No room at the doctors’ office
I’ve been going to my doctor – let’s call him Dr. X – for about twenty years now, and I really really like him. That may not sound so unusual, but for me it is, because I have always loathed going to the doctor; it makes me quite nervous and I’ve had some bad experiences. As I’ve gotten older and health care has gotten colder and more impersonal, my doctor was a real oasis. I would always come back from my appointments saying, “I love Dr. X! I hope he never retires!”
Today I got a message that I need to call the office – which is a large group practice – and reschedule. That’s all it said. It seemed odd and possibly ominous to me because I already have an appointment with him in January. When I spoke to a staff member on the phone, I was told that Dr. X has a serious health problem and may not be coming back to the practice. That was a blow. But a worse blow was that all their doctors have full patient lists and I’m on my own – find a new doctor, and good luck.
I’m well aware that most doctors these days, and certainly most good doctors, are full up and not taking new patients. I just have to start asking around and hoping for the best. There’s also a slim chance that my doctor might be returning. But I can’t rely on that at all and the reality is that he’s pretty long in the tooth at this point anyway.
There’s a silver lining, though. I used to joke that I can’t move away because I can’t leave my doctors. Well, now I can move if I want to. Got any suggestions? I probably won’t take them.
I had a similar experience last year. After years of taking a very common blood pressure med and having the prescription renewed regularly and more or less automatically, I suddenly couldn’t get it renewed. Called the doctor’s office and was told that he had retired. And moreover the practice of which he was a part was now some kind of inapplicable specialty.
“Can you refer me to another practice?”
“No. Bye.”
Couldn’t find another internal med practice that was taking patients. Finally resorted to a med-school-affiliated pool of interns. Not very happy with it. Currently struggling to get the dang prescription renewed again. Grrr
You know the nice thing about ObamaCare is “If you like your doctor, you can keep them!”
Of course, because of ObamaCare my doctor quit, but you know …
Mac:
Unfortunately I think this sort of thing is becoming more and more common. Part of the general decline of quality of life, something hard to measure but very real.
Look into Christian health care networks. That’s what we did when we moved to NW Indiana a few years ago.We went with Franciscan and found our doctors, good doctors, via the network website. Plus there’s a very good Franciscan hospital near us in Michigan City — all my docs are affiliated with it. And, two nights ago I had occasion to be transported by ambulance to the local Franciscan urgent care center. A very good experience. In Illinois my doctors were all in the Adventist network and I was happy with them. I know, I know — Adventists right? But they run a good health care network, including hospitals.
I have a number of friends who are doctors, and all of them are aware of what seems like a sudden shortage. Some are aging out and retiring. Others just can’t stand the “managed care” model.
Meawhile, people I know are waiting weeks if not months for routine medical care–and, in one case, for a critical procedure. It’s bad out there.
At the practice where I go, I rarely if ever see my doctor. Instead I see a clinical physician’s assistant, and I like him very much. He is young, smart, kind, respectful, and very knowledgeable about both traditional medicine and alternative approaches. Several of my friends are happy to be seeing physician’s assistants and nurse practitioners. In my experience, PA’s and NP’s are an excellent choice for primary care. They probably also have more time to keep up with current literature.
I hope you quickly find someone you want to keep seeing.
I have posted about this before, and it’s relevant here.
The chickens have come home to roost.
We once had a good medical system in this country. Medical practice was a cottage industry, with most doctors in private practice. They had the resources and more importantly the desire to do whatever was needed to serve their patients. They would “work you in” if you were acutely ill. If a colleague fell ill, as in this case, they would pitch in, stay an hour later, and take care of the absent doctor’s patients.
It’s different now. We have 60 years of Medicare and Medicaid, EMTALA, work hour restrictions for residents, and a whole alphabet of acronyms which they pretend is to improve “quality” and “value,” but is actually a means of paying the physician as little as possible so they can hire another bureaucrat and write more regulations.
