Dr. Pamila Brar examines patient Louise McCabe Friday in San Diego. Brar, a internal medicine specialist, is one of a growing number of local physicians practicing concierge medicine.

Paying extra for better access to a doctor, often called concierge medicine, is growing in San Diego County.

Experts say the reasons range from a long-standing dissatisfaction with traditional managed care to more immediate worries about a possible doctor shortage driven by federal health reform.

While local specialists have mixed opinions on what is driving the growth, many said they believe the practice of charging a yearly membership fee in exchange for direct access to primary care doctors is on the rise.

An online directory maintained by the American Academy of Private Physicians, which listed 17 concierge specialists in 2011, today lists more than 60.

Tom Blue, chief strategy officer for the academy, said the directory can give only an approximate number for concierge doctors in a given community because none are compelled to be listed. Still, he said, concierge medicine is becoming more popular.

We estimate that were seeing a 25 percent per year growth rate nationwide and, in terms of the concentration of private physicians around the country, it appears that California is the leading state, Blue said.

Growth has come not just from single physicians deciding to change the way they practice. Major players like UC San Diego Health System and Scripps Health are also big players in the local market.

Concierge medicine is, at its most basic, a return to the age when doctors made house calls and were paid directly by the patients they treated.

These days, with instant communications and health insurance companies in the mix, things are more complicated. But the main point is the same: Families pay a subscription fee, ranging from hundreds to thousands of dollars per year, for more direct access to their doctors.

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Concierge medicine on the rise in San Diego