How accessible is your pediatrician?

[Rachel]

Just now, kbutton said:

I will try, but I will not likely get 3 recommendations for the same place. Lots and lots of practices here. 

I’m sorry it’s so frustrating. My siblings and I live in 5 different states and we have all had varying experiences, but I’ve never heard of any of them having the trouble you are having. 

[kbutton]

4 minutes ago, TexasProud said:

Ok, there is something really, really wrong for another doctor to be told they cannot talk to the doctor by the nurse.  Just wrong. 

I don't know if she said no, or he was all bluster and didn't ask. I heard only bits and pieces. Otherwise, I agree.

2 minutes ago, TexasProud said:

No.  None of my children had pediatricians.  They go to family practice doctors.  Most do that in our area. There are only a few peds docs. It depends on where you are in the US. 

Yes, but if you are in a part of the US that has pediatricians used as family doctors, they are the PCPs for kids--they aren't specialists. They will refer out to specialists for dang near everything.

[kbutton]

Just now, Rachel said:

I’m sorry it’s so frustrating. My siblings and I live in 5 different states and we have all had varying experiences, but I’ve never heard of any of them having the trouble you are having. 

THANK YOU. Seriously, it's been so frustrating!

[QueenCat]

Just now, TexasProud said:

No.  None of my children had pediatricians.  They go to family practice doctors.  Most do that in our area. There are only a few peds docs. It depends on where you are in the US. 

Interesting. Most of dh's family is in TX. Now I'll have to ask them what they do 😉 I've lived in several states with kids and it's always been pediatricians. A lot of people will switch over when their child hits their teen years, but they don't have to. 

But the thing we're hearing from people in other countries is that the family doctor/GP refers their kids to a pediatrician for major issues. Have never experienced that either. If my kiddo has multiple ear infections, he goes to an ENT, not a ped, for surgical options. For the one with AS, he was referred to his neurologist and then a neuropsych.

[TexasProud]

Just now, kbutton said:

I don't know if she said no, or he was all bluster and didn't ask. I heard only bits and pieces. Otherwise, I agree.

Yes, but if you are in a part of the US that has pediatricians used as family doctors, they are the PCPs for kids--they aren't specialists. They will refer out to specialists for dang near everything.

Oh, so do the family practice docs. That is part of the reason I don't quite understand why the specialist isn't the one you are dealing with. I'm sure there is a reason, but once we are referred we don't deal with the fp for that issue.

[TexasProud]

Just now, QueenCat said:

Interesting. Most of dh's family is in TX. Now I'll have to ask them what they do 😉 I've lived in several states with kids and it's always been pediatricians. A lot of people will switch over when their child hits their teen years, but they don't have to. 

But the thing we're hearing from people in other countries is that the family doctor/GP refers their kids to a pediatrician for major issues. Have never experienced that either. If my kiddo has multiple ear infections, he goes to an ENT, not a ped, for surgical options. For the one with AS, he was referred to his neurologist and then a neuropsych.

I will say that again, it depends. If you live in Dallas, then you may very well only be able to see pediatricians.  But our family practice sent them to the specialists. I don't get sending them to a pediatrician before sending them to the specialist. Just doesn't make sense. The family practice guy did everything the peds guy could do.  

[kbutton]

2 hours ago, QueenCat said:

A lot of people will switch over when their child hits their teen years, but they don't have to. 

Here people often keep their pediatricians until their kid graduates from college. I think this is especially true if there are ADHD meds in the mix.

2 hours ago, TexasProud said:

Oh, so do the family practice docs. That is part of the reason I don't quite understand why the specialist isn't the one you are dealing with. I'm sure there is a reason, but once we are referred we don't deal with the fp for that issue.

See, this is being seen as an every day issue, not post-surgical. The issue didn't exist before surgery. 

 

Edited June 8, 2022 by kbutton

[Arcadia]

4 minutes ago, Melissa in Australia said:

Not necessarily. 

