By Ansley Franco

After over two decades in traditional obstetrics and gynecology, Ashley Gooding, MD saw a gap in women’s healthcare. In fall 2025, she opened Flourish MD, Birmingham’s first concierge gynecology practice, offering extended, individualized care for women in perimenopause and menopause.

Gooding’s journey to medicine began early, dressing up as a doctor for Career Day in kindergarten. Growing up in Decatur, she was surrounded by physicians within the family, including her grandfather and several cousins.

She completed her undergraduate degree at Birmingham-Southern College, attended medical school at the University of Alabama at Birmingham and completed her residency at Prentice Women’s Hospital at Northwestern in Chicago. Despite training out of state, Gooding always planned to return home.

“Birmingham is a great place to practice medicine. It has an exceptional medical community, and I always wanted to come back,” she said. “It was back in the day when you could change your cell phone number, and I never changed it to a Chicago number because I knew I was coming back to Alabama.”

Gooding chose obstetrics and gynecology after realizing she wanted to be in a field with both surgical work and long-term patient relationships.

“You can take care of patients for their whole life, and you can also do surgery and have that operating room experience,” she said. “And it turned out to be the perfect field for me.”

But after 22 years at a traditional OB-GYN clinic, Gooding began to feel constrained by the structure of volume-based care. “I wanted a model that allowed more time for the complex counseling that I thought was required in women’s health,” she said. “But I also wanted to stay evidence-based and clinically rigorous.”

Flourish MD opened in September 2025 with in-office patient visits beginning the following month. It is the first concierge gynecology practice of its kind in Alabama. The clinic focuses on personal care and exams, and does not provide obstetric services, a deliberate decision Gooding said was necessary to meet her work-life balance needs.

“It was mostly about time,” she said. “Women need a lot more time in their visits in the perimenopause and menopause space. I don’t know that it’s possible to do deliveries and work nights and weekends and still give your undivided attention and the time to women in the office that they need after childbearing.”

The principal difference between Flourish and traditional practices is the time she is able to give to her patients. At Flourish, patients are typically scheduled for hour-long visits, often with multiple follow-ups during the first six months to review lab work and create a treatment plan.

To become a patient, the practice operates on a membership basis that is not covered by insurance. A package for people aged 12 to 22 years old is $495 for the year. The services provided include gynecological visits, contraception counseling, and cycle education. For people over 22 years old, the annual membership fee is $1950. Some of the package’s inclusions are unlimited office visits, comprehensive annual physical exams and prescription management.

Despite the services Gooding provides at Flourish, she said that her business is not meant to replace traditional care. “It’s sort of like a pressure release valve,” she said. “It’s not a replacement for traditional medicine, but it can take some of the medical complexity and some of the longer time-based visits off of other doctors.”

Gooding said many OB-GYN physicians who are not yet at retirement age leave practice early due to burnout driven by the volume-based care model, which prioritizes high patient throughput and shorter visits. She also said that menopause can significantly impact career-focused women, particularly those who are unaware of its symptoms and side effects such as brain fog and poor sleep.

“I wanted to make sure that other women who were high-functioning career women like myself didn’t lose their space in their career because of the menopause changes,” Gooding said. “I hope that I can help the whole system by taking some of that pressure off of those physicians and also providing the service women are looking for.”

When needed, Gooding continues to collaborate with physicians across Birmingham for referrals, imaging and surgical care. Since opening, the practice has grown faster than she anticipated. Many of her former patients followed her to the new practice, something she finds particularly meaningful. “That was probably one of the hardest things about leaving the traditional model,” she said. “So when they’ve come to Flourish, it’s especially rewarding.”

Looking ahead, she plans to cap membership to preserve the quality of care and hopes the model can help address physician workforce challenges.

“If physicians are considering retiring early, this is a great way to pivot and still keep your experienced physicians in the system,” she said. “I wasn’t burned out. I was super excited. But I just wanted a way to be able to sit down and spend time with women, helping them through what I’ve been through.”