Nevadan at Work: Family doctor disavows insurance, turns to concierage medicine

Dr. William Pierce needed to try something new.

As a family doctor, Pierce grew tired of today’s standard care model, with its insurance-based billing practices and its big patient counts.

So six years ago, Pierce turned to concierge medicine. He no longer accepts insurance, instead billing patients directly for an annual membership that comes with routine office visits, phone consultations and on-site fills of prescriptions for antibiotics and cough medicines.

Patients even have after-hours access to Pierce via cellphone or email.

Pierce says ditching insurance lets him be the doctor he trained to be, playing a more active role in his patients’ cases: He has just 250 patients, about a tenth of the load of a traditional family practice.

Plus, freeing himself from the tangled insurance web has given Pierce time to treat patients for free at the Volunteers in Medicine of Southern Nevada Clinic at 4770 Harrison Drive. The group, which held its fifth annual charity ball at The Venetian on Saturday night, provides free medical care for the working uninsured or the unemployed.

Question: Why did you choose medicine?

Answer: It’s the stereotypical answer. It was an idealistic thing. When I was eight years old, I thought it was what I wanted to do. The career brochure looked good. In college, I got to look seriously at whether I really wanted to be a doctor, doing the rotations and seeing the lifestyle. I originally wanted to go into microvascular surgery, but I didn’t want to spend every day in the hospital. I considered emergency medicine for the variety, but I changed to family practice. I like to be my own boss, so I wanted my own practice. And I like the fact that people trust me to solve their problems at a personal level.

Question: Why did you switch to a concierge model?

Answer: For the relationship between patient and doctor. It’s what we all trained for, but no one gets to do it because of insurance. You’re catering to third parties, and their primary interest isn’t patient health, it’s profits. So you might have to make decisions for their benefit, not the patient’s. It’s a real conflict for doctors.

I got tired of working with insurance. The reimbursements were getting worse, and I knew I had to do something different. I could move, or sell vitamins and Botox, or go to a quick-care model where you spend three to five minutes with each patient. None of those appealed to me. The concierge model, with the smaller patient base, made more sense. I could get more involved with patients, which is what I was trained to do.

Question: What do you enjoy most about your work?

Answer: The relationship with my patients. Having a practice of less than 500 patients lets me get to know patients more intimately. I can do more. If a patient calls at 2 a.m., I’m in a much better position to respond than if I’m covering for colleagues and I’m guessing at how to respond.

Question: What’s the downside?

Answer: One of the things I didn’t really think about is how the volume of patients in a traditional practice helps keeps you up on experience. I go to medical conferences for continuing education, but let’s say you’re putting in stitches. In a smaller practice, you need to do that once to a few times a week, or a few times a month. In a higher-volume practice, you might do it more frequently. Or take eye care. If someone gets something in their eye, like a shred of metal, they usually go to the ER or urgent care. We may not see that kind of case very often.

Question: You also give your time to Volunteers in Medicine of Southern Nevada. How did that start?

Answer: My belief is that when doctors are well-compensated for their care, they can do things they used to do a long time ago. We would offer care to the indigent. We would offer care to the community. When you’re scrutinizing nickels and dimes, some of that additional community care dries up. A lot of doctors don’t have the time, they’re so busy seeing patients and getting paid a fraction of what they’re used to. The altruistic side doesn’t always come out.

I created this practice. I can’t look at myself in the mirror and say, “You’re not as pressed for time. Why are you not doing what medicine does when it has the opportunity to help?”

I talk to colleagues who wish they could do it, but they just don’t have the time.

Question: Any special experiences that have stuck with you?

Answer: With the volunteer clinic, it’s the gratitude of the patients. They’re great human beings who honestly appreciate the care we’re providing. It’s an enjoyable environment to work in. I don’t have to punch a clock or have a certain number of patients, so it mirrors my clinic in that I can have a relationship with the patients and spend time with them. And I don’t have overhead to worry about.

Question: What would you say has been your biggest career accomplishment?

Answer: My concierge practice, because there was no model. There was no book laid out for this. Clearly, there are problems in health care, and I’ve tried to do something about it on the national and state levels (as a member of the American Academy of Family Physicians). But it became clear I wasn’t going to get anywhere with a single voice. If I can’t make change on a bigger scale for my colleagues, what can I do for my patients, my family and myself? So creating this practice is my greatest accomplishment.

Question: What’s ahead for you career-wise?

