PICTURE OF HEALTH, THE

Business, North Carolina, Mar 2008 by Gray, Tim

Lamplight glints off the stainless-steel coffee machine, one of those high-tech models that make a mug at a time. Beside it sits a basket of bagels and muffins, each tucked in a plastic bag tied with a silver bow. A bowl of organic pears and apples, perfect as a Renoir still life, snuggles up to the baked goods. Across the room are unruffled copies of today's New York Times, Wall Street Journal and USA Today. A Bose Wave Radio murmurs nearby. A door at the back swings open, and Bobbie Wingate-Fisher presents herself. She's wearing a clingy pink sweater and matching pumps. Her knee-length skirt reveals shapely calves. Flashing a toothpaste-ad smile, the brunette appraises the two 40-something guys slouched in soft chairs. Her gaze, friendly but firm, settles on one. She wiggles her fingers in a come-hither wave, says hi and beckons him to follow. "This is not good," he thinks. "She's come to take my vital signs, and my heart's already racing."

Yes, this is a doctor's office, but, no, not a typical one. Duke Executive Health Program, a division of the university's nationally esteemed hospital, offers a level of convenience and coddling rare in today's healthcare industry. The waiting room, like nearly everything about the program, underscores a message that's straightforward but, in medicine, startling: We care about your business, and we're here to serve you. In a typical doctor's office, that notion would be shocking enough to send you into cardiac arrest. If it does so here, the folks at Executive Health want you to know you'll be whisked up the hill to Duke University Hospital, ranked eighth in the nation in cardiac care by U.S. News & World Report (see pages 61 and 62). (Listing and table omitted) "It's a way for them to practice concierge medicine," says Curtis McLaughlin, an expert in the business of medicine and emeritus professor at UNC Chapel Hill. "It's a way of maintaining relationships with a well-heeled population who'll pay a premium to see a physician who gives them lots of time."

Programs like this once were common, with the Mayo Clinic leading the way. "When my father-in-law was with Arthur Andersen, it used to be a big perk to send somebody to Mayo for a day at company expense," McLaughlin says. They lost popularity as employer-provided health insurance expanded, but now with medical centers scrapping for every dollar in their ongoing smack down with managed-care insurers, they're resurging. "If you bring in executives and they've got a leaky heart valve, where do they send them? Chances are to Duke. Imaging, orthopedic replacements and heart surgery arc the most profitable things in health care. So this is another way of capturing and servicing profitable market segments." With a full-time staff of nine, the Executive Health Program operates profitably, an unusual enough distinction in a major academic medical center, but its contribution is a pittance to an enormous operation such as Duke University Health System, with its $1.8 billion annual revenue and more than 20,000 employees.

The program's other benefits might outweigh its financial contribution, says Charles Sanders, former CEO of Glaxo Wellcome and a cardiologist by training. Sanders, who has used the service himself, points out that clients may become donors. "That's been proven at Duke with Roger Milliken and Dave Thomas." The chairman of Spartanburg, S.C.-based Milliken & Co. provided one of the testimonials on the Executive Health Web site and contributed to Duke Eye Center. The late founder of the Wendy's fast-food chain's name is found on the R. David Thomas Executive Conference Center.

I've come to Durham to learn firsthand what could make a tough textile baron like Milliken go gaga over Duke doctors. I'm the guy Wingate-Fisher summoned from the waiting room, and I'm here to find out what executives get for their money. The typical client - a man between the ages of 45 and 60 - pays $2,765 for his visit. The program doesn't take insurance, though some who come submit the bill on their own and often see some reimbursement. Others have the fee paid by their companies as a fringe benefit. Each typically gets a physical, separate diet, fitness and stress assessments and a raft of chemical and digital evaluations, including an electrocardiogram, body-fat scan, chest X-ray and multiple blood and urine tests. Like the executives, I'll devote a full day to meeting with a retinue of specialists who will assess everything from the rhythms of my heart to the soundness of my psyche. (Unlike some of them, I won't spend the night at the luxurious Washington Duke Inn, just up the road, nor squeeze in a round of golf at its Robert Trent Jones-designed course.) I'll be poked, prodded, measured and scoped to create the most complete picture of my health and physique I've ever had.

I've already had seven vials of blood drawn, and as Wingate-Fisher and I pad down the hall to the nursing station, a courier is shuttling them to a Duke lab so that I'll get the results by that afternoon. Later, he and the program's shiny silver SUV will be available in case I need a lift to the hospital to see a specialist. Even at the main hospital, Executive Health customers get VIP treatment. They often get to jump to the front of the line, instead of camping out with the common folk amid the blaring TVs and dog-eared copies of Car and Driver and Good Housekeeping. After Wingate-Fisher checks my vitals, she drops me off for an introductory chat with Kevin Waters, the program's director and one of two physicians on its staff. He gives me the rundown of the day ahead and a piece of advice: "Don't try to beat the treadmill," he says, referring to the stress test. "We get a lot of competitive guys here, and sometimes they overdo it. The treadmill always wins."