Private practice models are changing how physicians provide care
By Jenny Peterson
In many ways, the independent practice model offers a return to the way medical care should be: time to talk, a physician who knows their patient’s history and the chance to look beyond whatever brought them into the office that day.
For dermatologist Fiona Rahbar, co-founder of Mara Dermatology in Mount Pleasant, it means having time to investigate skin concerns, explain treatment options thoroughly and, in a recent case, catch a melanoma that was small but deep, thanks to the extra time she was able to spend on the cancer screening exam.
Private Practice and Time for Personalized Care
“I think our current model for medicine does not set up physicians nor patients for successful outcomes,” Dr. Rahbar said.
She sees the problem as systemic, not a failure of individual doctors or patients. When appointments are rushed, patients may leave with unanswered questions, then turn to the internet for explanations that can be confusing or inaccurate. This is especially important for dermatological concerns, and Mara Dermatology is the only concierge dermatology-specific practice in the area.
At Mara Dermatology, visits can last 20 minutes for a straightforward concern or up to an hour, depending on complexity. Many high volume dermatology practices in the U.S. allot only 5-7 minutes per visit. Flexibility lets Dr. Rahbar address multiple issues in one visit, from skin cancer screenings and rashes to questions about skincare products, aesthetic procedures and long-term skin health.
The extra time can be especially critical when examining a patient’s skin for precancerous moles and spots, or determining the best aesthetic procedures in an increasingly complex landscape of therapy options.
“Finding cancer early can change your survival percentage, so it really matters,” she said. Time also gives patients a chance to understand what’s happening and why a treatment is recommended.
With skincare marketing booming and social media crowded with advice, Dr. Rahbar said patients sometimes arrive carrying bags of products and asking which ones they should use. Some may do little for the skin, while others can be harmful.
Having time to explain what works, what doesn’t, and why, can help patients make more informed choices and follow treatment plans.
Especially in our sunny Lowcountry location, year-round outdoor activities mean plenty of sun exposure. New residents may be unfamiliar to the region’s sun, while longtime residents who golf, fish, surf or spend their days outside may see signs of cumulative damage, including brown spots, fine lines and changes in pigmentation. Dr. Rahbar said the practice diagnoses skin cancers every week.
For Dr. Laura Lee Kinney, an internist at Salt Marsh Internal Medicine in West Ashley and MDVIP practitioner, private practice means longer appointments, direct communication with patients and a more proactive approach to health to learn a patient’s entire medical history. New-patient visits last an hour, follow-ups typically run 45 minutes and MDVIP wellness visits can last 90 minutes.
Knowing a patient over years can also make subtle changes easier to spot. Dr. Kinney describes how a physician who knows a patient’s usual appearance and behavior may notice when something seems off, even before the patient recognizes a problem.
“I can say, ‘Mrs. Smith doesn’t look right,’” Dr. Kinney explains. “Because I know what she has looked like over time and can notice if she’s not presenting the way I know her to be, that’s different than a doctor who sees you for eight minutes at a time.” That familiarity can prompt a closer look and help understand a new symptom in the context of the patient’s broader health.
That continuity was one reason Dr. Kinney wanted greater control over how she practiced medicine. In a traditional health system, she said, she repeatedly requested a medical scribe to help with documentation but was turned down. She often spent hours after work finishing tasks that kept her from her family. A different practice model gave her more say over staffing, scheduling and the time she could devote to patients.
MDVIP combines a membership fee with traditional insurance billing for covered services. Its wellness visits include extensive lab work and screenings that Dr. Kinney uses to evaluate risks, including cardiovascular and metabolic concerns. The results give her a starting point for discussing potential problems and developing a plan tailored to each patient.
At Mara Dermatology, patients are charged a flat fee for office visits rather than requiring a membership. Patients with traditional insurance may be able to submit a superbill for possible reimbursement. Lab work, biopsies and certain procedures may still be billed through insurance.
The spirit of independent medicine is that the relationship doesn’t end when a patient walks out the door. Dr. Rahbar said after laser treatments, her team stays in touch through texts and photos, giving patients a way to ask questions and share concerns as they recover.
For Dr. Kinney, it means having time to see the whole person, not just the problem that brought them in.
The goal is for patients to leave feeling heard, with questions answered and a clearer understanding of their care. In medicine, this extra time isn’t simply a luxury, it’s part of the care itself.
To learn more about Mara Dermatology, visit www.maradermatology.com or call 843-896-2789. To learn more about Salt Marsh Internal Medicine, visit www.saltmarshinternalmedicine.com or call 843-936-4455.
