Jes­sica Sul­li­van’s two-and-a-half-year-old twins, Tea­gan and Clare, were due for a checkup. Rather than pile into the car and then sit for an hour or more in a crowded wait­ing room filled with snif­fling kids and im­pa­tient par­ents, they stayed home. The doc­tor came to them. Nitin Gupta, MD FAAP, ar­rived at their Dobbs Ferry home…

Where he spent an hour and 15 min­utes ex­am­in­ing the two girls. Af­ter he left, he texted Jes­sica with a tai­lored ac­tion plan de­signed specif­i­cally for each girl to main­tain their health go­ing for­wards. There would be no bill for the ex­am­i­na­tion. They were cov­ered un­der a con­tract with Dr. Gupta that cost the Sul­li­vans $125 each per month for any and all med­ical ser­vices, 24/ 7, in­clud­ing house calls like this. Be­fore sign­ing up with Dr. Gupta, Jes­sica had com­pared the pro­jected costs with her fam­i­ly’s high-de­ductible in­sur­ance pol­icy and con­cluded that it might be 50% more ex­pen­sive, “but it was in­com­pa­ra­ble in terms of con­ve­nience.”

Katie Wil­son had a sim­i­lar ex­pe­ri­ence, though she took her daugh­ter to Dr. Gup­ta’s Dobbs Ferry of­fice. “She had been tug­ging at her ear. I picked her up at day care at 4:02. We were in his of­fice at 4:20.” He di­ag­nosed her ear­ache and handed Katie a pre­scrip­tion—“all within an hour. I prob­a­bly would­n’t have got­ten in to see our old pe­di­a­tri­cian un­til the next day. By the time I woke up the next day, I had a text from him ask­ing how she was.”

Dr. Gupta, 40, is a board-cer­ti­fied pe­di­a­tri­cian trained in gas­troen­terol­ogy at Cor­nell Weill. A Berke­ley un­der­grad who went to med­ical school at St, George’s in Grenada, he has been an ER doc­tor at Brook­lyn Hos­pi­tal Cen­ter and an Ur­gent Care physi­cian at PM Pe­di­atrics. Mar­ried and a fa­ther of a boy and a girl, he made the switch from group and hos­pi­tal prac­tice to be­come a “concierge” doc­tor — the first pe­di­a­tri­cian to do so in New York State, he said. He takes no in­sur­ance and there are no co-pays. In­stead, he charges a flat monthly fee for his ser­vices, when­ever and wher­ever needed. Chil­dren un­der a year old cost $150; chil­dren ages one through four are charged $125, and those five and over cost $100.

If he took in­sur­ance, he ex­plained, his over­head, in­clud­ing back of­fice staffing, would run around $350,000 a year. As a concierge doc­tor, he said his over­head is just $50,000. He does­n’t need many pa­tients to break even and said, “I’m try­ing to keep my pa­tient vol­ume down.” Doc­tors who carry in­sur­ance must see thou­sands of pa­tients to cover their costs. For them, the av­er­age time spent with any one pa­tient is about seven min­utes.

Cur­rent state law does not al­low him to sell pre­scrip­tion med­i­cines, and his pa­tients’ fam­i­lies would still have to pay sep­a­rately for hos­pi­tal­iza­tion or treat­ment by spe­cial­ists. “But with time to man­age my pa­tients, there is less need for spe­cial­ists,” he says.

“Concierge” prac­ti­tion­ers con­sti­tute a small frac­tion of the 300,000-some doc­tors na­tion­wide that prac­tice fam­ily or pri­mary care med­i­cine. Ac­cord­ing to Bret Jor­gensen, CEO of MD­VIP, a com­pany that has ag­gre­gated some 950 such physi­cians, there are about 5,000 na­tion­wide. Very few are strictly pe­di­a­tri­cians; for the most part their pa­tients are in the 50 to 80 age range. They see an av­er­age of 300 to 400 of them, ver­sus 2,000 for the typ­i­cal pri­mary care doc­tor. The pay­off is a re­newal rate of about 90% and a re­duc­tion in hos­pi­tal­iza­tions for their pa­tients of be­tween 70 and 80 per­cent. Their num­bers are con­tin­u­ing to grow, said Jor­gensen.

Frus­tra­tion with the cur­rent sys­tem of pay­ing for health care plays a large part in the shift to concierge med­i­cine. In­sur­ance re­im­burse­ments keep shrink­ing; de­ductibles keep ris­ing. To cope with the re­pay­ment deficit, many doc­tors, labs and hos­pi­tals in­flate their bills, which only adds to the prob­lem. Both doc­tors and their pa­tients are caught in the squeeze. Some fam­i­lies cope by post­pon­ing or skip­ping needed health­care. As for the doc­tors, said Dr. Gupta, “Physi­cian burnout and physi­cian sui­cide rates are at an all-time high.”

“I burned out seven years ago,” Gupta con­fessed. “My fa­ther was dy­ing and I was fly­ing back and forth from New York to San Fran­cisco every other week­end. Af­ter my dad died, I con­sid­ered leav­ing med­i­cine al­to­gether.” In­stead, he took time off, left New York and took up prac­tice in Cari­bou, Maine. There, he said, “I was sur­rounded by a com­mu­nity of peo­ple who viewed each other as neigh­bors, and neigh­bors were con­sid­ered fam­ily. There were sto­ries of doc­tors com­ing to the hos­pi­tal in any way pos­si­ble. Some were picked up on a snow­mo­bile; oth­ers came in on skis and snow­shoes. I re­main in­spired by those doc­tors, and that’s why I want to do house calls for my neigh­bors.”

For most par­ents seek­ing a good pe­di­a­tri­cian, the men­tion of “house calls” is about all they need to hear. As Joanie Lester-Gill, whose son is a pa­tient, put it, “Who wants to go sit in a doc­tor’s of­fice with all those sick kids?” One Sun­day in Oc­to­ber, she was with her son at a sur­prise birth­day party when he be­gan to ex­hibit breath­ing prob­lems. She called Dr. Gupta, who ar­rived with a neb­u­lizer ma­chine and ex­am­ined him in the trunk of their SUV – in time not to ruin the sur­prise.

Ju­lia Laspina, who took her then five-month-old to Dr. Gupta when he was in a tra­di­tional prac­tice in Rock­land County, said he saved her daugh­ter’s life by di­ag­nos­ing bac­te­r­ial menin­gi­tis and get­ting her hos­pi­tal­ized im­me­di­ately. She was dev­as­tated when he moved across the river, but when he called to tell her that he was go­ing to set up a concierge prac­tice, she signed on im­me­di­ately, say­ing, “I, of course, would fol­low him to the ends of the earth.” She had only to drive across the Mario Cuomo Bridge from her home in Pomona so that her daugh­ter could spend more than an hour with him in his Dobbs Ferry of­fice.

Concierge doc­tors rely heav­ily on so­cial me­dia and word of mouth to bring in new pa­tients. Dr. Gupta had only about a dozen as of Thanks­giv­ing but plans to have no more than 400 tops. Ash­lee Keane, a med­ical as­sis­tant study­ing to be a li­censed nurse, heard about him through the doc­tor she works for. “He’s bring­ing back old school med­i­cine,” she said, “which is a great idea.”

Dr. Nitin Gup­ta’s web­site is www.river­town­speds.com. For those seek­ing in­for­ma­tion on concierge doc­tors in gen­eral, there are a num­ber of re­gional and na­tional net­works in­clud­ing MD­VIP, whose web­site is www.md­vip.com.