Doctors Deciding to Go Home Again

Bill and Barb Pivarnik started seeing Prasse at the clinic near their home when they moved from Alexandria to Locust Grove in 2001, and they followed him when he began making house calls in July 2004. Between her diabetes, scarred lung and chronic pain disorder and his high blood pressure and arthritis, the couple have seen Prasse dozens of times at home and in the hospital. Last year, Barb Pivarnik said she had to nudge the doctor to accept an extra $140 in payment.

"He says: 'I don't want you to ever go without food or medications or anything to pay my bills. You tell me what you can afford because I don't want to deprive you of anything,' " said Pivarnik, 67, whose husband is 69. "I would have followed him to the ends of the earth."

Prasse said he has taken a pay cut, but he expects that will change eventually. He also plans to open an office so he can see patients who prefer that to a house call.

Some health care groups have expressed concern about physicians dropping out of insurance networks. Many of these doctors have begun opening "concierge" offices that can charge patients from a few-hundred dollars to $20,000 a year, said Alwyn Cassil, spokeswoman for the Center for Studying Health System Change.

"People with money can always get more stuff, so the worry about concierge medicine is that we already have a tiered medical system and this makes it worse," she said.

For Prasse's part, he is certain he is providing his patients with much better care than he used to. And he is happier, even if he works seven days a week and makes less money.

"This way, I don't feel like someone is taking advantage of me all the time," he said. "And I can control that patients no longer have to wait. I just don't have that impending feeling of doom anymore."