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The doctor is always in, for a fee

Published May 9, 2007


Growing up in rural North Carolina, Jon Hemstreet remembers people thanking his veterinarian father for the time he spent with their animals. So when Hemstreet became a medical doctor, he wanted his patients to feel he cared.

"This is a personal medical practice, " said Hemstreet, who in March opened HometownMD at 2300 First Ave. N. "We sell availability."

Hemstreet's practice is one of a small but growing niche in which patients pay a fee to have 24-hour access to the doctor, who will even go to them for appointments. Sometimes called concierge or membership medicine, the practice is designed for fewer patients and more time for each.

"The time frame with the patient is getting smaller and smaller, " said Hemstreet, who still accepts insurance and charges regular fees along with a membership price of $500 to $1, 500 a year. "The fee enables me to cover my operating expenses with fewer patients so I can spend as much time with you as you need."

Hemstreet has never had a private practice before, moving from work at Tampa General Hospital to HometownMD. He has fewer than 30 patients but aims for perhaps 10 times that. He said the average doctor has 2, 000 to 3, 000 patients, with little time for any one of them.

Concierge medicine is only about 10 years old in the United States. Critics suggest it limits the best care to those who can afford it. Others say this care model is a symptom, not a cause, of a broken medical system.

"It's hardly a threat to medical care, " said Dr. Michael O'Neal, who has membership-based practices in Palm Harbor and in South Tampa. "We already have a tiered health care system. We just don't like to acknowledge it."

O'Neal has about 400 patients who pay him $1, 500 to $3, 500 a year. Of that number, half are professional athletes - he is also the team physician for the Toronto Blue Jays - but the rest are busy people as well as those with complex medical circumstances that require attention, he said.

When O'Neal started his practice in 2002, he was one of about 150 such doctors in the country, he said. Now there are perhaps 400. The federal government is taking notice, as are insurance companies and universities.

"This is a self-inflicted social wound, " said Kenneth W. Goodman, director of the bioethics program at the University of Miami. "Society has created this dilemma for physicians."

Goodman said doctors want to give personal care to everyone but can't afford it without extra payments. The more insurance companies squeeze costs, the more doctors will turn to a concierge model, even if it means turning some patients away, he said.

Goodman said the university has formed its own concierge practice to study the outcomes. It may be that highly personalized care keeps people healthy and reduces their impact on the larger health care system, but that's unproven.

Hemstreet said his aim is not to exclude but to care.

"I don't like the thought of this being elitist, " Hemstreet said. "This is not going to make me a millionaire. I just think this is how medicine should be practiced."

Blakemore Kearney agrees. The 24-year-old real estate salesman is one of Hemstreet's patients. Three years ago he had abdominal pains for weeks while waiting for appointments, tests and followups. Before a doctor could get to him, he had to have emergency surgery to have his gall bladder removed.

"I was in a lot of pain, waiting weeks, then I'd get to see the doctor for five minutes and then wait another month, " Kearney said. "After that, this makes perfect sense to me."

Hemstreet said he has seen patients after hours when they otherwise would have to have gone to the emergency room. He can't say his patients are healthier, but he feels his practice offers value.

"To me, it's a bargain, " he said of a fee that amounts to a few dollars a day. "People spend more than that on a latte."

Paul Swider can be reached at 892-2271 or

Fast Facts:


Dr. Jon Hemstreet

2300 First Ave. N


[Last modified May 8, 2007, 20:49:14]

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