 My boys have very complex medical including FASD, extreme neglect, ID etc.. They see a paediatrician. I got a referral from the GP to access the peadiatrician. 

Twin 1 has bilateral talipies, his original GP at birth would have written the referral to the orthopaedic surgical ward of the children's hospital where he gets the treatment for that. 

Here the gp can give referrals to specialists as well. 

The system in Australia is similar to where I am from where general practitioners would see the kids. I had a GP and a paed.  In the US though, kids would be channeled to the paediatricians for even things like immunisations and filling up medical forms for schools and summer camps. For things like strep or hand food and mouth disease, I could walk-in with my kid to the healthcare group we use and have him seen by whichever general practitioner is available because there are more “idling” general practitioners than paediatricians. If their paediatricians have no appointments scheduled when my kids walk in, they will take a look.

[Melissa in Australia]

Here in Australia a paediatrician does 6 years extra study after finishing doctor in medicine degree and 2 years of residency training. They are specialists. They aren’t just for immunisation or general health complaints.

[itsheresomewhere]

Ours is wonderful, easy to get ahold of and will call you back.  He left a large practice to open his own and only sees a limited amount of patients.  He hated not being able to spend time with his patients and getting to know them.  We absolutely love him. 

 Our old was difficult and made you feel like he was doing you a favor by even speaking to you ( we had a wonderful one before at that practice who died and this guy who shouldn’t have been allowed to deal with people took over.  We left). 

[Farrar]

We had two. Now my kids are with the grown up doctor, which was an option when they turned 16 that I jumped at.

The first was AMAZING. Accessible in every possible way. A two person practice - one MD, one NP, some assistants. You could call in the morning and someone always called you back that day and had an actual conversation with you, sometimes even calling in a prescription for that or telling you to wait before coming in. They were not a very connected online practice at all. It was very old fashioned. They also had an emergency service that you could use for when they weren't in the office. You called and left the message and then they called you back, including on weekends and things - generally within several hours, but always within a day. It wasn't for ER level stuff, but more like when you can't figure out if you need to go to the ER or if something could wait or if an ongoing issue needed a sooner decision about something. I ran into the NP not too long ago and she remembered both my boys and lots of things about them and honestly, I cry when I think of how much we LOVED HER and how important she was in my kids' early lives.

Around the time my kids were 10 or 11, the MD retired. The records went to a large practice and we were transferred there.

They charged an arm and a leg for everything and you had to go in to talk to them. No more of this "hey, here's the situation, do I have to come in?" business. They had an elaborate online portal thingy for messages, though no responding to anything medical, more like practical things around appointments and timing for shots and things. They did have lots of reminders and official things through it. Very easy to get things like sports forms signed and vax records sent. Many docs, none of them got to know my kids. Very impersonal. No communication. I stopped going and my kids basically suspended all non emergency medical treatment until we could get them into our adult practice at 16.

[Jean in Newcastle]

Healthcare isn’t a monolithic entity in the US. Each state has their own medical boards etc. And so much seems to depend on the area as far as access to medical care and how to navigate it. And it can even depend on the hospital and/or practice. 
 

Some places have better communication than others and as you have discovered certain key people can put up big barriers.  In my area people of all ages can be seen by a general practitioner. Pediatricians are actually specialists. We also had other specialists within pediatrics- a pediatric gastroenterologist, a pediatric cardiologist, etc. but the more specialized you get the more narrow their focus.
 

I found that asking for their general procedures helped me to get things done without stepping on as many toes. But dh still camped out in the waiting room and refused to leave until the doctor came out when we ran into a bureaucratic logjam with my dd’s brain tumor so there are no guarantees.  

[kbutton]

1 hour ago, Jean in Newcastle said:

But dh still camped out in the waiting room and refused to leave until the doctor came out when we ran into a bureaucratic logjam with my dd’s brain tumor so there are no guarantees.  

Your DH is also in health care, correct? It used to be that there were some professional courtesies extended.

