Dr. Cheruba Prabakar featured in Diablo Magazine: The Price of Personalized Care

Dr. Cheruba Prabakar was featured in Diablo Magazine discussing concierge healthcare with journalist Rachel Orvino. Read the full article here. Three excerpts featuring Dr. Prabakar and patients of Lamorinda Gynecology and Surgery are available below.

After Irene Tsatsos underwent a cesarean section while giving birth to her second son in 2014, she knew something was wrong. Aside from her post-
surgical recovery, she was experiencing constant pain. Three years of seeking help from her health-care providers in Texas brought no relief and few answers. It wasn’t until 2017, after she and her family moved to California, that a pelvic and abdominal MRI revealed she had a rare condition called nutcracker syndrome.

"It's when your left renal vein becomes compressed and causes blood to reflux into your kidney; It also causes a secondary disorder called pelvic congestion syndrome, where your body creates collateral veins," says Tsatsos, who currently lives in Orinda. She suffered from abdominal and flank pain, and doctors recommended surgical options: either an autotransplant to move the left kidney to the right side of the body or removal of the kidney entirely. Tsatsos's MRI also indicated she had endometriosis and adenomyosis.

“It was then that I realized complicated patients don't have a place in mainstream medicine. The industrial medical complex didn't work; I could not get any answers. More importantly, I couldn't get anyone to spend time with me and really plan out my care in a way that made sense," she recalls.

Tsatsos's medical journey eventually brought her to Cheruba Prabakar, M.D., an ob-gyn and founder of Lamorinda Gynecology and Surgery. The Lafayette practice provides direct-access specialty care, meaning patients pay for visits without going through their insurance. Tsatsos consulted Prabakar about treating her endometriosis and adenomyosis with a supracervical hysterectomy—allowing her to keep her healthy cervix, as opposed to the full hysterectomy recommended by her in-network gynecologist.

“I wanted a doctor who would work with me in a collaborative fashion,” says Tsatsos. “When I arrived, Dr. Prabakar spent an hour talking with me at intake. She got to know every part of me and was interested in approaching my health in a holistic way. I was blown away. Everyone should have access to this kind of care."

Does Wealth Equal Health?

Physicians such as Lafayette's Prabakar say concierge and direct-care models are still in the early stages, however, so there aren't long-term studies about clinical outcomes. “In the last year, I have diagnosed three breast cancers and one uterine cancer, all of which would have been diagnosed months later in a traditional health-care model," she adds.

Concierge medicine sparked headlines this summer thanks to a June article in The New Yorker about Sally Greenwald's concierge gynecology practice in Silicon Valley. Nicknamed the "Billionaires" Vagina Club," the practice has membership fees that exceed $30,000 a year at the highest tier.

But Prabakar says concierge gynecologic care doesn't have to come at an astronomical cost. A board-certified ob-gyn with close to 15 years of experience, she opened Lamorinda Gynecology and Surgery in 2022, with the intent of offering quality, compassionate care without the time constraints imposed by insurance dictates. “You get may be 10 minutes with your doctor, and the doctor has to see 20 to 30 patients a day to keep things going. This is often mandated by the larger corporate entities they work for," explains Prabakar. “That is not why I went to medical school. I wanted to be able to provide care in a different way.”

Physician burnout is an oft-cited reason for establishing out-of network-practices. Prabakar founded the East Bay Concierge Coalition and says many of her colleagues are tired of being "a cog in the wheel." Starting their own independent concierge practices was better than quitting medicine altogether. We want to practice medicine because we love what we do, and we have trained for many years to be good at it." she adds. "This is another avenue of making it more sustainable for us while also providing better care."

Along with Lee Christianson, M.D., Prabakar offers both membership and fee-for-service models. The Menopause Mastery Membership costs $5,200 and includes hormone therapy, nutrition guidance, weight optimization, and metabolic health support as part of the one-year program. The Concierge Circle combines Menopause Mastery benefits with all-inclusive gynecological care, such as preventive care, as-needed visits for problems, and 24/7 communication. Patients use their insurance to cover medications, including GLP-1s and hormones. The practice treats everyone from CEOs seeking access and discretion, to teenagers having their first wellness exams. “Direct care is not just for the wealthy." says Prabakar. “Aside from membership, patients can come in for an annual exam and pay a one time fee of $550. It comes down to what you value in life."

Beyond Big-Box-Store Medicine

Katie (last name withheld for privacy), a law enforcement professional who lives in Sacramento, started experiencing heavy bleeding and period pain in her early 40s. A diagnosis of fibroids and hysteroscopic myomectomy through her “big-box-store health-care system" didn't relieve her pain, so she consulted Prabakar on a friend's recommendation. The physician ended up doing a hysterectomy at a hospital in Katie's network, meaning most costs were covered by insurance. Now a member of the Concierge Cirele, Katie continues to work with Prabakar to regulate her estrogen levels. Her insurance covers some costs, and she pays for much of the rest using her flexible spending account. “I can make an appointment with Dr. P. in a week, or even a day. With the big-box stores, it's six months out to get an appointment," she says. “It’s an extra expense, just like a gym membership. If I want to feel better, that's what I have to pay."

Tsatsos considers her care costs an investment in her health. In addition to seeing Prabakar, she has a membership with Makhija. Tsatsos began working with the endocrinologist to help manage prediabetes—a condition that had to be addressed before donating her kidney, something she hoped to do after getting the organ removed to treat nutcracker syndrome.

“We’re average middle class people, so we had to redirect some finances, but it was worth it," she says. “I can see the return on investment, being able to interact with my kids and not outsource tasks like cleaning the house because I'm in too much pain to do it myself.” Tsatsos praises her PCP, who works within the John Muir Health network, but says she values the quality and access of the concierge care model. “It's not a condemnation of the health-care system that is readily available to people, but complex patients need more care," she adds.