Answer: I would be content for the remainder of my career to simply grow this practice, and grow my relationships with the patients I have and the new ones I get. I feel like I get to be the doctor in the brochure I read when I was eight years old.

Question: How will Obamacare affect your practice?

Answer: A lot of people are scared. People want to know what they need to do. A lot of people have questions about the individual mandate, so I do a lot of educating. And a lot of people have employer-based insurance, but there are so many obstacles to care that they use me to help them navigate the system. We’re all trying to interpret this.

Question: Will the law hurt your practice?

Answer: I don’t see it that way. What I prefer is that patients do something like catastrophic insurance anyway. In the scheme of health care, I’m relatively inexpensive. It’s hospitalizations and surgeries that can bankrupt people. There are some changes in health-savings account contributions that could affect the practice. We just have to educate patients and let them know the law doesn’t mean they can’t use a concierge practice.

Contact reporter Jennifer Robison at Follow @J_Robison1 on Twitter.

Business Videos
Impact of parking fees on visiting the Las Vegas Strip
There are no data showing a relationship between Strip resort and parking fees and the number of out-of-state visitors to Las Vegas. But there are data showing a relationship between Strip parking fees and the number of local visitors to the the Strip. ‘’As a local, I find myself picking hotels I visit for dinner or entertainment, based on whether they charge for parking or not,”’ said David Perisset, the owner of Exotics Racing. ‘’It is not a matter of money, more of principle.’’ A 2018 survey by the Las Vegas Global Economic Alliance found 36.9 percent of Clark County residents reported avoiding parking at Strip casinos that charge for parking. 29.1 percent reported avoiding using any services from a Strip casino that charges for parking.
MGM's sports betting deals
MGM Resorts International signed a sports betting sponsorship agreement with the NBA in July It was the first professional sports league to have official ties with a legal sports betting house. The deal came just two months after the U.S. Supreme Court overturned a law prohibiting sports betting in most states. In October, MGM became the first gaming company to sign a sports betting partnership with the NHL. In November, MGM became the first gaming company to sign a sports betting partnership with the MLB. Financial terms of Tuesday’s deal and earlier partnerships have not been announced.
Faraday puts Las Vegas land on the market
Nearly two years after Faraday Future bailed on its North Las Vegas auto factory, the company has put its land up for sale. (Michael Quine/Las Vegas Review-Journal)
El Cortez owner Kenny Epstein on running the iconic property
Kenny Epstein, owner of the El Cortez Hotel in downtown Las Vegas, talks about Jackie Gaughan mentorship and answers rumors about bodies in the basement at the mob-era casino. (K.M. Cannon/Las Vegas Review-Journal) @KMCannonPhoto
LVCVA recommends construction of underground people mover
The Las Vegas Convention and Visitors Authority announced the recommendation for an underground people mover for the convention center. The system would have the potential to expand and connect Downtown and the resort corridor all the way to McCarran. (Michael Quine/ Las Vegas Review-Journal)
LVCVA/Boring Company Press Conference
The Las Vegas Convention and Visitors Authority announced a collaboration with Elon Musk's The Boring Company to develop and operate an autonomous people mover system for the Las Vegas Convention Center District.
International Pizza Expo includes green and gluten free
The International Pizza Expo at Las Vegas Convention Center included companies focused on vegan and gluten free, and plant-based pizza boxes. (K.M. Cannon/Las Vegas Review-Journal) @KMCannonPhoto
International Pizza Expo kicks off in Las Vegas
The first day of the International Pizza Expo at Las Vegas Convention Center is everything Pizza. (K.M. Cannon/Las Vegas Review-Journal) @KMCannonPhoto
T-Mobile program aids guests with sensory needs
A program at T-Mobile Arena is designed to provide a more sensory friendly experience for guests.
Photo Booth Expo
Danielle May talks about how Simple Booth transformed her Volkswagen bus into a business.
Nevada Gaming Commission's highest fines
