Jan. 08, 2001 -- Nestled between two ridges of the Allegheny Mountains in West Virginia sits The Greenbrier, a grand, historic resort. With its three picture-perfect golf courses, The Greenbrier's 6,500 acres in White Sulphur Springs have served for decades as a sumptuous playground for presidents, movie stars, and royalty.
But for the past 52 years, those seeking to be pampered by more than designer rooms and haute cuisine also have flocked there for its renowned Greenbrier Clinic, with its comprehensive, leave-no-stone-unturned, two-day physical examination.
During the 1950s and 1960s, the captains of industry and other well-heeled Americans looking for the best head-to-toe physical began the trend by heading either for the Greenbrier or the Mayo Clinic in Minnesota. More recently, as times and the U.S. healthcare system have become less personal, the demand for efficient yet high-quality physical programs has only increased. So have the number of facilities.
In particular, more corporations are recognizing the value of their executives and starting to offer in-depth physicals as a perk. "It's a matter of financial impact and what the effect of the loss of a key executive has on a company," says James R. Clapp, MD, director of the Duke Executive Health Program in Durham, N.C. "It's an investment, really -- a cost-effective investment."
Today, anyone seeking an encyclopedic physical can chose from an impressive list of elite medical institutions including Duke, the Mayo Clinic, the Cleveland Clinic, Scripps Medical Center in La Jolla, Calif., and Baltimore's Johns Hopkins. Each has a daylong, all-encompassing evaluation, complete with plenty of physician/patient contact and immediate consultation with a specialist should a problem be discovered.
Such attention doesn't come cheap. While your insurance may pick up some costs, be prepared to pay four figures for the extras.
For example, among the heart studies done at The Greenbrier is a test from California's Berkeley Heart Lab, considered one of the foremost cardiovascular diagnostic laboratories in the country. This test searches for an excess of lipoprotein (a), a condition that has been associated with clogged carotid arteries. The Greenbrier physical also includes a heart fluoroscope, a test that can detect plaque buildup in the arteries.
Thomas F. Mann, MD, a Greenbrier staff physician, says the most common reaction he gets from local doctors is that the testing ordered by Greenbrier doctors is an unnecessary extravagance. He counters that those tests help him find things others would miss.
"We get to spend more time with patients, and we find things," says Mann, who specializes in internal medicine and lipid disorders. "It's not that I'm smarter. I'm just set up to figure stuff out."
That extra time, proponents say, is the main difference between an executive physical and the examination many other doctors give. In today's medicine, most doctors are seeing more patients and spending less time with each one. Physicians in executive programs say they see no more than six patients a day.
The typical "executive" physical begins with the doctor taking a detailed medical history that can last from 30 to 60 minutes. The core of every physical is a battery of blood chemistry and hematology tests. There is a thorough hands-on examination. Other standard tests include a chest X-ray, hearing and vision testing, pulmonary (lung) function, electrocardiogram, urinalysis, and nutritional and lifestyle consultations.
Men aged 50 and over receive an exercise stress test, and either a flexible sigmoidoscope (a test where a scope is used to look at the colon to look for suspicious lesions), or simpler colon cancer screening like the fecal occult blood test. Some clinics offer a fitness assessment as part of the standard package. Women, who represent a growing number of patients, receive the same core group of tests plus a gynecological examination if they choose one, a Pap smear, and mammogram. In addition, the Scripps Center makes bone density scanning, pelvic ultrasound, hormone panels (tests to measure levels of different hormones in the body), and a cancer antigen blood test available to all its female patients.
Most examinations end with the physician spending another 30 to 60 minutes reviewing test results and making recommendations. A written report usually follows in 10 days.
Among the best known programs are:
- The Mayo Clinic's Executive Health Program. Its physicians see 3,000 people a year, approximately four patients per doctor per day. So getting an appointment at the 30-year-old clinic is like trying to get dinner reservations at the hottest new restaurant in town -- you can get them, but you're going to wait a few months to get in.
- The 31-year-old Center for Corporate Health at the Cleveland Clinic. It also sees about 3,000 people a year.
- The Scripps Center for Executive Health. It sees 1,500 patients a year, with a staff that includes internists, gastroenterologists, and cardiologists. Along with the typical tests, lifestyle counseling comes as part of the package. It includes a visit with the clinic's mind/body counselor. (Hey, it's California.)
- Duke's Center for Living. Started in 1992, nutrition and fitness assessments come as part of the basic package there. While most procedures are done at the 30-acre center, patients needing a sigmoidoscope or mammogram are taken by van to the Duke Medical Center a mile away.
- The five-year-old Executive Health Program at Johns Hopkins. This one gives each patient a personal representative who escorts him or her around the medical center. The representative's job is to make sure that patients find doctors' offices and are seen on schedule.
- The Manhattan-based Executive Health Group. A stand-alone clinic founded in 1913 as the Life Extension Institute, the group has been extolling the benefits of not smoking, healthy diet, and exercise for almost a century. EHG has staff physicians at its offices in Manhattan and Chicago, and sites in New Jersey and Connecticut. Specialists, such as cardiologists, are under contract. Along with its three main locations, EHG also has a 900-member nationwide provider network. A standard examination, including a sigmoidoscope and stress test, takes about four hours.
- The Greenbrier Clinic. Opened in 1948 with four staff physicians, today it has a staff of board-certified physicians (including radiology and cardiology) and sees between 2,000 and 3,000 patients a year -- about 27 patients a day.
Bob Calandra is a freelance writer whose work has appeared in several magazines including People and Life. He lives in Glenside, Pa.