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Quill

I dont understand why it takes so long to see one’s doctor!

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4 hours ago, Farrar said:

Several things... First, my understanding is that the shortage is not so much doctors overall, but primary care. And that part of the reason is that you can't make as much in primary care. My friend who is a primary care and palliative care doc says that in many countries with single payer healthcare they pay primary care docs the most on the scale. Specialists don't end up sinking money into becoming specialists like they can here, but they also don't profit from it - they have to want to be specialists. Because to keep your system running, you need more primary care docs than anything else.

Second, CareFirst sucks. I have a lot of words about CareFirst that I can't post on this board. They're evil. It's gotten better because they resolved a lot of their payment disputes, but for awhile they were holding practically every practice hostage around here. They're the biggest provider around us and they were engaged in such a shakedown that a ton of practices and hospital and urgent care chains had to ditch them for awhile.

Finally, how far are you willing to drive? Because One Medical is worth the $. And possibly the drive.

When/if something serious developes, I’m willing to drive pretty far for great care. But I would be reluctant to head to the city for a regular visit. What is One Medical? 

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Or when you finally get in, and they only have 15 minutes to spare for you. 

We had a concierge doctor for a stretch, that was terrific. Nice long appointments and availability. Not cheap, though; it was a stop-gap choice for a while. If we weren’t tied to dh’s employer provided insurance, I’d go back to that physician in a heartbeat. 

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6 hours ago, TravelingChris said:

Dh and I do have concierge care.  We get a physical each year as part of  the package but the real advantage is we get to see our doctor usually the same day or next day even if it is not an acute illness.  I have also called him several times on vacation and had him either advise me or do a prescription for me that I could pick up locally.  We do not have any limit to how many times we see him (like the 3 or 3 mentioned above).  For me as a super consumer of medical stuff (I have so many chronic illnesses) and for me to feel comfortable that my dh is at least being seen once a year, it is totally worth it.  We use our FSA to partially fund it (and it would totally fund it if we weren't also using the FSA for optical and dental expenses too).

Fortunately, this is exactly what I get from my non-concierge primary care doctor.  Specialists can be a bit harder to get into initially, but once I am established as a patient, I haven't had difficulties getting into seeing them quickly as well. 

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20 hours ago, Quill said:

When/if something serious developes, I’m willing to drive pretty far for great care. But I would be reluctant to head to the city for a regular visit. What is One Medical? 

One Medical is a concierge care chain. They have them in several cities, including DC. You pay a fee yearly on top of the regular visit fees, though those are in line with other places and covered by your insurance with your regular co-pay, etc. Though, it's also affordable and transparent enough to go out of pocket for just regular check up type visits. You can pretty much always get in to your specific primary care person in a week. You can always get someone at one of the locations within a day. They spend actual time with you. I've never felt taken so seriously by a doctor that wasn't my kids' pediatrician. Everyone I know who uses them feels the same.

I know of other concierge care places in northern Virginia, but there may be some in Maryland as well that I just am not aware of. In general, I used to be dismissive about concierge care, but now I think if you don't want to be told some of the idiotic things I've been told over the years by doctors, that it's the only way to get anyone to actually listen to you. 

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Our PCP is a family doc and sees all six kiddos plus myself. She only works three days a week, so for urgent visits (or for like the baby's three day checkup), we never see her, but we can generally get a followup or well visit with her in a reasonable time frame. She saw me a few months postpartum after N and wanted to see me again in a month and made sure the office made it happen for me. But we can see one of her partners or the NP/PA for urgent visits, or I usually just use urgent care because more convenient hours, and if I'm not going to see our regular doc anyway, I don't really care who it is that we see for an ear infection or the like. The UCs around here are all the same hospital system as our primary anyway, so the records are all there. 

 

Pediatric specialists, though. Oh boy. Talk about a wait!

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On 7/18/2019 at 9:36 AM, Serenade said:

 

I think this is the new model for primary care.  