Starting in 2003, residents’ work hours were restricted, and it became a firing offense to take care of a patient past quitting time. Prior to that, it was unthinkable to leave the bedside of an unstable patient. The generation of physicians that trained prior to 2003 is beginning to retire, and many of the docs who replace them are clock-watching technicians who are very smart, very hard working, and very competent, but typically employees of a large corporation that get a salary for seeing X number of patients per day, or generating Y number of RVUs.
RVUs are Relative Value Units, which purport to determine the relative worth of procedures, surgeries, and office visits. You can guess what effect that had on practicing physicians; it came out of Harvard via a CMS contract. Many physicians are now working under the same labor theories as Uber drivers.
It will get worse as the previous cohort of physicians gets eliminated through retirement or “burnout.”
To further ruin your day: https://tinyurl.com/ymxcxbe8
Find a concierge practice if you can, and can afford it. Otherwise, stay healthy.
The Christian health care network idea sounds good, but I have no experience there. I can say that the health care I’ve received since moving here to Texas (Dallas area) from Oregon is better in every way. And I’m on a Medicare Advantage plan, too. I’ve had open-heart surgery and a hip replacement and both experiences have been stellar.
yes, move to Maine. Healthcare here sucks badly, but it is a clean safe and beautiful place to live. Think about it.
As we age (77 now) we dread what happened to you Neo. Happened to my Dad. His Doc left to go to a new hospital network, without telling us. Dad was in what turned out to be his final illness.
We have had Doc retire and have been lucky to find new ones that we like. Earlier this year our Doc left the practice she was in because it was joining a network that she didn’t like. She went with a big Hospital based network. So far so good. Now, all our Docs are in the same network. Info on the network website is shared among them all. Blood work results posted within a day. We have an advantage plan too and like it very much.
I’m looking at your problem soon also. Been going to the same doctor for about 30 years and other family members have gone to him even longer and he is in his early seventies and my sister told me he didn’t seem as sharp (he usually could recite all family members and their medications by memory it was pretty impressive considering about ten of us from four generations have gone to him) when she went to him a couple months ago and she has switched doctors. I’ve looked at the doctors that are in my network and most aren’t accepting new patients and the ones that are mostly are women with names like you can all guess. Maybe they are fine maybe not my mom had some foreign born doctors in her later years that were great and some that were terrible for many reasons ( poor English ranking high). Thankfully I don’t have to go to the doctor more than once a year and and will next go in a few months so will just wait and see.
Here in Manhattan I’m in a similar predicament, and if I find a doctor it will be my fifth in a span of about 12 years. One retired, one went in-house or concierge, two relocated out of the city (one to another state). The few recommended doctors I’ve contacted are either not taking new patients or only taking them in their concierge practice. I’m sure I could find a doctor if I just chose someone randomly, not based on a recommendation, but I’m not desperate yet.
We once had a good medical system in this country.
==
No, we had a medical system with problems, which have since been replaced with different problems.
“No, we had a medical system with problems, which have since been replaced with
differentworse problems.”Fixed it for ya.
Here in NE Florida there are basically two choices: UFHealth or Baptist Health; no independent doctors. After a bit of research BH seemed the better organization. Then finding the doctor by looking over the published bios. My wife found an internist she likes and I found a primary care doctor I really like. She’s a Navy vet, common sense approach, and she’s around 50 so I’ll be gone before she retires.
Art D-
I said it was good. I did not say it was perfect, or without problems.
The previous problems were more individualized- a lot of docs did not keep up, or were unpleasant to deal with. There was always another office down the street, or in the next town.
Now the problem is systemic. As described by neo and others, it’s often extremely difficult to get a doctor at all, and when one is found, it’s logistically impossible to change if the doc is not a good fit for whatever reason.
As G Britain said, worse problems.
Neo et al: I thought at first it was just my bad luck, but have since realized that similar problems are spreading throughout the system. I’m not sure how Obamacare fits into it but the general replacement of individual or small group physician practices by corporations seems to be a significant factor.
