Doctors dare to be different

Dr. Bruce Nitsche is a primary care doctor who is returning to the “old ways.” - RYAN SCHIERLING/Staff Photo
Dr. Bruce Nitsche is a primary care doctor who is returning to the “old ways.”
— image credit: RYAN SCHIERLING/Staff Photo

You walk into the doctor’s office, and the receptionist greets you by name, and offers you coffee or hot chocolate.

The magazines are current, but you don’t have time to begin reading them, because the doctor is waiting for you.

If you have a question, you can call the doctor at the office, or at home, including nights and weekends.

“This is like practicing medicine the old way, but with access to this unbelievable new technology,” said Dr. Bruce Nitsche about his practice at the Lewis and John Dare Center at Virginia Mason’s Winslow clinic.

The Dare Center, staffed by Nitsche and Dr. Greg Keyes, offers personalized medical service reminiscent of the Norman Rockwell era – or at least, fantasies of that era.

“Patients have my direct telephone number and my cell phone number,” Nitsche said. “They can call at any hour, and with the switching technology that is available, they can find me wherever I am. I had a patient who was scared and called me at 3 a.m.”

Nitsche and Keyes are primary-care doctors, who refer patients to specialists as needed. They can offer the level of service they do because their patient load is only about 10 percent of what their colleagues normally carry.

“We have a maximum of 300 patients each,” Nitsche said, compared to the 2,000 to 3,000 patient load most primary-care physicians carry today. “I’m at about 250 right now, and we’re paying close attention to make sure we can maintain our level of service.”

Not surprisingly, personalized service costs money. Dare Center patients pay annual subscription fees of $3,000 for an individual, $5,000 for a couple and $6,000 for a family of four, with an additional $500 for each extra child.

Subscribers must keep their insurance coverage.

“The subscription fee pays for service, not for care,” Nitsche said.

Nor do they claim that their subscribers buy a superior level of care.

“There is no difference in the quality of care, particularly critical care,” he said. “The difference is in the level of satisfaction.”

The Dare Center has become more visible since taking over the small building on the corner of Ericksen Avenue and Winslow Way formerly occupied by P.A.W.S. last November. But the Center is hardly brand new. Nitsche opened the Bainbridge Dare Center in January of 2000 in the basement of the clinic building.

The Dare option was a response to demands from patients frustrated by the present medical system, which Nitsche calls the “ten-minute doctor” paradigm.

“Virginia Mason asked patients where their frustrations were and what they were looking for, then decided to provide this service,” Nitsche said. “A number of other groups in Seattle provided this kind of practice, and Virginia Mason began losing patients.”

Virginia Mason began the Dare Center program on Bainbridge Island, Nitsche said, because a number of Bainbridge patients, including a number of his patients, had expressed interest.

When he transitioned into the new practice, he invited all of his roughly 2,500 patients to join him. Some 10 percent did.

The remainder were not left in the lurch, he said.

“They don’t get a letter saying find another doctor,” he said. “Virginia Mason recruited a doctor to replace me, so there was no change in the level of care,” he said.

“Anytime a doctor changes practices or retires, there is some disappointment, but a lot of patients who had been with me for a long time saw the patient volumes increasing, and understood.”

Those high patient volumes, demanded by today’s medical economics, rule out some of the services the Dare Center can offer – things like accompanying patients to consultations with specialists, and even making occasional house calls.

“There are limits on what we can do,” he said. “We ask our patients to look at what they are asking, then ask whether if 200 people need it, could we do it.”

Nitsche likes what he calls “the positive energy” in the Dare Center environment among physicians, staff and patients. And while he said the Dare Center is a profitable enterprise for Virginia Mason, his salary hasn’t changed much since he switched from his high-volume practice.

“I probably work more hours now, though,” he said.

Patient satisfaction is also high, he said, with only about a 4 percent patient loss despite the challenging economic times.

Patients are attracted to the Dare Center for a variety of reasons, Nitsche said. Some adult children enroll so they can keep informed about the condition of elderly parents. Some patients simply want more attention from the doctor. And those who travel extensively, or spend part of the year elsewhere, have also found the service useful.

“It’s sort of like having a doctor they can carry with them to all different spots,” Nitsche said.

However, fears that the Dare Center is going to become the standard for health care – a standard not all can afford – are unfounded, he said.

“This will always be for a small percentage of people,” he said “My own family doesn’t come here – they go next door to the main Winslow clinic.”

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