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Boutique. Concierge. Express service. There are a variety of names but the end result is the same: patients pay an annual retainer, and for that money - usually between $1000 to $2000 - patients receive a variety of special services: a smaller patient base which allows for no-wait appointments, longer appointments, and quicker return phone calls. It probably can not be called a trend yet, but a number of physicians around the country have dropped Medicare and others have stopped accepting managed care. Now, this new twist is being added - personalized medical care - for a fee.