Foreign-born doctors speaking just-adequate English seem to be a widespread problem as well. It’s one I have. Every interchange feels like a struggle.
And as we all know left-wing dogmas have really taken hold in medical education. Twenty years from now: “You’re being referred to our psychological staff for treatment of your transphobia. Yes, you can refuse treatment, but be aware that your social credit score may be affected.”
Mac,
‘Foreign-born doctors speaking just-adequate English’
Yep, that was the issue my mom had. She had hearing problems and some of these doctors even I had a problem totally understanding. But we were always concerned that one of these doctors was going to take offense at something she said or did because she didn’t understand the doctor. More than once after an appt. in the car she would ask what he said and she was mentally fine just couldn’t understand.
Mac, also twenty years from now: “But if you’d like referral to a euthanasia clinic, we can arrange that sooner.”
neo writes,
Yes! Absolutely! I notice it in so many places. I’m not even thinking about it, but find myself in familiar places; stores, restaurants, museums, parks… and I notice something is “off.” I start paying more attention and it’s always a degradation. A degradation in service, quality, appearance…
My doctor was forced to retire during COVID. It made no sense and it is a long story of putting profits ahead of patient care, but I won’t bore you with those details. It took me over two years to find a doctor accepting patients who would actually see me.
My first attempt was at a large medical center very near my house. Must be 20 or my GPs there, but only two were accepting new patients and neither could see me sooner than six months.
So, I chose one and made my appointment. Six months out. Two weeks before the scheduled date his secretary called. He has to cancel. Next available slot was in 4 months.
So I set about trying to find a different doctor. Finally found one who could see me. Also had to schedule 4 months out. And he’s about 10 miles from where I live. Nice guy. Foreign, of course. And young enough that he won’t retire in the next few decades.
Best of luck, neo and welcome to the worsification of everything!
Where I am it has been one merger after another. Soon, I think, there will be one corporate health conglomerate and it will draw your blood, write you scripts, and send you home.
My elderly mom has had four PCPs since her long-time doc retired a few years back. She prefers the old-school male no nonsense types, and now the neighborhood practice is, yes, all younger women. Her cardiologist and two eye doctors are also retired.
Do agree with the poster above that PAs and NPs seem to be more cordial and better listeners in many cases, though. Mom saw a PA instead of her rheumatologist last month, a NP in orthopedics last week and will be seeing a PA in cardiology tomorrow.
I don’t particularly like my current doctor, but get most of my care through other specialists. Just had to reschedule due to a surgery and the first specialist opening was May 2024. Considering I am having the condition now and it is interfering with little things like sleep and work, I settled for an 8 AM virtual visit.
Oh yes, this is Boston. Health care hub of the nation. (Right).
My experience – I had a wellness check in April 2022, booked my next annual check up in April 2023 and was given a September 2023 appointment. Office called the day before to say they accidentally booked a ‘sick’ appointment and to reschedule a wellness checkup – first open appointment in June 2024!!
I don’t know why, but it’s been easy for me to find new doctors. My old one that I had seen for about fifteen years retired in 2015. I immediately found a Nurse Practitioner who was very sharp, and I got along well with. She decided to move in 2021 and I immediately found a new doctor. He’s a young doctor and I’ve only seen him twice. I like him and hope he sticks around.
My Nephrologist is a forty something woman, who will be around long after I’m gone. I just saw her this morning. She liked what she saw in my blood work – my kidney function is holding steady. Yay!
My Retina Specialist is also young and will be around long after I’m gone. So, I’m good. Just one lucky old codger.
Maybe we have more doctors per capita here in Washington than in the cities back east. Or maybe I’m just a blind squirrel who found some acorns.
We moved 4 years ago to a retirement community in Kansas just outside Kansas City. There are two doctors and several nurses in our medical center. There also is an excellent set of medical centers and hospitals nearby, such as the St. Luke’s system, and HCA Midwest.
Without a word-of-mouth recommendation, it might be wise to stay away from any physician who graduated within the last 20 years, and certainly 10 years.