 

Edited June 8, 2022 by kbutton

[kbutton]

Removed for privacy

Edited June 8, 2022 by kbutton

[TexasProud]

7 minutes ago, kbutton said:

Can I also just vent that we had basically no choice over where the squad took my son for the ER visit? He has the potential for complications that could require a helicopter ride to a specialty hospital to save his life (and this could've been that, frankly, though it wasn't), and this experience made us feel as though risking having him die by the side of the road waiting for an ambulance after trying to take him in on our own is preferable to going by squad because we can at least choose where to try to seek care. Next emergency, we are taking him in the car ourselves all the way "downtown," and it probably won't be to the pediatric hospital that has all his records--it will be to a regular ED where DH works or maybe the local ED if there are enough people there who used to work with DH that we can get somewhere. We wish we would've chosen differently the other night.

And the squad responded to a respiratory distress call with bare faces and didn't put masks on until they got to the hospital where they were required. Cause my kid with respiratory distress needed added Covid risk.

I am pretty jaded at this point.

Ughh. I am so so sorry. You did the best you could. Always easy to see what you should have done in hindsight. You did great!!!!

[Wheres Toto]

I can send a message through the patient portal and get an answer fairly quickly.  Sick visits can be made same day, well visits take months to schedule but might be quicker if I was willing to go to a different doctor or PA in the practice.   I've had the same pediatrician for 28 years and we like one doctor the most.  

My younger kids are now teens and so far that hasn't caused any issues. 

[prairiewindmomma]

Things are great through the patient portal, and routine visits are fine. There's no availability for sick visits, ever, so we've found a really good urgent care for those things.

ITA the frustration about which hospital you end up at @kbutton. When we lived in another state, we regularly drove ourselves to a further away one because the local one would have killed me or my dd given all that we had going on. As it is, I'm still hesitant to call for an ambulance because wait times for arrival are so awful and the local hospital is awful. 

[EKS]

Ours was very accessible.  If a kid was sick, we could usually get a same day appointment, and he frequently dealt with phone calls himself as well. 

[sweet2ndchance]

We used to have terrible problems with our family doctor's nurse gatekeeping. She would regularly deny medications that the doctor had approved at an appointment, try to answer questions that, judging by her answers, she had no idea what she was talking about, argue with patients, purposely not pass on information from doctor to patient or patient to doctor... and she made sure every interaction with the doctor went through her first. It was horrible. If the doctor wasn't so fantastic, we might have left because of this nurse but eventually enough complaints stacked up against her that the nurse was forced to retire early. 😉

Now we get messages directly from the doctor the same day most of the time. A lot of time if you describe the problem well enough in the online message, she will prescribe meds as needed and call it an "online consult". If we get one of the nurses instead of the doctor, they actually consult the chart to see what the doctor said or say they will ask her as soon as they can and get back to us. Usually the same day. I hope this doctor never moves or retires lol. Oh and we drive 45 minutes away just to see this particular doctor.

[kbutton]

3 hours ago, Katy said:

I’d ask local friends or maybe on local social media which practice they recommend nearby where the doctor is easy to contact and ask to get in ASAP. I can’t remember ever having a bad experience when one practice was recommended more than 3 times. 

Now that I said I wouldn't get recommendations for the same doctor, I got two for one doctor, but she's not taking new patients, even siblings of current patients, lol!!! I do have a promising lead on a doctor that also has a degree in psychology and mentions ADHD on the website. 

[happypamama]

We use a family doctor who sees all the children and me, rather than a specific pediatrician, and she is great for all of us.  She only works three days a week, so we do have to book checkups with her several months in advance, and I also know that if we email her, we may not get a reply for a couple of days, so I plan accordingly.  However, I have never had a problem with reaching her with non-urgent questions.  She is part of a group practice of about eight doctors and nurse practitioners, so if we have a sick need or something else (like needing a physical for a driver's license), or if I call after hours, I have always been able to get one of her partners or a nurse.  Never been an issue at all.

