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Reitz, like any patient of Dr. Philip Henjum, can get a same-day appointment because Henjum and his partner, Dr. Robert Fields, practice retainer medicine in their Olney office.

Their patients pay a $1,500 annual retainer fee to see them as soon and as many times as they need to. They also make house calls.

As it turned out, Henjum diagnosed Reitz with Lyme disease, an infection from a tick bite, and prescribed antibiotics. If not diagnosed and treated early, Lyme disease can lead to severe headaches, muscle pain and serious heart problems.

Fields and Henjum are two of about a dozen doctors in Maryland and an estimated 600 nationally who won’t take insurance coverage. Instead, they charge a yearly or monthly retainer. Some work out of comfortable medical office such as Fields and Henjum, next to Montgomery General Hospital.

Others, such as Norm Balog, an osteopath, work out of their homes. Balog is a family doctor in Silver Spring whose entire retainer practice, called Doc at Your Door, is based on making house calls.

After retiring from the Army, Balog grew tired of working as a civilian doctor in a Fort Meade clinic. He now calls himself an old country doctor.

‘‘I am the guy who gets into the horse and carriage to see people in their home, the environment they are comfortable in,” he said.

AMA: It started in Seattle

Retainer practices — also called concierge, boutique or just plain old-fashioned medicine — began in Seattle in 1996, according to the American Medical Association. Physicians who convert to retainer practices say it solves many problems of primary care.

‘‘The relationship has changed in medicine between the physician and patient,” Balog said. ‘‘It is no longer between the patient and the physician. It is between the patient and the insurance company or third-party payer.”

He said he began Doc at Your Door because ‘‘there was no longer continuity in patient care.”

Martin Wasserman, director of the Maryland State Medical Society of 6,500 physicians, said low insurance payments are driving doctors to seek alternatives.

‘‘Physicians are not getting adequate reimbursements, so retainer medicine is a decision by the doctor and is a new business model,” Wasserman said. Doctors in Maryland receive some of the nation’s lowest insurance reimbursements.

He called retainer practices in Maryland ‘‘a relatively new trend. I think it is probably still in an upsweep, gaining momentum as established physicians with a set clientele would go for it first.”

Critics of retainer medicine say it provides better care for people who can afford it, but does not help those who can’t afford the fee, plus additional costs for diagnostics or surgeries.

Most retainer physicians charge less than $2,000 a year, which includes one full physical exam. At the high end, physicians in the MD2 network in Seattle charge $13,200 per adult and $20,000 per couple for services in spa-like settings, complete with monogrammed robes, slippers and sweat suits.

But other retainer practices are less opulent.

‘‘I loathe the terms concierge or boutique practices because it sounds elitist,” Fields said. ‘‘I feel this is about being an old-fashioned doctor.”

Fields said he makes about 100 house calls a year.

‘‘I charge $1,500 a year,” he said. ‘‘It is the price of a pack of cigarettes a day, or a Starbucks coffee. I set this up to serve the mailman, the grocery checker or the housekeeper. It should help the middle class.”

‘A primary care problem’

Most family doctors will convert to a retainer-type practice within the next 15 or 20 years, said Dr. Christopher Ewin, president of the nonprofit Society for Innovative Medical Practice Design in Fort Worth, Texas.

‘‘We believe that there is a primary care problem in this country,” said Ewin, a primary care physician. ‘‘We have been working for the wrong employer for way too long — the insurance companies and the government.”

Ewin’s retainer practice, he said, reduces the cost of an MRI from about $1,500 to $500. Laboratory blood analysis that would normally cost $300 through insurance costs $33.

Despite the benefits of retainer practices, Walter J. Cherniak Jr. a spokesman for Aetna, the nation’s third-largest health insurer, downplayed the magnitude of the trend.

‘‘We don’t take a position on it,” Cherniak said. ‘‘But, in the larger context, we have 774,000 health care providers with the great majority of them as doctors. We also have 4,400 hospitals as members.”

Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a national association of nearly 1,300 insurers, said physicians refusing insurance usually is not a concern to insurers.

However, it does become an issue if a ‘‘boutique doctor” still wants to accept insurance, she said. The physicians must ensure they adhere to the rules of the insurer’s agreement.

The AMA has no problem with retainer medicine.

‘‘Retainer practice is consistent with longstanding AMA policy in support of pluralism in the delivery and financing of health care, as well as with policy in support of the right of physicians to freely enter into private contracts with their patients,” the association said in a 2002 study.