NEW PORT RICHEY — Not long ago, the phone rang at the doctor's house. It was about 3 a.m., and an anxious mother wanted to know what to do about her teenage son.
His arm was apparently broken — he'd neglected to tell his parents about it until late that night — and now he couldn't get to sleep because of the pain. Should they take him immediately to an emergency room?
Dr. Amir Shirmohammad told her to hold off on the ER because the family would only spend all morning waiting. Instead, he told them to try and get a little sleep, meet him at his office at 7 a.m., an hour before it opened, and he'd get the boy set up with X-rays and a specialist.
Not every patient can call her family doctor at home, at 3 a.m. But this patient had paid a premium for unlimited access to Shirmohammad under a "concierge" care program.
Think old-time country doctor — with a cell phone.
"It gives (patients) the added advantage of having a doctor in the family," said Shirmohammad. "When you build that kind of relationship, it doesn't feel like work anymore."
Shirmohammad and his wife and medical partner, Dr. Stephanie Eldridge, both 33, in August started a new family medical practice, temporarily located in New Port Richey but soon to open in Trinity once their new office is completed.
For the most part, Trinity Family Physicians is a conventional practice: Patients call and set up appointments to see the doctors.
But the couple hope to enroll a limited number of patients in their concierge program, thought to be the first of its kind in Pasco County.
These patients will pay an annual fee — between $1,000 and $2,000 based on factors including family size — for 24-7 access to their doctors and for "VIP" status: They can come in the same day they call and never have to wait.
The couple promises to stretch visits for the VIPs to at least 30 minutes, more than twice the time that doctors typically spend with patients. As part of their annual fee, VIP patients also get an extensive head-to-toe physical that most insurance plans would not cover, said Shirmohammad, and the doctors then put together a customized health plan.
The doctors still collect typical fees for service or insurance reimbursements — both private and Medicare — for visits and tests.
Their market includes Trinity-area families, self-employed people who don't have time to wait for appointments and anyone willing, they say, to pay the equivalent of a cup of Starbucks coffee a day for the extra attention.
"It's a great concept," said Eldridge. "You're giving focused, quality care."
Why not give every patient VIP treatment? Time and resources, of course. Shirmohammad and Eldridge are the sole doctors in the practice. They say the most patients they can handle on a round-the-clock basis will be about 500. They don't plan for the total number of patients at their practice to get above 3,000.
"The level of care is exactly the same," between regular and VIP patients, said Shirmohammad. The difference, he said is "the matter of accessibility."
Concierge care is a spinoff of the medical boutiques that opened in the western United States in the mid 1990s. Those clinics catered to upper-class clients able to shell out big money for preferential services.
But in the last dozen years, a small but growing number of doctors nationwide have switched totally to concierge care because of the problems associated with managed care plans. The Florida Medical Association does not have statistics for the state, but more than 1,000 doctors nationwide have switched to concierge care, according to the Society for Innovative Medical Practice Design, a Richmond, Va.-based trade group.
Proponents say the concierge model allows doctors to treat fewer patients and give them better, more attentive care. The financial benefits can be especially seductive given low Medicare and Medicaid reimbursements.
Critics of the model say it limits the best care only to those patients able to pay for it, worsening the inequities in the health-care system and increasing the workload of doctors who don't participate. In addition, doctors who switch from a conventional model to concierge have sometimes dropped services to longtime patients and forced others to pay up or go shop for a new doctor.
Shirmohammad and Eldridge say their hybrid model is a response to those kinds of problems. They plan to keep a good mix of conventional and concierge patients; the conventional side of the practice will comprise about 75 percent of the business and the concierge about 10 percent.
Though the pair does not take Medicaid, they say they will devote the remaining percentage of the business to uninsured, low-income patients, most of whom they expect to meet and "adopt" while on call at Community Hospital's emergency room.
They say they don't think it would even be financially feasible in this area to convert their practice totally to concierge care. Simply put, the demand is not there.
"This isn't something that could make a business stand alone," he said.
But they say their mixed model takes into account more than financial realities.
"We want to be the neighborhood doctors," said Shirmohammad. If they were serving only those able and willing to pay a premium, he said, "we'd get away from where we came from."
Shirmohammad, whose parents ran a small printing company, grew up in Westchase. Eldridge, whose father worked in an Ohio aluminum factory, spent her teenage years in Tampa.
The couple met as teenagers while they were working at a gift shop at Busch Gardens. They went to college and medical school at Tulane University in New Orleans, and completed their residencies at Florida Hospital in Orlando. Now Trinity residents with a 20-month-old daughter, Jasmine, and another baby due in a week, the pair opened their practice in west Pasco to be close to Community Hospital's new Medical Center of Trinity, scheduled to open in 2009.
Though their practice has been open only since August, the couple has already attracted a small number of devoted patients.
One of them is Mike Conforti, a 47-year-old from Tarpon Springs who owns a blinds manufacturing company. He heard about it from a friend and signed up for the concierge services. He said Shirmohammad has worked with him on a plan to get his blood pressure down. He hasn't had to call him after hours too often, but said he likes that he has the option.
And not having to wait to see the doctor is a plus for a business owner; after all, he says, time is money.
"They really treat you like you're important," said Conforti. "I've never waited more than five minutes."
Information from the Washington Post was used in this report. Jodie Tillman can be reached at firstname.lastname@example.org or (727) 869-6247.