[Katy]

1 hour ago, kbutton said:

Now that I said I wouldn't get recommendations for the same doctor, I got two for one doctor, but she's not taking new patients, even siblings of current patients, lol!!! I do have a promising lead on a doctor that also has a degree in psychology and mentions ADHD on the website. 

Is anyone in her practice taking new patients?  A well managed practice is typically well managed for all doctors.

[Jean in Newcastle]

Regarding ambulances. My understanding is that ambulances have contracts with certain hospitals. At least they do here. Back when I was averaging four ER visits a year, we made sure that we didn’t call an ambulance from our home because they were contracted with a hospital that I didn’t want to go to. Dh would drive me to the ER that specialized in the issues I was having. (Of course this was a gamble and we only did it because we were confident that I didn’t need care enroute and dh is in healthcare and could have hopefully revived me in a worst case scenario. ). 

Edited June 8, 2022 by Jean in Newcastle

[kbutton]

1 hour ago, Jean in Newcastle said:

Regarding ambulances. My understanding is that ambulances have contracts with certain hospitals. At least they do here. Back when I was averaging four ER visits a year, we made sure that we didn’t call an ambulance from our home because they were contracted with a hospital that I didn’t want to go to. Dh would drive me to the ER that specialized in the issues I was having. (Of course this was a gamble and we only did it because we were confident that I didn’t need care enroute and dh is in healthcare and could have hopefully revived me in a worst case scenario. ). 

I think the Children’s ones are outside the system so to speak, and they would’ve taken him to the farther location if he had not been stable. 

[TravelingChris]

6 hours ago, Arcadia said:

My surgeon does the pre-op clearance herself. She also does the post-op review appointments. My oncologist would refill my asthma medications so I don’t need to bother my family doctor for that. No idea if ADHD medications can be prescribed by someone other than a pediatrician. 

That is why mine did

[Laura Corin]

7 hours ago, kbutton said:

What is this phone appointment you speak of? (Sarcasm alert) I would be happy to be offered a phone appointment. 

That's a shame.  They are useful for routine follow-up and also the kind of situation when you just need a discussion rather than an examination. 

[Jean in Newcastle]

7 hours ago, kbutton said:

Here people often keep their pediatricians until their kid graduates from college. I think this is especially true if there are ADHD meds in the mix.

See, this is being seen as an every day issue, not post-surgical. The issue didn't exist before surgery. 

 

Here college kids on ADHD meds can still get them from an adult doctor.  Some doctors don't feel comfortable prescribing and will refer you to a psychiatrist or even a psych nurse (this is highly state dependent).  But I don't know of anyone who had to continue to go to a pediatrician once they were over 18. 

[Melissa in Australia]

Here peadiatricians only go until the child is 16

[Soror]

I'm so sorry. That is such a huge stress 😞 I hope you find a new practitioner that is accessible.

We had a ped when the kids were younger that was fairly accessible and nice. But we switched to a GP family practice Dr at dhs work. Everyone could see them. It was $5 a visit. We got in quickly. We loved the doctor but the clinic switched management companies and then just got a NP and changed a bunch of policies making it where we basically couldn't use the place.

I had to switch D's to a Ped then because NP couldn't do his meds. I couldn't find any GP or family practice doctors that would take him. I called multiple ones. Now the ped practice we switched to has this phone system you can't get through to anybody there us only leaving messages and waiting at least all day. I hate it. I'm hoping after ds turns 18 we can find a FP doctor that isn't awful.

