I understand where you are coming from Joephill. In addition to running my web hosting company, I also run a web development company where I speak to people a lot regarding design & development, but also tech issues for web hosting. A lot of these development calls are local, but my hosting can be from all over the place.
Maybe consider development calls goto your phone, and all your tech calls get directed to an outsourced web support company. Or, like Naz.A said, a lot of people just stick with the email solutions for tech issues.
BTW, I've seen VOIP in action and I absolutely love it! Can be very useful when you forget 'that' phone number or want to keep a record of your phone calls.