Your family doctor, if you have one, is likely miserable. The Physicians Foundation found that over half of the doctors it surveyed last year rated their professional morale as somewhat or very negative. The reasons include massive patient rolls and tons of paperwork, which eat up time that doctors could be spending with patients.

Industry watchers expect pressures on physicians to grow worse. First, the number of medically uninsured people in New Mexico dropped from 23 percent in 2012, before the the implementation of the Affordable Care Act, to 13 percent in 2015, mirroring a national trend. At the same time, the Association of American Medical Colleges estimates that there will be a deficit of 90,400 physicians nationwide by 2025. A New Mexico Health Care Workforce Committee report released Oct. 1 found that New Mexico was already short 139 primary care doctors in 2016, a gap almost totally concentrated in rural areas.

In response to these converging pressures, some physicians in New Mexico have decided to scale back their operations and focus their attention on far fewer patients for higher fees. Anecdotally, it appears that about a dozen physicians in Albuquerque and Santa Fe are making their practices more exclusive, removing patients from their rolls to reserve their time and attention for those who can afford to pay for premium access to better care.

This form of care goes by a few different names, including concierge care and direct primary care. Concierge care caters to people with the means of paying for basically unlimited access to a physician. It started in affluent California and Washington neighborhoods in the mid-1990s, and today retainer fees in richer areas can reach upwards of $30,000 a year—but are usually a few grand annually. Some physicians choose not to charge retainer fees, or charge less, instead charging patients for visits, consultations and procedures directly, rather than routing payment through insurance programs. This is called direct primary care.

No institution closely tracks the number of physicians maintaining these kinds of practices. A report by the Government Accountability Office from 2005 only surveyed 112 concierge doctors; the trade publication Concierge Medicine Today estimates there are 6,000 to 12,000 doctors that do concierge and similar practices across the country today. The Physicians Foundation reported that 8.8 percent of doctors it surveyed last year planned to transition to concierge, up over the past five years.

One physician in Albuquerque, who asked to remain anonymous so as not to attract attention from the insurance companies he works with, says the number of physicians slicing down their patient numbers there has roughly doubled since 2011, from about five to 10. Some of them meet for lunch every month or so to talk shop.

"My full practice was somewhere between 2,000 and 2,500 [patients]. Now I see 275," says the physician, who went concierge six years ago. The doctor charges individual patients a retainer fee of $1,350, and says that's reduced the pressure to see as many patients as possible so as to receive higher reimbursements from insurers. "I greet my patients at the door. They have access to my office phone, cell phone, home phone, fax and text, and they have a longer amount of time with me. I feel like my practice is relationship-based now."

The fewer doctors who are willing to treat everybody equally, the more pressure there is for those who do. The Physicians Foundation estimates that doctors who make the transition to concierge care typically maintain only about 25 percent of their patients, and warns that the "widespread adoption of concierge medicine would have a negative effect on patient access to physicians."

Dr. Heather Brislen, who runs a "membership-based primary care clinic" in Albuquerque, sees about 100 patients right now with plans to reach 250. Each patient pays her a $1,500 retainer for a year of access.

"I can't work in a model where I have 2,500 [patients] and feel like I'm doing a good job," she tells SFR. "There were people that I worked with and respected who felt I left my position in the trenches to do this thing that's relatively easy."

SFR confirmed at least four Santa Fe physicians who currently offer concierge care, including Doctors Tom Kravitz, Lee Levin, Eric Grasser and Alan Rogers. Only Dr. Rogers answered our request for comment. He says he is “not strictly” a concierge doctor because he does not charge his patients retainer fees. He also does not accept insurance in a county where 85 percent have medical insurance, although patients can receive reimbursements from their insurers. A 60-minute appointment in his office is $300, with each 15-minute interval thereafter running for $75.

"What I wanted to do was simply not take insurance and opt out of Medicare," says Rogers, who says he was encouraged to start a concierge practice by former Christus St. Vincent CEO Alex Valdez. "I would say there's a market for what I do in the community.  There's certainly a population of people who have the means to access care however they might want to get it. And there are other people of modest means looking for a certain something from their health care that they can't find in the system."

Jerry Harrison, the executive director of New Mexico Health Resources, says there are bigger threats to patient access to physicians, including an aging physician class (News: "Grayed Anatomy," July 19) without a corresponding number of younger ones to replace them. But he acknowledges that it wouldn't help the situation if more doctors decided to treat fewer patients.

"When you've got nearly half the state on Medicaid," Harrison says, "those folks are not going to be able to have the disposable income to buy in."