The highest fines assessed by the Nevada Gaming Commission, according to commission Chairman Tony Alamo: 1) Wynn Resorts Ltd., $20 million, 2019 2) CG Technology (then known as Cantor G&W Holdings), $5.5 million, 2014 3) The Mirage, $5 million ($3 million fine, $2 million compensatory payment), 2003 4) Stardust, $3 million, 1985 5) Santa Fe Station, $2.2 million ($1.5 million fine, $700,000 compensatory payment), 2005 6) Las Vegas Sands, $2 million, 2016 7) CG Technology, $1.75 million, 2018 8) CG Technology, $1.5 million (also $25,000 in escrow for underpaid patrons), 2016 9) Caesars Entertainment, $1.5 million, 2015 10) Imperial Palace, $1.5 million, 1989 11) Peppermill Casinos, $1 million, 2014
Tiny Pipe Home vs Shipping Crate
A Tiny pipe home was displayed at the International Builders Show this week in Las Vegas.
Auto repair shortage affects Las Vegas
The auto repair industry is facing a national shortage of workers.
Franchising industry booming
Experts say Las Vegas is a hotbed for the franchise industry.
Africa Love owner talks about his store in Las Vegas
Mara Diakhate, owner of Africa Love, gift and decor store, talks about his store in Las Vegas. (Bizuayehu Tesfaye/ Las Vegas Review-Journal) @bizutesfaye
Developer gets approval to build homes at Bonnie Springs
The Clark County Planning Commission has approved a plan to build 20 homes on the site of Bonnie Springs Ranch. (Michael Quine/Las Vegas Review-Journal)
Dig This opens new location In Las Vegas
Remember when you were a kid and played with construction toys in the sand box? Dig This Las Vegas has the same idea, except instead of toy bulldozers, you get to play with the real thing. (Mat Luschek/Review-Journal)
Town Square developer Jim Stuart building again in Las Vegas
Las Vegas’ real estate bubble took developers on a wild ride, something Jim Stuart knows all too well. (Las Vegas Review-Journal)
Salon opens at Veterans Village
T.H.E. Salon, owned by Nicole Christie, celebrated their opening at the Veterans Village with a ribbon cutting ceremony.
Southwest Airlines considering Las Vegas-Hawaii flights
Southwest Airlines CEO Gary Kelly says the airline is "very focused" on Hawaii. Hawaiians have a strong presence in Las Vegas.The city’s unofficial status is “Hawaii’s ninth island.” In 2018, at least 2,958 people from Hawaii moved to Nevada. Of those, 88.7 percent moved into Clark County, according to driver license surrender data. According to the Las Vegas Convention and Visitors Authority, 310,249 people came to Las Vegas from Hawaii in 2018.
Fewer Nevadans are celebrating Valentine's Day
Fewer Nevadans are celebrating Valentine's Day. About 1.2 million Nevadans are expected to celebrate this year, a 5 percent drop from 2018. A growing number of people consider Valentine’s Day over-commercialized. Others weren’t interested in the holiday or had nobody to celebrate with. But spending is expected to rise. Those who do celebrate are buying for more people. The average American is expected to spend about $162 this year for Valentine’s Day, a 57 percent jump from a decade prior. Katherine Cullen, director of industry and consumer insights at NRF
Foreclosures of mansions in Las Vegas
Las Vegas was ground zero for America's foreclosure crisis after the housing bubble burst. (Eli Segall/Las Vegas Review-Journal)
Rick Helfenbein talks about the impact of tariffs on the clothing industry
MAGIC fashion convention showcases men's clothing trends
The MAGIC fashion convention has come to Las Vegas at the Mandalay Bay Convention Center to showcase some of the hottest clothing trends for men. (Nathan Asselin/Las Vegas Review-Journal)
Allegiant Air flight attendants learn how to handle a water landing
Field instructor Ashleigh Markel talks about training prospective flight attendants for Allegiant Air getting live training with a raft for a water landing at the Heritage Park Aquatic Complex in Henderson on Monday. (John Hornberg/Las Vegas Review-Journal)
Smith & Wollensky CEO Michael Feighery speaks
Smith & Wollensky CEO Michael Feighery speaks about the new Smith & Wollensky restaurant coming to the Grand Canal Shoppes at The Venetian in Las Vegas.
Smith & Wollensky CEO Michael Feighery speaks
Smith & Wollensky CEO Michael Feighery speaks about the new Smith & Wollensky restaurant coming to the Grand Canal Shoppes at The Venetian in Las Vegas.
Smith & Wollensky CEO Michael Feighery talks about Las Vegas return
Michael Feighery, CEO of Smith & Wollensky Restaurant Group, discusses the restaurant's upcoming return to the Las Vegas Strip.
Apartments to Come to Hughes Center
Developer Eric Cohen discusses his current building project at the Hughes Center office park in Las Vegas, Thursday, Jan. 31, 2019. Caroline Brehman/Las Vegas Review-Journal
Stratosphere to rebrand to The STRAT
The Stratosphere, a 1,150-foot-tall property in Las Vegas will be renamed The STRAT Hotel, Casino and Skypod.
Home Front Page Footer Listing