TRINITY — The 4-year-old boy screamed in terror as the frustrated nurse tried to put the blood pressure cuff on his arm.
"There's no reason for this behavior," she said, thinking the child was simply being a brat.
Dr. Jay Harvey heard the commotion and walked in. He knelt, held the boy's hand and looked into his eyes. "Everything is going to be okay," he said softly. "I won't let anybody hurt you." Instantly the boy calmed down.
Evelyn Garza was amazed. Unlike other doctors, Harvey was able to connect with her son, Geoffrey, who was later diagnosed with Asperger's syndrome, a mild form of autism.
That was 18 years ago. But it's a style of medicine Harvey, 49, yearns to return to: unhurried visits, personal follow-ups, knowing patients so well that he's able to not only zero in on problems but help them stay healthy.
But in an era of 3,000-plus patient loads and slashed insurance reimbursements, Harvey became frustrated in traditional practice.
"I would refuse to compromise my standards and ethics," he said of the days of seeing 35 patients a day. "So I would run late. I would spend most of the day apologizing. It wore on me."
So he's going solo with an office that will provide all that personal attention. But not for everyone. And not for free.
His new lavender-walled office in the Longleaf community, which opens in two weeks, will offer "concierge" or "boutique" medicine. It's a model that began on the West Coast in the mid 1990s. Critics call it elitist and a symptom of a broken health care system. Supporters say it's another option for those willing to make personal health a priority.
Here's how it works. In exchange for an annual fee, doctors restrict their practice to a certain number of patients and provide 24/7 access, no-wait times and extended visits, among other amenities. Some, like Dr. Scott Serbin of Pittsburgh, who is credited as the nation's first concierge pediatrician when he opened in 2004, do not participate in insurance plans. Others do but require the fees for the services that insurance companies don't cover.
Harvey's office accepts private insurance. Concierge fees will range from $1,800 for families with babies to $1,200 when the youngest child reaches middle school age.
In return, he is limiting the number of families he sees to 300. Patients will be able to contact Harvey directly by cell phone, e-mail or text.
They also will get four secure e-mail consultations and three video conference visits per year, receive lab results via e-mail, same-day, next-day, evening or weekend appointments with little or no waiting, office visits that take as long as needed, access to an in-office pharmacy for common medicines, as well as waiting rooms that offer video games, wi-fi and Starbucks coffee. They also will get to see Harvey, not whomever happens to be on call.
For additional fees, Harvey will even make house calls and accompany parents to school meetings for special needs kids.
"I'm offering things no traditional practice can hope to touch," said Harvey, who had signed up five families as of last week.
Although concierge care is not new to the Tampa Bay area, Harvey is among the first pediatricians to offer it here. Three years ago, a married couple opened a family practice in Trinity that offered conventional care and, for an extra fee, VIP care.
Harvey, who wears a Mickey Mouse wristwatch and a Lance Armstrong bracelet, said his practice isn't practical for everyone.
"If you have a healthy 12-year-old who gets strep throat once a year, then I don't necessarily see the value in it," he said.
But parents with four kids, or a child with asthma or diabetes, might want the peace of mind that comes with knowing they can talk to the doctor any time, he said.
"There's a clear-cut value there," he said. "You won't have to make a zillion phone calls."
As for the cost, Harvey says his fees are reasonable compared to some doctors who charge $5,000 and up.
"I figure it comes to about $100 a month," he said. "Some people spend $100 a month on cable. It's where you put your priorities."
Sign of broken system?
Critics of concierge medicine say it creates a "two-tier system" and puts more burden on the doctors in traditional practice if more physicians opt for a fee-based model. But they don't condemn the doctors.
"I would say Dr. Harvey is doing what he thinks he has to do to maintain the viability of his practice," said Dr. Marc Yacht, retired director of the Pasco County Health Department, who knew Harvey as a volunteer. Yacht said only a single-payer system would solve the problem.
"Actions such as these are a product of a health care system that is failing the general population," Yacht said. "Fix the health care system and such schemes will disappear."
From Kenneth W. Goodman, a professor and director of the University of Miami bioethics program: "If you've got a couple thousand dollars you want your doctor to have, then God bless you," he said. "We should be ensuring the health care system provides (these benefits) anyway.
He said he's not sure concierge care means better care. When his mother had to go the emergency room, her doctor showed up.
"We didn't have to pay extra for that," he said.
An affordable option
But Mark Murrison, president of marking and innovation at MDVIP, a South Florida-based network of 450 concierge physicians in 33 states, said concierge practices are within reach and gaining in popularity. His company's patient surveys show a 96 percent patient satisfaction rate and a 92 percent renewal rate. At $125 a month, middle class people can afford them, he said, He points out that his customer base includes teachers, municipal workers and small business owners.
"Our model is predicated on the premise that helping somebody stay healthy is just as important as treating them when they become sick," Murrison said, adding that the health care system has become "conveyor belt medicine."
"A doctor has to see 35 patients a day," he said, adding that typical visits are 10 minutes or less. "Eight minutes is not even adequate to time to deal with the symptoms you're seeing them for" much less offer wellness care.
Murrison said as health insurance reform overtaxes the system with more patients and aging baby boomers need care, more people will be driven to concierge practices.
"Add 30 million people to the rolls, and it'll be harder to get in and see a doctor," he said.
The fee-based plans, he said, actually help by keeping primary care doctors from abandoning medicine altogether.
"We're helping them extend their practices for the foreseeable future," he said.
Serbin said he feels no guilt about switching.
"I'm just another option in the health care system," said the Pittsburgh pediatrician, who built a successful practice and now does only house calls. "There are many traditional practices within the area to deliver care."
What's necessary for such a model to succeed? Not only superior skills, Serbin said, but an outstanding bedside manner.
"If you're asking people to pay extra, then you'd better be a personable individual," he said.
A doc in your corner
Evelyn Garza, whose son Dr. Harvey comforted in that exam room 18 years ago, has been a fan for years. When Harvey began practicing in Tarpon Springs in 2001, she would make the drive from her home in Spring Hill to have Geoffrey see him.
"He's been in my corner for many years," said Garza, 49, who is helping Harvey ready his new office, with its hand-painted murals of Scooby-Doo, Sponge Bob Squarepants and other kid-friendly characters.
On Harvey's shelf is a photo of him standing with Geoffrey, now 22 and due to graduate April 30 from Saint Leo University.
Geoffrey was allotted six invitations to commencement. One is set aside for Harvey.
He plans to be there. At no charge.
Researcher Shirl Kennedy contributed to this report.