How does this sound? - 24/7 access to your doctor, same day office visits, no waiting, more face time, and house calls. Like a nostalgic picture of medicine practiced in small town America 50 years ago? Nope. It exists today for some Americans willing and able to pay. It's called Concierge Medicine.

A new sitcom called Royal Pains, on the USA Network, will expose the medical concierge concept to the masses. Royal Pains' central character is Dr. Hank Lawson, a fictional ER doc who loses his job in a prominent New York hospital because he breaks rules to try to save a patient. While attending a ritzy party in the Hamptons, Hank brilliantly diagnoses the medical condition of one of the wealthy guests and provides lifesaving treatment on the spot. Overnight, he becomes the most sought after doc in the Hamptons social set.

Unheard of 10 years ago, concierge medical practices have grown to about 5,000 practitioners nationwide. Concierge practices are generally for the affluent but run the gamut in terms of what they charge for the privilege of membership. Perhaps the most obvious market for concierge medicine is the affluent elderly. But not necessarily, take Steven Knope, MD, for example. Dr Knope is a sports medicine internist. He's a four-time Ironman triathelete. His Tucson, AZ practice focuses on preventive medicine including a two-hour physical, nutritional analysis with a staff nutritionist, and fitness analysis with a personal trainer in his in-office gym. Dr. Knope's concierge patients pay an annual retainer of $6000 each.

The Concierge Medicine / LA practice in the Brentwood section of Los Angeles serves a wealthy clientele similar to that depicted in Royal Pains. Medical Director, Raphael Darvish MD, says that not all of his patients are wealthy. Some are just very health conscious. The practice has two other doctors in addition to Dr. Darvish serving about 1,000 patients. Memberships range from $2,000 to $10,000 annually depending on age and other factors. Concierge Medicine / LA features the presidential physical which is similar to the comprehensive physical Obama receives each year.

Concierge doctors say this style of medical practice is very rewarding to them in ways other than financial. The pace is relaxed and they get to build relationships with their patients.

Childbirth is an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results and may be doing more harm than good.

As the number one cause of hospital admissions, childbirth accounts for more than $79 billion in hospital charges alone. Pregnancy is the most expensive condition for both private insurers and Medicaid.

The financial toll of maternity care on private insurers (employers) and Medicaid (taxpayers) is huge. Maternity care therefore plays a considerable role in escalating healthcare costs, which increasingly threaten the financial stability of families, employers, and federal and state budgets.

Cesareans Out of Control

The cesarean rate in the U.S. is higher than in most other developed nations. And in spite of a standing government goal of reducing such deliveries, the U.S. has set a new record every year for more than a decade. Once reserved for cases in which the life of the baby or mother was in danger, the cesarean is now routine. The most common operation in the U.S., it is performed in 31% of births, up from 4.5% in 1965.

Among privately insured patients, uncomplicated cesareans run about $13,000. nearly twice as much as a comparable vaginal birth. Cesareans account for a disproportionate amount (45%) of delivery costs.

The problem, experts say, is that the cesarean -- delivery via uterine incision -- exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans also have been shown to increase premature births and the need for intensive care for newborns.The typical American newborn is delivered at 39 weeks, down from the full 40. Even without such complications, cesareans result in longer hospital stays.

Oxytocin Induction Adds Risk

Inducing childbirth -- bringing on or hastening labor with the drug oxytocin, also raises the risk of complications that lead to cesareans. Experts say miscalculations often result in the delivery of infants who are too young to breathe on their own.

Despite of or perhaps because of all this intervention, childbirth in the U.S. doesn't measure up. The U.S. lags behind other developed nations on key performance indicators including infant mortality and birth weight. More intervention, such as cesareans, is linked with declining outcomes, such as neonatal intensive care admissions

Informed Mothers must Fight the System

If an expectant mother has had a cesarean with her first baby, she will have a difficult time holding out for a vaginal birth with her second one. With a toddler underfoot, most mom's would opt for vaginal delivery if for no other reason than faster recovery. But finding a physician to deliver her second child by vaginal delivery will be difficult.

Most U.S. physicians discourage vaginal deliveries after a cesarean because of some widely publicized cases several years ago in which the uterus split disastrously along the prior incision. The modern C-section in the United States is the low transverse, an incision in the bottom part of the uterus, from side to side. Those heal better. All the studies say, in those types of incisions, the risk is less than 1%, probably a half percent that it will open during labor. Doctor's will insist on a C-section again for the second birth because of a 1% chance of a uterine rupture.

Over time, Cesarean births have become a profit center in many hospitals, There's a wide variation in cesarean rates among hospitals: cesareans range from 16% to 62% of births. There's no justification for that kind of variation. That means a lot of women are getting unnecessary cesareans.