been prevented as an outpatient in your office. Good. Lou, any wrap-up questions? I just you mentioned cost. So obviously this is a you know exclusive offering that that you have. Um what would be the difference in cost? And I I know it’s you know it probably depends on on on the patient, right? Um, but the difference in cost versus, you know, coming to you versus going to a regular physician or clinic down the road, the cost for being a member of MDVIP in my area, Orange Park, Florida, is $2,000 per year. That’s handled by MDVIP and they handle membership issues. But the question is, will you get in front of a physician right in a timely fashion without some concierge membership? And maybe, maybe not. But let me, you know, let me reframe that. So, you know, given they have the subscription fee, which actually is fairly affordable for most of the people that are watching, particularly if it’s an HSA. But after that, the costs are very similar, right? Because the insurance it’s it’s identical. Yeah, it’s identical. So, that’s really the only difference with Medicare, Medicare Advantage plans. It’s the same model, but you’re really getting immediate attention and referrals to specialists that you trust, not just whoever. Exactly. They are hand selected by me based on my three decades of experience and with them. Sounds like money well spent. It is money well spent. Absolutely. And obviously this is not just you and your office, your small clinic. This is a national it’s a national group. So it’s available all over the country. You have to go to mdvip.com and look for a doctor in your area and you’ll immediately see a list and you can again interview them, you can scrutinize them, you can look at their credentials online and you can do all these things. You can examine them if you want. The right is um the specialists are not MDBIP though. No, they may or may not be or they they’re not part of MDBIP. That’s only for a primary care model. To summarize everything we’ve talked about is that patients in America are tired of one the medical runaround, the fact that they can’t talk to someone. When people call an office, they get a recording. They get a press one, press two, call 911. if this is an emergency. That does not happen in my office. A human being picks up the phone in my office. And that’s the way I’ve modeled it for my liking. And the patients of course love it. I recommend that if this is within your means to have a concurge individualized physician at your beck and call 24 hours a day. It’s invaluable to anyone, especially if you have a problem in the middle of the night, you know. And he’s my uh poster child. He’s a poster child. Right here. That really is true. That was a minute. He texted me within the minute I texted back. No kidding. Yeah. That was quite a coincidence. All right. Well, thank you so much for coming, Dr. Al, our super CFS Lou and Anna and me. Your wealth, Dr. Jeff Camarda. Until next time. Thanks so much for watching. Smarter money matters. It really does. We’ll see you next week. Thank you so much for having me here. [Music]