Roseanne Donahue is a healthy 58-year-old woman who has been seeing her primary care doctor twice annually for many years. But on a recent visit, the primary care doctor asked Roseanne, who is a friend of mine, to pay an additional $1,650 per year.

The doctor is making changes to her practice to focus on “wellness.” The doctor said that means she is reducing her patient load of about 1,100 patients down to just 200 or so.

Patients who are interested in continuing to see her will have to pay an annual fee to access her services. Those who don’t want to pay will have to find someone else to look after them. To facilitate that transition, Roseanne’s doctor is handing out a list of other doctors that patients might be able to switch to, and passing along their medical records.

Essentially the doctor is dismissing the vast majority of her patients from her practice.

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Some primary care doctors are offering new — or even old — services to longtime patients who pay a premium, leaving other patients to search out new doctors at a time when many are overburdened.

Roseanne asked me whether she should spend $1,650 more a year for the right to continue to see her doctor.

I asked Roseanne what extra services she might receive for that money. The doctor promises to spend more time with her, prepare a wellness plan, do comprehensive lab testing and see her on very short notice when Roseanne requests an appointment.

Patients who pay the fee will also be able to email the doctor’s office and access results electronically. They can also reach the doctor during off-hours in case of an emergency and, if she is out of town, see a replacement doctor from the same concierge system. Roseanne would have to pay extra for actual visits and any lab testing not covered by her insurance.

So why would a doctor turn away 80 percent or more of his or her patients, and then charge the remaining ones a substantial amount of money for services they should already be providing? If I were to venture a guess, I’d say it is about more money or, to be more precise, greed.

I told Roseanne, who doesn’t need a lot of attention during the course of a normal year thanks to her good health, she should not sign up for any additional “wellness plan.” She has been through the recommended tests for someone her age and everything was normal. Even if she had medical problems, I don’t think it is right to charge people extra for care and services they should already receive.

My own patients can already use an encrypted email portal to view their lab results. They can email my staff or me and make appointments online. Nearly all of them can come in with a day or two of notice when it is urgent. In case of an emergency, they can page me though the operator at our hospital 24 hours a day and, if I am not available, there is always someone covering the department who is accessible by phone or who can receive them for an office visit.

So why would a doctor turn away 80 percent or more of his or her patients, and then charge the remaining ones a substantial amount of money for services they should already be providing. If I were to venture a guess, I’d say it is about more money or, to be more precise, greed.

Proctor & Gamble’s MDVIP has signed up several local doctors to shift their medical practices toward an exclusive members only-style club, basically jettisoning patients who won’t — or can’t — pay the additional $1,650 fee.

It leads to a question: Where are such patients supposed to go after their doctor dumps them? The simple answer is that other doctors have to fill in the gap. I have accepted some of them myself.

No one has come forward with a study showing that patients who receive the special treatment end up healthier. There might be greater convenience and improved access, but the level of medical care is the same.

And this shift toward exclusiveness could have a ripple effect that undermines some people’s care. When a doctor like Roseanne’s limits his or her medical practice to make more money for the same services that many of us already provide, 900 people need to find a new doctor.

Hawaii can’t afford more doctors who cater exclusively to wealthy people at the expense of the middle class, elderly and the poor.

This new trend comes on top of private practice doctors refusing to take patients covered by Medicare, Medicaid or associated Quest health insurers, and pretty much anyone who doesn’t have insurance coverage that is good when it comes to reimbursements.

But while those doctors certainly don’t do their fair share, at least they don’t restrict their practices to a couple hundred patients and shift the burden onto the rest of us.

In a state where we already have a serious shortage, this concierge system further aggravates the problem and creates a two-tiered medical system among the insured.

People who want special services are obviously free to pay a fee, but on the medical side, it sure seems like a new way for doctors to game the system on behalf of their bottom line. I’m embarrassed that some of my colleagues would even consider it.

Any doctor given a license to practice in Hawaii should be expected to share the burden of caring for people who need it most. They don’t have to do it all the time, or even a lot of it, but they should at the very least be required to give back to the community by serving patients who don’t have the premium insurance policies that pay the most.

As for Roseanne, she is not going to pay just to retain the right to see her doctor. I will help her to find a new one because she deserves a doctor who cares more about her health and less about her pocketbook.

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