See this excellent piece: https://graboyes.substack.com/p/take-your-clothes-off-oppressor
Roland,
Do you live in Meadowbrook? That is one of the most impressive new communities I have visited.
“Got any suggestions? I probably won’t take them.” Heh. Well, here goes, anyway.
I live in Charleston, WV. It is safe, fairly affordable, convenient (I can get to almost anywhere I care to go in 15 minutes or less), has four seasons with no extreme weather, has some of the friendliest people on earth, and has a surprisingly good cultural scene. All in all, an easy and comfortable place to live. My wife and I were looking at a house for sale in our neighborhood recently, and the realtor told us that, with the advent of work-from-home, she is seeing more people move in from other states for just those reasons. In fact, she had just sold houses to people from Texas and Michigan who are going to work from home.
Actually, I am sure that there are other attractive medium-sized cities all over the country that are similar, but they just don’t get much press. You could probably find one you liked with some research, though. Don’t rule them out.
I’ve always used an internal medicine doctor as my go-to. My previous one retired, and was reluctant to sell his practice or make a referral. That’s when I found out (and confirmed with medical professionals) that internal medicine is becoming an arcane specialty. Most internists today are on their way to a specialty, and this is just a way-station to eventually reach the big bucks. Others are ‘hospitalists’, which is to say, internists that work a regular shift, take the paycheck, see new patients every day, and view them as meat with interesting metabolic issues, instead of people. They have no interest in forming a practice, making housecalls, running an office, and getting to know their patients and the finer points of their patient’s long-term health peculiarities.
However – the good news for me is, I found a replacement that is pretty darn good, and pretty darn young (late 40’s). A blue jeans-type guy that doesn’t walk with a laptop, but sits, sifts through the papers, asks questions and listens, before he tells you what he thinks.
Hard to argue that Maine wouldn’t be a better choice over certain other New England sea-coast states starting with M. If cultural attractions are the issue, well distances are but a trifle up there, compared to Texas.
I couldn’t recommend Texas or Florida to a Yankee though, being one, once, long ago.
A timely topic, as AesopSpouse and I have had appointments with all our medical providers since we got home in early October, to make up for being out of town all summer.
When our previous dentist retired about 5 years ago, he passed all of his patients along to a colleague in the same building, who retired a couple of years later and the new dentist just bought the practice patients and all. He is young enough to out live us, has a great staff, and last year replaced a crown for me gratis because he volunteered the info that the cavity developing underneath was because he hadn’t done the first crown correctly. That was a bit concerning, but I would never have known, and all his other work has been quite satisfactory.
My original PCP in Colorado moved after about 10 years but sent adequate notice of the change. I shopped around a couple of years (not a very sickly time in my life fortunately) and settled on a young woman (had her first baby that year) in a practice affiliated with the hospital that had just been built in our neighborhood (5 minutes from our house to the ER when AS had a stroke not too long ago). It replaced a very old campus in Denver that had become unworkable for modern medical practices, and is religiously based (that seems to be a common element in the “good doctor” stories here).
Most of our specialists are affiliated with the same hospital, so all the records are shared, which is very helpful.
Our optometrist is also very good, reasonably younger than us, and expanded his practice over the summer, which is an encouraging sign.
Very happy with all of them.
Let me know if you want to move this way!
Can’t recommend the political climate nearly as much, but it’s not yet as crazy as California.
Here in Hawaii it’s Kaiser Permanente or HMSA (the PPO).
No issues with Kaiser. Been with them through kids and cancer for over 30 years. But I do feel it is up to us to do our research and take ownership of our health care.
In ’21 husband and I switched to a Medicare Advantage plan and a new primary care doc. Kaiser was heavily pushing the vaxx and the new PCP encouraged us to get it. We refused and stated our reasoning. Kaiser frequently sends us updates on the availability of the latest booster but after one mild reminder our PCP has never bothered us about it again.
