“Old-fashioned medical care in the modern world” is how Dr. Gail O’Brien describes her primary care practice at Alliance Internal Medicine in Edgartown. She offers “concierge medicine,” and the concept is simple: The patient joins the practice for an annual fee (in addition to insurance coverage) and receives personal attention beyond what insurance typically pays for. The advantages include longer appointments, enhanced phone and e-mail access to the doctor, flexible scheduling, secure electronic access to medical records, and assistance and counseling in arranging healthcare beyond what she can provide.

Dr. O’Brien moved to Martha’s Vineyard in 2005 from Providence, seeking a better quality of life and a better place to raise her two boys. She worked at Martha’s Vineyard Hospital for two years, then began commuting to Cape Cod, where the business side of medicine began to interfere.

“The driving force behind these bigger entities is the bottom line, which is true of any business, and that’s fine...but taking care of patients and doing it right, sometimes you have to ignore the bottom line,” she says. “It began to feel like a factory, because what they did was literally count the number of patients we saw...and [they] were constantly trying to drive those numbers up, regardless of the consequences.”

Instead of a fifteen-minute appointment, she wanted to offer patients a relationship with a doctor and healthcare advocate. She opened her current Island practice in March 2011. “The main motivator was wanting to be able to do my job in a better environment, in a better way.”

Dr. O’Brien’s business experience as an administrator at a large medical center in Providence has proved very beneficial, she says, since medical schools offer no business training. Her skills allowed her to open a concierge practice without outside help, which in turn has enabled her to offer personalized medical services. Annual fees vary on a sliding scale based on age; they run in the hundreds of dollars compared to thousands of dollars typically charged by the growing number of off-Island concierge practices.

“The biggest kink is explaining it to people,” who think everything should be covered by insurance, Dr. O’Brien says.

She explains that since “managed care” became the dominant healthcare business model in the 1980s, patients have become removed from the economic realities of their care. In earlier years, patients saw their bills and could make informed choices. Now the model is driven by “payers” (the insurance companies and government programs), and lost in the process are the efficiencies the free market generates when individual consumers are empowered to make economic decisions.

Another barrier is that people believe concierge medicine to be “elitist.” But Dr. O’Brien says it is intended simply as “an alternative....There is a subset of people out there for whom this is a great choice...for people who really want more time and more advocacy from their physician.” She adds, “We save people time, and time is money.”

A person with few health issues and a busy life may prefer the convenience of concierge medicine. “[For] a lot of the business owners I take care of, it makes their lives a whole lot easier,” she says. “They can’t lose time out of work. That’s a big deal for them.” For patients with complicated healthcare issues, particularly the elderly, developing a relationship is key. Dr. O’Brien’s more detailed knowledge of each patient helps eliminate unnecessary visits. She can also expedite appointments to specialists, and cut down on the “emotional pain” that often comes from delays in diagnosis and treatment that result from getting “passed around through the system.”

Dr. O’Brien mentions one patient who had uncharacteristically e-mailed her complaining of pain. “If I didn’t know him better, I wouldn’t have understood. Just based on the way he worded his e-mail, I knew that he was really scared that there was something seriously wrong,” she says. “I was able to see him that morning.”

Offering “extra TLC, extra service, and extra attention” has been a success for both her patients and her business, Dr. O’Brien says. “What I love about this practice is that I have been able to really get to know my patients, and develop a real relationship and rapport with them.”