"Before, I was treading water," Neibaur said. "I (now) feel very upbeat and very rewarded with what I do."

Neibaur is one of a dozen Las Vegas internal medicine doctors who have signed up with MDVIP, a medical practice business model that sets limits on patient loads, requires patients to pay a $1,500 annual membership fee - per adult - and focuses its care on wellness and prevention.

Most MDVIP-affiliated physicians make room for 10 percent of patients who don't participate in the program (and don't pay the fee) because they can't afford it, said Nancy Udell, MDVIP spokeswoman.

Rhonda Montgomery talks with Dr. Mavis Matsumoto during an office visit. Matsumoto, who has practiced medicine in Las Vegas for 11 years, is transitioning to a concierge practice. SAM MORRIS / STAFF PHOTOGRAPHER

Every year, patients are offered a comprehensive physical as part of their membership.

Doctor visits run about 30 minutes, and time spent in the waiting room is greatly reduced, doctors in the program said.

"We can see subtle changes (in patients) on a yearly basis," Neibaur said.

Nearly all of Neibaur's 600 patients are referred to him by other patients, he said. His patients are a mix of 50- to 60-year-old executives, Medicare beneficiaries and families - folks who want the convenience and increased accessibility of a doctor with a smaller patient load.

"It fits a lot of patient's needs," he said.

Neibaur debunked the perception that MDVIP practices are elitist.

"I have patients from every walk of life," he said, adding his patients include bus drivers and retired civil servants.

"It's not a practice for the elite and the rich," he said.

Neibaur's partner, Dr. William Schofield, also has about 600 patients.

Although there is some patient turnover, Neibaur said he has a 95 percent retention rate.

Neibaur sees about 15 patients daily, a far cry from the two dozen patients he took care of daily before he switched his practice.

"You have a higher sense of obligation to patients than before," Neibaur said. "In some ways, it's more challenging."

Long waits and short visits can be frustrating not only to the patient but also the doctor, Neibaur said.

Neibaur usually works 8 a.m. to 6 p.m.

"It's still a long day, but it's a rewarding day," he said.

"Things have gone wonderfully in the past year," Neibaur said. "I'm still happy with the decision I made. We're not reinventing medicine, but hopefully we're coming back to the way medicine used to be, but with technology."

MDVIP has signed 200 doctors and serves 65,000 patients nationwide, said Dr. Edward Goldman, its chief executive. In the past year, the number of MDVIP doctors has doubled in Las Vegas. The number could be even higher, but MDVIP only signs agreements with doctors it considers top-notch, he said.

MDVIP is considering seven Las Vegas doctors now, he said. Eight out of 10 doctors who apply are turned down, Goldman said.

"We think we will expand it as time goes on," he said. "For the time being, we're looking for the best and the brightest."

Larry Matheis, executive director of the Nevada State Medical Association said that with 2 percent to 5 percent of doctors in the concierge market, it isn't a major part of the health care system.

Although he understands that both doctors and patients are attracted to the model, he said there are some concerns about patients who need specialty care or have multiple health problems.

Those patients would have to be referred outside the system, he said.

"It's very difficult under that model," Matheis said, adding that "it's an alternative and it's very attractive to someone frustrated with the system."

Goldman said the company's focus on wellness and prevention is considered a selling point to patients.

"Patients are seeing an advantage in being proactive in terms of their own health," he said, instead of waiting until symptoms appear.

He used an analogy of a pilot flying an aircraft at high altitude when a mechanical problem occurs.

"How much better to check it (before), to stop it from happening at 30,000 feet," he said.

Wellness and preventive care cuts visits to emergency rooms by 50 percent, he said, and MDVIP doctors have 80 percent fewer hospital admissions.

A typical doctor's income is modest, at best, Goldman said, while the quality and prestige of their profession has declined.

"I think there's a crisis nobody is really talking about," he said. "The best doctors are getting out of their careers early. (Doctors can) get off this treadmill and have an opportunity to earn a better living."

The majority of MDVIP doctors do make more money, Neibaur said, including himself.

Udell said the company doesn't disclose details of contracts with physicians, but according to an article in the New York Times, it retains $500 per patient for its services. After deducting that fee from the $1,500 per adult membership, a doctor with 600 paying members stands to make $600,000 per year, in addition to insurance and Medicare reimbursements for services not included in the membership fee.

Some nonconcierce doctors, especially those who elect to see an even smaller patient load, could be operating at a loss, Neibaur said.

"It's not a major motivator to make more money," he said. "It's to have a better satisfaction."

Dr. Mavis Matsumoto is one of those physicians who has elected to keep her patient load at 400, at least while she develops her new practice. Over the past four months, she has been transitioning her practice to the MDVIP model.

"I'm very excited to be having a new practice and spending more time with my patients," she said. "But I'm having to say goodbye to 1,600 (leaving patients)."

So far, Matsumoto, who has practiced medicine in Las Vegas for 11 years, has signed up 200 patients, 90 percent of whom are from her original practice. The rest came via word of mouth, she said. Her staff includes a medical assistant and a registered nurse.

"Patients are liking that they can get in the same day," she said. "Everyone is a lot more relaxed. I'm able to sit down with patients. Appointments can be as long as they want them to be."

Her advice to doctors thinking of incorporating the MDVIP model?

"It's something not to be thought of lightly," Matsumoto said. "It's a big change to how we practice medicine currently."

Nicole Lucht covers health care, workplace and banking issues for In Business Las Vegas and its sister publication, the Las Vegas Sun. She can be reached at (702) 259-8832 or nicole.lucht@lasvegassun.com.