[skimomma]

To the OP, I totally understand your situation!  We are in an underserved area and the turnover for doctors is unreal, so we have had to switch family doctors many times.  Several times we have not even been formally handed off to a new provider.....I find out ours is gone by calling the number and being told, "oh so-and-so left 6 months ago...."  We never used a pediatrician but all of our family doctors have been very inaccessible.  Getting an appointment is usually not a problem but any sort of follow up is blocked by gatekeepers.  I actually snorted during my last appointment when my new doctor, who I like, said, "Just let me know if X does not work and I can prescribe Y."  Let you know HOW?  The only way to do that is to make another appointment.  We have high deductible insurance so that is $200 out of pocket to "let her know" something.  There is a patient portal and I have tried this MANY times.  All I get is a follow-up call from a scheduler to make an appointment.  If I call to leave a message to "let her know," again, I get a follow-up call to make an appointment.  We are lucky in that none of us has ever had a big enough medical issue that could not just be dropped, but I totally understand the problem and in many places, like mine, switching providers will not solve the problem.  There are ZERO private practices in my area so anyone I go to is governed by one of two medical groups that use the same tactics/systems.  I have often wondered if the doctors even know there is no "letting them know" anything!  I mean, THEY go to doctors, right?  Surely they have seen this in action?

[Jean in Newcastle]

1 hour ago, skimomma said:

To the OP, I totally understand your situation!  We are in an underserved area and the turnover for doctors is unreal, so we have had to switch family doctors many times.  Several times we have not even been formally handed off to a new provider.....I find out ours is gone by calling the number and being told, "oh so-and-so left 6 months ago...."  We never used a pediatrician but all of our family doctors have been very inaccessible.  Getting an appointment is usually not a problem but any sort of follow up is blocked by gatekeepers.  I actually snorted during my last appointment when my new doctor, who I like, said, "Just let me know if X does not work and I can prescribe Y."  Let you know HOW?  The only way to do that is to make another appointment.  We have high deductible insurance so that is $200 out of pocket to "let her know" something.  There is a patient portal and I have tried this MANY times.  All I get is a follow-up call from a scheduler to make an appointment.  If I call to leave a message to "let her know," again, I get a follow-up call to make an appointment.  We are lucky in that none of us has ever had a big enough medical issue that could not just be dropped, but I totally understand the problem and in many places, like mine, switching providers will not solve the problem.  There are ZERO private practices in my area so anyone I go to is governed by one of two medical groups that use the same tactics/systems.  I have often wondered if the doctors even know there is no "letting them know" anything!  I mean, THEY go to doctors, right?  Surely they have seen this in action?

Did you explain the issue to him instead of just snorting?  What was his suggested solution?  

[kbutton]

1 hour ago, skimomma said:

I have often wondered if the doctors even know there is no "letting them know" anything!  I mean, THEY go to doctors, right?  Surely they have seen this in action?

I honestly think they are often oblivious to this dynamic. I plan to talk to our pediatrician about the accessibility the next time we need to see him. However, I plan to also interview new pediatricians and have a Plan B before I tell him that accessibility problems are going to sever our relationship if it doesn't change.

My condolences about being underserved. I am from a rural area but don't live there anymore--I am amazed at how they piece things together when it's so hard to get providers. The only silver lining is that the people that stay really want to be there and have been surprisingly highly qualified. I am not sure if your service issues are rural or stem from area-wide socio-economic problems, but I am sorry you're in that situation. 

[Soror]

3 hours ago, skimomma said:

To the OP, I totally understand your situation!  We are in an underserved area and the turnover for doctors is unreal, so we have had to switch family doctors many times.  Several times we have not even been formally handed off to a new provider.....I find out ours is gone by calling the number and being told, "oh so-and-so left 6 months ago...."  We never used a pediatrician but all of our family doctors have been very inaccessible.  Getting an appointment is usually not a problem but any sort of follow up is blocked by gatekeepers.  I actually snorted during my last appointment when my new doctor, who I like, said, "Just let me know if X does not work and I can prescribe Y."  Let you know HOW?  The only way to do that is to make another appointment.  We have high deductible insurance so that is $200 out of pocket to "let her know" something.  There is a patient portal and I have tried this MANY times.  All I get is a follow-up call from a scheduler to make an appointment.  If I call to leave a message to "let her know," again, I get a follow-up call to make an appointment.  We are lucky in that none of us has ever had a big enough medical issue that could not just be dropped, but I totally understand the problem and in many places, like mine, switching providers will not solve the problem.  There are ZERO private practices in my area so anyone I go to is governed by one of two medical groups that use the same tactics/systems.  I have often wondered if the doctors even know there is no "letting them know" anything!  I mean, THEY go to doctors, right?  Surely they have seen this in action?

