Robert Schiff, an internist at Pali Momi Medical Center, will cut his primary care practice by about 80 percent in June to focus on the 500 patients willing to pay extra for more personalized care.

Schiff, who has been a primary care physician for 28 years and has about 2,500 patients, is among the first Hawaii doctors to shift away from conventional primary care to what is known as "concierge medicine," where a smaller number of patients pay an annual fee — usually between $1,500 and $1,800 — for better access to their physician.

Concierge medicine is gaining momentum nationwide. Patients who can afford it are treated to unhurried office visits and individualized wellness plans.

The annual fee is not covered by health insurance.

Proponents say it is a way for doctors to spend more time with patients and help them prevent the onset of disease, rather than simply treating illness.

"I got to a point where I just felt the amount of time I had to spend with them (patients) and my ability to evaluate their problems wasn’t enough to really address their health care needs," said Schiff. "I’ve been looking for different venues to see how I could improve care."

But the shift to a pay-for-access model might come with "a lot of unintended consequences," including exacerbating an already severe shortage of primary care doctors and reducing access to care, according to Jay Maddock, director of the University of Hawaii’s Office of Public Health Studies.

"If doctors see this as a way to have a less rushed practice and more secure incomes, I think that’s great, but you’re going to have a lot of people who aren’t able to access and afford the care," Maddock said. "It’s good for physicians, but it may not be great for the public. Our health care system should address (wellness and prevention) for everybody. When you don’t, you’re going to see the gap widen between the rich and poor in life expectancy."

The concierge model has worked well in places where people have universal access to health care, Maddock said.

"When we see health care work well, it’s … when everybody has equal access to care," Maddock said. "It works well in places where everyone has basic access and can pay extra for more concierge services, but you’re not leaving behind that population who are unable to pay. Infectious disease is an equal population disease where if you’re not treating people, transmission is going to hit people with or without care. It’s going to challenge some of the population and put a bigger stress on the health care system than we already have."

Schiff recently signed on with Florida-based MDVIP, whose doctors are required to reduce their practices to no more than 600 patients to provide personalized care — from exercising to grocery shopping with patients to educate them on how to make good choices and live healthier lifestyles.

His 10-minute routine office visits will increase to a minimum of 30 minutes and give him more time to get to the root of a symptom.

"That’s a dramatic difference that’ll give me the time to spend with people to really address all of their aspects of health care," Schiff said. "When you don’t have a lot of time, you tend to be a lot more didactic. You don’t necessarily get a chance to partner with them."

This alternative to traditional medicine that goes beyond simply treating illness has resulted in better patient outcomes and fewer hospital readmissions, according to Mark Murrison, MDVIP’s president of marketing and innovation.

"It’s about transformation," he said. "The whole history of health care has been a reactive approach waiting for people to become sick before there is intervention. This hasn’t changed for thousands of years."

Mark Kimbrell, who practices primary care in Kailua, is considering switching to the pay-for-access model, also known as direct care, after years of shuffling patients through a "volume-based practice." He has roughly 1,500 patients and recently sent out a letter asking whether they would buy in to this program.

"The idea is to try to create a practice where you don’t feel volume-driven, you feel quality-driven and have time to listen to what patients have to say, provide them with the answers they’re seeking and deserve, and address some issues you may not have time to address in a volume-driven practice," he said.

Kimbrell, who said he brings home less than $100,000 after expenses and before taxes, is exploring the possibility of a gradual move to concierge medicine, which would ultimately shrink his practice to 600 patients over several years.

He believes that any shortage of primary care doctors due to the reduction of patients would be short-lived.

"If you create a different model that’s more attractive to physicians graduating from medical school, then more physicians will go into primary care," he said. "They don’t want to be nonstop rushed."

Nuuanu resident Ken Luckey, 62, and his wife, Mary, 59, have agreed to pay an annual combined fee of $3,200 to continue as patients of Schiff, who has been treating them for 30 years, particularly because of their strong belief in preventive medicine.

"As soon as I heard it, I bought into it — it made so much sense to do," Ken Luckey said. "It’s about time they started doing this kind of stuff. If you can prevent getting a disease and tearing your body apart, you should embrace it, rather than wait until your body starts falling apart. It’s quality of life."