I had an interesting conversation with an urgent care physician about this very thing. About a month ago I was having lyme symptoms. I have had lyme a couple times before (live in CT) and so I am acutely aware of the symptoms. I was headed out on a backpacking trip in a couple days so I decided to try just going to urgent care (I had a primary care physician for years but she left the practice to set up her own private concierge type practice so I don't currently have a designated PCP, although I guess I am still considered a patient of the practice). Anyway, the urgent care doctor kept insisting that I should really see my PCP for these types of things because he was just an emergency physician. I explained to him that the truth of the matter was that even when I did have a PCP, I only ever saw her for yearly physicals. All three times I had seen a doctor for lyme in the past it had been whomever in the practice was available that day (which of course was never my PCP), and that the care he gave me was indistinguishable from the care I received from doctors in the practice. I could get timely sick appointments, just never with my PCP. I eventually came to the conclusion that there is not much use for a PCP unless you have an ongoing health problem for which you are making regular follow-up appointments (ie, appointments that are scheduled weeks or months in advance). If you are like me and only see the doctor for a yearly physical and the very occasional thing like lyme, then you are going in blind anyway. 

IME, the only solution to this is to avoid doctors in big multi-physician practices. But of course doctors like these big shops because they don't have to worry about billing etc. My kids have seen a pediatrician in her own private practice, by herself, and they have had exactly the kind of care medical professionals seem to be alluding to when they tell you to get a PCP. We schedule routine physicals far in advance, but she does same day or next day sick/injury visits and of course they always see her, so we have a 15 year history with the same doctor. She knows me, she knows our family, she knows our lifestyle and just generally she treats us all with respect. She also knows how insurance and billing work, so she is able to warn us ahead of time about which things might not be covered, or how to get around various insurance requirements. She is generally more knowledgeable about insurance than doctors in large practices, which is also a huge benefit. Anyway, I fear this type of care is quickly disappearing....

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That’s crazy. It does take a little while (2-3 months) to get my three kids in for well checks with our preferred pediatrician at our preferred location. Part of that is wanting all the kids done the same day. However, whenever I have anything urgent I can usually get in the same day with any doctor or within a day or two with our preferred, as long as she isn’t on vacation or something. It’s the same for the general practice where my husband and I go. I do specify when I call that I want to be seen today or tomorrow depending on what I’m calling about.

I did switch away from a doctor in the same health system as one of the hospitals because they couldn’t get patients in for urgent needs withinin a day or two. My kids would have strep, I would develop symptoms, then be told the doctor could not see me for a couple weeks. I felt like if was part of how that particular hospital system operated or poorly trained scheduling staff, I don’t think the doctor has any clue patients had trouble getting in  to see her.

Have you talked to your son’ pediatrician to see if they have a practice they would recommend?  They may be aware of someone taking new patients. 

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This is one of the reasons I generally prefer a group practice, rather than a specific PCP. As long as I don't have my heart set on seeing any one particular doctor in the practice, I can usually get an appointment for the same day or the next day.

Now, when it comes to attempting to see a specialist, don't get me started.

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On 7/18/2019 at 8:30 PM, Seasider too said:

Or when you finally get in, and they only have 15 minutes to spare for you. 

We had a concierge doctor for a stretch, that was terrific. Nice long appointments and availability. Not cheap, though; it was a stop-gap choice for a while. If we weren’t tied to dh’s employer provided insurance, I’d go back to that physician in a heartbeat. 

With our very-difficult-to-see doctor, one reason was that, once you got in to see her, she would spend as much time as needed with you. That also meant that she was always hours behind (not sure what her home life was like...). So people put up with those two problems because she herself was so great.

Emily

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On 7/19/2019 at 12:18 PM, Rachel said:

That’s crazy. It does take a little while (2-3 months) to get my three kids in for well checks with our preferred pediatrician at our preferred location. Part of that is wanting all the kids done the same day. However, whenever I have anything urgent I can usually get in the same day with any doctor or within a day or two with our preferred, as long as she isn’t on vacation or something. It’s the same for the general practice where my husband and I go. I do specify when I call that I want to be seen today or tomorrow depending on what I’m calling about.

I did switch away from a doctor in the same health system as one of the hospitals because they couldn’t get patients in for urgent needs withinin a day or two. My kids would have strep, I would develop symptoms, then be told the doctor could not see me for a couple weeks. I felt like if was part of how that particular hospital system operated or poorly trained scheduling staff, I don’t think the doctor has any clue patients had trouble getting in  to see her.