Yes, so many of the practices are going to the system of outside companies handling all calls. So instead of 1 layer to get through to the doctor there are now 2 and you can't even get through to the clinic itself. It's madenning. The one Ped place I finally had to stop in person as multiple messages they never returned my call. Then even when I stopped in and they said they'd sent in the prescription they didn't and I had to go back in again and not leave until they did it with me there 

[skimomma]

1 hour ago, Jean in Newcastle said:

Did you explain the issue to him instead of just snorting?  What was his suggested solution?  

I did explain it to her.  Her "just let me know" really did mean make another appointment and come in.  That is what she expected me to do.  I explained that would cost me $200.  We came to the compromise of her just writing me a prescription for Y that I could fill on my own if X did not work and that I promised to send a message through the portal if I filled it so it would be in my record.

I think there is also a wide assumption amongst the providers I have been to that people are in PPO type insurance plans so a visit is just a small copay to the patient.  That's a little nuts since the largest employer in the area (which happens to be mine) is high deductible only.

[skimomma]

1 hour ago, kbutton said:

I am amazed at how they piece things together when it's so hard to get providers. The only silver lining is that the people that stay really want to be there and have been surprisingly highly qualified. I am not sure if your service issues are rural or stem from area-wide socio-economic problems, but I am sorry you're in that situation. 

Thanks.  It is both a rural and economic issue.  I have also noted that the ones who stay are good, but even they are starting to leave due to staffing shortages and Covid-rage in the community.  It is a scary situation.  I know many a potential new hire in other local industries has been scared off by lack of available medical care.  It is routine now for people here to travel 4-8 hours to access specialists.  We had to drive two hours to even see the closest orthodontist!  If anyone in my household had special medical needs, I think we would have no choice but to move.

[kbutton]

3 hours ago, skimomma said:

Thanks.  It is both a rural and economic issue.  I have also noted that the ones who stay are good, but even they are starting to leave due to staffing shortages and Covid-rage in the community.  It is a scary situation.  I know many a potential new hire in other local industries has been scared off by lack of available medical care.  It is routine now for people here to travel 4-8 hours to access specialists.  We had to drive two hours to even see the closest orthodontist!  If anyone in my household had special medical needs, I think we would have no choice but to move.

A friend's daughter is mid-way through pre-med, and she's considering underserved areas or the military as a way to get funding for medical school. I am pushing the underserved areas via her mom. 

This is just heartbreaking.

[TexasProud]

4 hours ago, skimomma said:

Thanks.  It is both a rural and economic issue.  I have also noted that the ones who stay are good, but even they are starting to leave due to staffing shortages and Covid-rage in the community.  It is a scary situation.  I know many a potential new hire in other local industries has been scared off by lack of available medical care.  It is routine now for people here to travel 4-8 hours to access specialists.  We had to drive two hours to even see the closest orthodontist!  If anyone in my household had special medical needs, I think we would have no choice but to move.

The other issue with medicine is that it is getting super specialized right now. We need a lot more general people. For orthopaedics, it is rare now for someone not to do a fellowship and specialize in hand, total joints, elderly, etc. I guess we need that. But then you will have situations where there is no ortho to do hand and so they have to go 3 hours away.  A few years ago, a general orthopod would have been fine.

Now in OP's case, a specialist is needed and I guess you could say maybe all of them are needed. But there just cannot be the good access to all of these specialists for everyone. And then you need 5 orthopods (sports, spine, hand, total joint, peds) instead of one. 

[SKL]

We never "had a pediatrician."  But to answer your specific question, I have been able to get our unique questions answered by calling the practice and leaving a message.  The response is relayed through the admin staff, as was my original message.  It's been good enough for us so far.

(I decided to delete my standard long whine about MD practices ....)