So-called boutique practices haven'tyet attracted large numbers of doctors,but the trend is growing. In these practices,physicians typically charge a relativelysmall number of high-incomepatients a large annual retainer fee inreturn for high-end medical services,such as faster access, longer appointments,and more thorough diagnostic,preventive, and wellness services thantheir health insurance or managed careplan covers. MDVIP (800-706-4384;www.mdvip.com), a boutique practicethat started from a single location inFlorida, now has 14 practices involving25 doctors in seven states. The numberof doctors nationwide who are involvedin boutique practices is estimated to bebetween 125 and 175. Critics of suchpractices charge that they create a two-tieredmedical system in which the well-offreceive first class medical care thatthe average American can't afford.