Boutique Docs Set Up Shops

doctor house call
In Knoxville, Tennessee, Dr. Bryan Smith and registered nurse Pam Williams are trying to practice modern medicine -- the old fashioned way.

Together they are "Doctor at Your Door" -- one of a growing number of boutique medical practices. For an annual fee of $1,100 Smith and Williams will treat you in your home, reports CBS News Correspondent Elizabeth Kaledin.

They make office calls; they're available 24-7. And there's no voice mail. They forward their landlines to their cell phones when they're out on a call. And they carry a back-up phone in case the first one dies.

They have no staff, minimal overhead, and most important, they don't accept Medicare -- or insurance.

"I felt like the insurance companies were practicing medicine," Smith explained.

Before starting "Doctor at your Door," Smith was ready to quit medicine altogether. He said he was going broke.

"I would end up hiring two or three people in the back just to work the insurance. And then we would only get back 40 percent of what we billed."

Doctors across the country are experiencing the same frustrations as Bryan Smith.

"Physicians will be paid in 2005 less than they made in 1991," said Dr. Donald Palmisano, of the American Medical Association.

That -- along with a 40 percent increase in overhead means many doctors are looking for a new job.

"We have a crisis throughout the nation. Twelve states are in crisis right now," Palmisano said.

One of those states is Mississippi, where escalating costs and falling reimbursements mean more and more doctors are abandoning the state -- and their practices altogether.

Determined not to hang up his stethoscope, Dr. Todd Coulter is trying an experiment of his own. At his small family practice in Ocean Springs, he has also sworn off insurance and charges $40 dollars cash per visit.

"When we stopped taking insurance our overhead dropped immediately by $2,800 a month. Just dropped," he told Kaledin.

Rejecting that third party has allowed Coulter to limit expenses while increasing the quantity and quality of time he gets to spend with his patients.

"I'm not under a time table. It's not like I'm working for Kaiser Permanent and I've got to see 50 people by lunch time," he said.

There are no forms to fill out, no waiting for basic care. The patient is happy. And the doctor is staying in business carving out a nice living.