Have you talked to your son’ pediatrician to see if they have a practice they would recommend?  They may be aware of someone taking new patients. 

They did give me two recommendations but they are both not accepting new patients. 

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On 7/17/2019 at 12:43 PM, Quill said:

Also, P.S., if it is this difficult in the DC Metropolitan region, which has outstanding health care, how hard is it in, I don’t know, Iowa? 

I live in Iowa, in a town of 3500 people. I can get in to the doctor day of, at least next day. I often wonder if it is harder in larger cities, with more people. 

When my dd18 was 6 and having seizures, we got into the neurologist at the children's hospital in Des Moines within the month. Maybe quicker, it wasn't long at all. 

ETA- We can't always see our primary physician day of, but there are only 2 doctors, and 1 PA. I know them all fairly well having 3 kids 🙂 

Kelly

Edited by SquirrellyMama
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10 minutes ago, SquirrellyMama said:

I live in Iowa, in a town of 3500 people. I can get in to the doctor day of, at least next day. I often wonder if it is harder in larger cities, with more people. 

When my dd18 was 6 and having seizures, we got into the neurologist at the children's hospital in Des Moines within the month. Maybe quicker, it wasn't long at all. 

ETA- We can't always see our primary physician day of, but there are only 2 doctors, and 1 PA. I know them all fairly well having 3 kids 🙂 

Kelly

Having grown up in IA and lived on both coasts, I think lots of people have misconceptions about Iowa. Yes, there are lots of small towns. But IA is very evenly settled and most people do not live too far from a city. Relative to population, IA also has a good number of training spots for most medical professions. OR, where I live now, is quite different. The population is very concentrated west of the Cascades. There are counties east of the Cascades that are larger than some states in area, but very sparsely populated. We also have no public physical therapy or occupational therapy grad programs, quite limited nursing school options relative to population, and the same size medical school as IA, despite having almost 1M more people.

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On 7/19/2019 at 10:03 AM, hepatica said:

 

IME, the only solution to this is to avoid doctors in big multi-physician practices. But of course doctors like these big shops because they don't have to worry about billing etc. My kids have seen a pediatrician in her own private practice, by herself, and they have had exactly the kind of care medical professionals seem to be alluding to when they tell you to get a PCP. We schedule routine physicals far in advance, but she does same day or next day sick/injury visits and of course they always see her, so we have a 15 year history with the same doctor. She knows me, she knows our family, she knows our lifestyle and just generally she treats us all with respect. She also knows how insurance and billing work, so she is able to warn us ahead of time about which things might not be covered, or how to get around various insurance requirements. She is generally more knowledgeable about insurance than doctors in large practices, which is also a huge benefit. Anyway, I fear this type of care is quickly disappearing....

Just wanted to respond to the bolded. My bil has been a doctor since the 80's. He was forced to join one of the large groups, but didn't want to. He wouldn't have been able to keep his clinic open otherwise. He feels like his ability to care for his patients has significantly decreased, due in part to the required electronic records and the number of patients he's required to see daily. He doesn't like belonging to a large group at all and is looking at retiring about 10 years earlier than planned because, among other things, of the increased work load.

I expect to see many of the older, more established doctors retire in the next 5 to 10 years. The new med students won't have the personal experience with the old way and won't be bothered by all the electronic stuff because that's the way they're being taught now.

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On 7/19/2019 at 11:03 AM, hepatica said:

 

My kids have seen a pediatrician in her own private practice, by herself, and they have had exactly the kind of care medical professionals seem to be alluding to when they tell you to get a PCP. We schedule routine physicals far in advance, but she does same day or next day sick/injury visits and of course they always see her, so we have a 15 year history with the same doctor. She knows me, she knows our family, she knows our lifestyle and just generally she treats us all with respect. She also knows how insurance and billing work, so she is able to warn us ahead of time about which things might not be covered, or how to get around various insurance requirements. She is generally more knowledgeable about insurance than doctors in large practices, which is also a huge benefit. Anyway, I fear this type of care is quickly disappearing....

