As the months go on, a trickle of doctors are making the switch - either with the help of a management service called MDVIP or on their own.

The services charge yearly fees to ensure no waiting times, plus long visits with their physicians and 24-hour access in the case of an emergency. The less packed their schedules are, the better health care works for the patients, the theory goes.

But is it working for the doctors?

So far, doctors say yes. According to a couple of practices, patient limits filled up more quickly than expected, and they feel more comfortable about their work.

"It's very fulfilling for us. We really enjoy this style of practice," said Dr. Russell Neibaur, also speaking for his partner, Dr. William Schofield. The two see patients near St. Rose de Lima Hospital, and they were the first in the valley to sign onto MDVIP's service.

MDVIP, based in Boca Raton, Fla., has 11 physicians in the Las Vegas area who pay the company one-third of patient fees for services like electronic medical records setup and patient Web sites. Others, like Dr. Corey Brown in Las Vegas, do it themselves.

Nationally, the Society for Innovative Medical Practice Design - the association for such practices - guesses there are between 300 to 500 clinics in this style.

It's easy to see why doctors continue to adopt the systems.

Neibaur and Schofield have practiced under the name Concierge Care Physicians since September 2005. Before they each had 2,400 patients, and "we were literally burning out," Neibaur said.

After the first year, more than 95 percent of patients agreed to stay on, paying the yearly $1,500 fee again. Neibaur has reached the 600-patient maximum; Schofield has a few spots open.

Currently the doctors are making more money than they did before, when they scraped by with low reimbursement rates and growing malpractice premiums.

The workload has not lessened, but the rushing has. They had to remember to return from lunch on time, every time. Neibaur said he at first stopped going to see movies, for fear the phone would ring during the best part.

"But I go to movies now," he said. "It's happened occasionally but the general rule is we don't get called often at night anymore." Instead, people tend to wait until the next morning, he said.

Brown opened his concierge practice on Dec. 1 and is downsizing from 2,000 patients to 500. Brown's story is different: As the owner of a group of clinics, Fremont Medical Centers, he could send extra patients to the doctors who work for him.

Greg Griffin, chief executive of Fremont Medical Centers, said he presented Brown with the research on how to set up a concierge service. The decision was easy because Brown had not been comfortable rushing through patients.

"He's almost full," Griffin said, though he did not want to make specifics public because of competition with MDVIP. "Actually I expected it to take a little longer. I did not expect it to take two months (from the start of signups) for him to be almost full."

Brown charges $3,000 per year, a fee that Griffin said patients pay because "he's really popular ¦ patients do adore him."

The format may have been easy choices to the physicians, but it involved some risk (What if not enough people sign up?) and some touchy moments (How do you dump the majority of your patients?).

Brown's decision to switch was the subject of a local newscast, featuring a woman who was angry because she could not afford the fee.

"It was hard to go up against," Griffin said. But he knew many of the patients wanted the concierge-type service, and he posed the question: What if Dr. Brown had retired instead?

According to Neibaur, the decision to switch was a "soul-searching event."

There are many patients you know will not be coming with you to the new style," he said. "You feel obligation to know those people are being taken care of." MDVIP's service included finding doctors for those, though.

Criticism from academics and others in the medical industry say that concierge practices are too elitist and had the potential to harm the Medicare system. Those accusations warranted a report in August 2005 by the U.S. Government Accountability Office, but that report found the sub-industry was too small to affect health care in a national way. The office did promise to keep an eye on the phenomena.

The perception bothers Neibaur. Even though his practice put the word "concierge" in the name, he now balks at the characterization.

"Honestly speaking we think that sounds like it's really elite, and we don't feel like it's an elite practice," he said. "We feel the $1,500 fee we charge is in grasp of most people. We do have a lot of patients in our practice who are not wealthy - middle income, hard-working schoolteachers and civil servants."

But on principle, a few insurance companies are protesting the trend by refusing to offer coverage for routine services.

"We've had a couple that said they were going to cancel just Dr. Brown's participation (but not Fremont Medical Center's)," Griffin said. "They feel you're discriminating by ability to pay."

Anthem Blue Cross Blue Shield is one insurer that cancels contracts with doctors who go 100 percent concierge. "It goes against the philosophy of having health insurance and having access to a network," said Janet Pogar, director of network management for the company, which covers Colorado and Nevada.

"About 85 percent of the insurers across the nation embrace our model of this. About 15 percent have difficulty with it," said Dr. Ed Goldman, founder of MDVIP, in a telephone interview from Florida. "What we have told them is: What we are doing is what they're not doing. We are truly doing preventive services."

MDVIP, as any new business that has created a nationwide trend would, plans to grow. It sees great opportunity in the Las Vegas market, Goldman said.

"You're service-oriented, so everyone is busy, and they're in environments that really challenge prevention, like smoke-filled environments," he said. "We think there is a growing population there, with a growing need."

Besides contacting doctors, the firm will also recruit employers to pay the fees for their executives or entire workforce. The 6-year-old company has recruited companies nationally, but so far none has signed on in Las Vegas.

According to Neibaur, who has practiced locally for 20 years, the niche market has great potential to grow.

"This product is becoming more and more known in the public sector," he said. "What I've found in the past year is people joining my practice, not particularly looking for me as a physician, but looking for this type of practice."