Kaiser is very big on preventative care and screening. But it does seem as though my PCP is never available to be seen at short notice. He will fill scrips or order tests as requested, which I do online. However, I can always get in to see another doc, NP or PA at short notice or same day for something acute like a sinus infection.
Ironically, my most recent encounter with an actual MD was in emergency when I broke my pinkie finger last month. But all the followup, casting and removal has been with an NP or PA.
Dermatological check ups – too much tropical sun exposure! – are also by an NP.
Last year, after almost 20 years, I decided to have the scarring and displacement from my old breast cancer surgeries corrected. Kaiser came through and it was done by one of their board certified plastic surgeons. Because of a complication it ended up being 3 surgeries. No waits for surgery except for healing between surgery 2 and 3. The total bills were well over $100,000 but my part was under $1,000. I can’t complain. And to tell the truth, when I needed a highly skilled doc – the reconstruction – I got one. Frankly, I’m OK with an NP checking out a funny mole if it lowers the cost of health care.
Then there’s the PPO route. While all the above was going on with me a dear friend had a blackout experience. This woman is very fit and very active so I told her to consult a cardiologist. Her primary doc is her ex husband on the Mainland. She could not get in to see a cardiologist in Hawaii for 6 months! After spell #2 she went straight to the Mainland where she got in to see a cardiologist pal of her ex and a few weeks later had open heart surgery to replace a failing valve.
I think she may have died had she waited to see a specialist in Hawaii.
I don’t really care for the corporatization of medicine but I must say Kaiser has taken very good care of me.
Neo, maybe move to a Kaiser region?
My GP of 20y retired last year. I pretty much wound up seeing someone recommended by the local “good” hospital (the other hospital is a university-run “teaching” hospital, of some non-trivial renown, but still… If I need an experimental treatment, I’ll go there. For anything else, I prefer these guys). It went well enough. They seemed to be pretty competent and very considerate.
My fairly socialistic Slovak doctor care, after tearing my Achilles tendon, has been pretty good and very very cheap. Tho many Slovak doctors and nurses leave for more cash elsewhere.
Before moving, you should try travel to Europe, today. Perhaps a Eurail pass & airBnB or hotels, including Vienna, Prague, Bratislava, and Budapest. Many think Budapest is a good example of responsible nationalism.
Moving in America? Here’s a joke about:
What’s the favorite wine of a Jewish American Princess?
(In a whining voice) When do we go to Miami?
(Homonym jokes are far better heard than read. Writing whine kills the joke)
All stereotypes are (somewhat) true. We need to joke about differences, and be able to be honest about them. So as to be friends with folk who are different, and not need to censor ourselves, including criticizing the “marginalized” for their behavior.
Lately I’ve been thinking about my High School Jewish girlfriend, from another school, who I met in an LA county scholarship competition in January. Really smart! We found out just before graduation in June that she was 2nd, I was 3rd.
I’m pretty sure Neo ain’t movin’ to no Florida, but maybe she should think more about it.
Molly Brown mentioned Medicare Advantage.
My advice: Avoid if possible. It’s great so long as one stays healthy, but they make some of their money by restricting care far more than Traditional Medicare.
You will get some freebies, to be sure, but when it’s time for that MRI or specialty referral or surgery, you will have to jump through many more hoops than Trad Medicare. Advantage programs have contracts with PTs, rehabs, and other ancillary services which means that you will get the service, but the service provider will be the one with the contract, not the one that is best in your area, most convenient, or most available.
The reason that your mailbox and inbox is being inundated with offers for Advantage Program has absolutely nothing to do with the $600 sign-on bonus or the $300 continuation fee that the program gets for each customer, it’s all for your own good (/sarc).
If you’re retired military, you get tossed into Medicare when you hit 65. I found out the hard way that many doctors won’t take new Medicare patients due to the extra paperwork and slow reimbursement. The saving grace is that your secondary becomes Tricare Prime, which usually covers whatever Medicare won’t. But first, you have to find someone who’ll take Medicare.
