For patients looking for a more personal relationship with their doctors or struggling to navigate the complicated Duke health system, Duke Signature Care may be the right health care option—if you are able to pay the annual retention fee.

The medical care model—in its sixth year of practice at Duke—focuses on “value care,” aiming to provide its patients with a greater continuity of care. The concierge medicine model greatly reduces the number of patients a primary-care doctor sees. By paying the annual retainer of $2,500, patients at the clinic receive highly personalized care, with perks including same-day appointments and all-day accessibility to their physicians by text message.

“I think the best part of it is the one-on-one physician communication—bringing back the personal touch both for the patient and the physician involved in their care,” said Sanziana Roman, professor of surgery and member of the Duke Signature Care physician team. 

Aside from the added level of intimacy in the physician-patient relationship, however, Roman explained that the level of care is consistent with all of Duke care.

“It’s exactly like all care at Duke, which is excellent,” she said. “We don’t treat them any differently, but Duke Signature Care has that extra level of communication because the primary care physicians have the time to do what we used to do back in the day, which is to call the referring physician and talk to them about patients.”

Concierge medicine in large not-for-profit health systems is relatively rare because the service is generally offered in the context of a physician’s private practice. John Paat, a physician for Duke Signature Care, started the program at Duke after witnessing it in action at the Mayo Clinic.

“One of the things that became apparent [at the Mayo Clinic] was how much service you could do to patients through a different model of care,” Paat said. 

Duke’s concierge medicine clinic charges a much lower retainer fee compared to other hospitals that offer concierge caregiving. At Massachusetts General Hospital and Mayo Clinic, patients must pay $6,000 to have access to the service. 

Paat noted that Duke has tried to keep the costs low in order to make it more affordable for more patients. 

“The cost is probably about the same price that people pay for cable for a year, so it’s not that much of a barrier," Paat said. 

Paat—who is involved with Project Access of Durham County, which serves low-income, uninsured Durham residents who have specialty medical care needs—pointed to the relatively low cost when explaining the clinic’s huge growth since its opening. The growing demand for the service has led to a new site in South Durham, set to open within the next year.

“We continue to have a demand from patients who want that service—they just want to spend time with their physicians and have the time to talk, and I think that that’s what they really want,” Paat said. “They want to feel comfortable with their care.”

Funds received in the form of gifts from patients who support the clinic have recently been used to support a program for medical residency education, allowing medical residents to do a board review. This kind of service is not unusual among the physicians at Duke Signature Care.

“Another thing that is unique about our practice is that we have four physicians in our practice, and we all do signature care, but we also spend time in the residents clinic,” Paat said. “The bulk of the work we do is patient care, but there’s a great deal of diversity, because if you are doing full-time clinical care in a concierge medicine clinic, not only does that get boring, but you lose why you like doing so in the first place.”