 

Pediatricians seem to handle the patient workload better than adult primary care doctors.  I wonder why that is?  My kids also have a relationship with their pediatrician much like you described above.  Sometimes when they need to be seen right away they have to see the doctor on call, but many times they are able to see their own doctor.

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On 7/17/2019 at 1:43 PM, Quill said:

What is the *point* of having a primary care physician if it is impossible to see that physician for any reason except a well-care appointment secured months and months in advance? I haven’t laid eyes on my actual, literal physician in several years; he’s like The Great and Powerful Oz. Now dh is trying to make an appointment because he has a very concerning lump on his neck. If he wants to see our actual, literal physician, guess when that could happen? December. What in the actual heck? By saying, “ok, I’ll take any medically certified, breathing person affiliated with this group in this location,” his soonest appointment is end of August. So now he’s trying to see if any of their other locations has any medically certified, breathing people who could possibly see him before, I don’t know, he dies of thyroid cancer or something. 

I’m very unhappy about this right now, as well as, obviously, concerned about dh. Why is this the reality? Is it a shortage of doctors? Is it just that there’s so many people with health problems? Should we all just make appointments every half-year for a well visit on the off chance there will be some concern that’s cropped up by then? 

(I have also been ignoring the fact that I need a primary care physician for ds19 because he can’t see his pediatrician anymore, but I hit a dead end when all four people I called were not accepting new patients. So I just kind of back-burnered it, though it still needs to be done.) 

Also, P.S., if it is this difficult in the DC Metropolitan region, which has outstanding health care, how hard is it in, I don’t know, Iowa? 

You might remember I lived in MD before - never had this problem.  You might want to find another PCP, there are better offices out there.

When we moved to MA - I couldn't find a doctor to take on a new patient.  Office after office after office kept telling me that they don't accept new patients.  And one DO finally took my husband after we were in a car accident - I can't even tell you about our horrible experience

Our dr office now will fit you in the same day with either NP or PA and if you want to see your dr, you can send him an email, he will either tell you that you don't need to come in or will fit you in in the next day or so.  also, there is no wait time!!!!!  Never ever ever!!!!!!!!!!!!  I wish I could say I did some smart research and found this office, but I just got super lucky when we moved.  BTW, I *think* our area is considered rural, about an hour north of Boston...

 

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It's very frustrating.  I have a similar system where I go.  I can easily get into the duty clinic for urgent appointments, and I don't really mind that I could get any doctor in the practice.  I can get an appointment for 6 weeks in the future with my doctor, unless it's near a holiday and then it may be 8 weeks.  But things that don't really fall into either category are a problem.

My step-father is   GP and he has said that part of this is they are not using the best scheduling methods.  Which is to say, running a clinic is not something all doctors or groups do equally well.

But part is also shortages of various kinds.  We have a significant perception of shortage here.  I'm told that we don't necessarily have fewer doctors, but changes in expectations and practice approaches come into it as well.  In terms of the testing people want, how often they go in, but also hw doctors want to practice.  It used to be normal here for examples for all GPs to do a few evening clinics a week, because many people cannot come in during the day.  Now few do this and leave evening things to the duty clinics meant for more urgent issues.  Also, many doctors now are working at walk-in clinics which are less efficient as they don't do certain types of things like administering tests that might require follow up.

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According to several doctors we've spoken with, it's because they are forced to take on too many patients.  Then they have the PA or NPs who work under them to get to many of the patients.  Then your doctor can review what they're doing.  Crazy world out there now.  

 

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I'm in North Jersey, 25 min. from NYC. I can usually get in to my primary same day or the next day if I call too late. I may not always get my preferred doctor, but that doesn't always bother me. The endocrinologist takes months, but I can call every morning for a cancellation. Same with the neurologist for ds, but my neurologist I can usually get an appointment within 3 days. It's the same for the in-laws - some doctors it's within a day or two, specialists much longer. Luckily we have a few decent urgent care type places around here too, but I don't think I'd see them for a lump on the neck. At least around here they would not be able to get the ball rolling on an MRI or anything, although if they thought it was something very concerning they would recommend the ER. 

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