Remaining in a Blue area because of your Doctors is not something to sneer at as mine saved my life. I have had several Doctors change medical groups or retire and it is distressing. When you find a new primary care physician you have to not only get to know and trust him but also have your medical records transferred and most imprtantly make sure he is in-network with your insurance company.
Stay where your friends are unless you cannot afford it. Moving near proximate relatives is a satisfactory idea. If I understand correctly, yours are in southern California, which is wretched. I assume you have satisfactory social skills in domestic situations and need no suggestions. Just hoping you’re keeping on your daughter-in-law’s good side. Your mission, should you choose to accept it, is to inveigle your son to move near you without offending your daughter-in-law.
We have two hospitals here in town–one is Catholic and the other was a non-profit. .About 6 or 7 years ago the non-profit was taken over by a “for profit” company. My doctor moved back east after telling me “I made more money here working for a non-profit than I do now working for a “for profit” company. In the years since two more doctors have come and gone. Recently all the male doctors left. It seems the female in charge of this local hospital is not well qualified to manage such a large system. I have heard this from two male doctors so there must be an issue there. However, not to worry every position has been re-filled by women. Most of these women are Doctors of Osteopathic medicine.
Please correct me if I am wrong. It is my understanding that a DO does the same pre med study in undergraduate school (B.Sci), they also study alongside MD students for four years of medical training at a medical school. However, rather than doing a more intense one-year internship in a traditional medical field they switch over to a school of Osteopathic medicine to study those principles for one year. Whereas another doctor would go on to a more focused study of some traditional medicine for that year.
It is interesting in this town now run completely by women, that only women doctors are being hired to fill empty positions, and almost all of them are DO as opposed to MD. I would love to hear your thoughts about this. If you have more info about DO please post. I am trying to stay unbiased.
Lots of good doctors and hospitals here in Charleston, SC. In part because of good overall quality of life.
Anne-
MDs and DOs study the same pre-med courses. As a general rule, with a LOT of exceptions, the average pre-med would prefer to go to an MD over a DO school. There is a lot of overlap between the academic qualifications of MD and DO students, but on the whole MDs are a step above DO students in their GPAs and MCAT scores. Curricula are similar, but DO students have extra courses in musculoskeletal manipulation that most forget the minute they graduate, and roll their eyes when asked to discuss it.
Residency training is more important then where a doc goes to med school. Many residencies are now mixed MD and DO; the Match Protocol that sorts graduating medical school students into residencies is open to both without any difference. The primary place where DOs are at a disadvantage is at MD academic centers.
DOs go into primary care at a higher rate than MDs. They like to say that primary care is their mission, but some of it is that specialty residencies can be very competitive and MD students typically score higher on the exams used to sort them out.
All that said, if anyone followed 100 MDs and 100 DOs around their hospitals and clinics for a month, it would be difficult to tell them apart without ID badges.
I have had excellent care from both MDs and DOs, and they are close enough in practice and qualifications that it should not be a factor in choosing a physician, if you’re lucky enough to have a choice.
Anne; West TX Intermediate Crude:
In my personal experience, DOs tend to be nicer and just as knowledgeable as MDs, on the average anyway.
Mr. Bill: Charleston, WV, home of the famous “Charlie West” (CRW) airport. Famous among airline pilots, anyway. It’s one of those “special airports” that requires a pilot who has landed there be in the crew when you make you first approach and landing there.
“The layout of Yeager Airport is once again trying for pilots.
************ The lone runway at this humble facility is positioned atop a plateau with a shear, 300-foot drop-off.”
It’s listed as one the six scariest airports in the U.S.
https://www.worldatlas.com/places/america-s-6-scariest-airports.html#Yeager%20Airport,%20Charleston,%20West%20Virginia
I landed there a few times back in the day. Of course, I was an old carrier pilot, so was used to challenging approaches and landings. Still, I remember it much more so than the routine airports.
Thank you WestTXIntermediate. Much appreciate the details.