The logic is - if they are capable of handling all these things in a pregnant woman, they are certainly capable of handling them in non-pg women.
H hears his ob-gyn peers complain to them that business is down and then he asks them if they do flu shots. Well, no. They are just letting their patients walk to a PCP for flu shots they are perfectly capable of administering with minimal effort. Sometimes doctors aren’t very bright!
Some PCPs don’t do flu shots any longer. I would assume its because they are easily obtainable at any pharmacy for not much $. I imagine there’s not much money made in providing them. Heck, I can stop by and get one in the grocery store on my way to the deli counter.
The health care climate is very competitive and each system must stay cutting edge. There is a lot of pressure on docs to perform - literally to see mega amounts of patients in a short amount of time. Just like someone who is not a doctor (most of us), doctoring is a job and if you’re associated with a health system, your job climate might be only as good as your health system is - and is to you.
Contrary to what many think, being a doc is not a walk in the park or the ticket to wealth. Finding the right fit at the right time may require job changes - just like we do!
Oh, man. At a certain age, it’s tough enough to get an OB/GYN who wants to deal with even gyn, much less give flu shots. JME.
H & I have been with the same family practice for 25 years. There are about 7 doctors in the practice. About 4 of them have been there since we started. The other 3 or seem to be a rotating crew. Thankfully our doctor has stayed. He’s a great diagnostician, easy to talk to, and accessible. The office decor hasn’t been updated since the 70s (dark paneled examine rooms with harvest gold countertops). The front desk people are sometimes cranky. Nonetheless, we love this practice. Our doctor is probably in his late 50s and I hope he doesn’t retire any time soon. I’ve teased him that if he leaves, I will reinstate house calls…I’ll show up at his house with my sick self.
93 year old dad was recently asked who was his PCP .
Answer: I don’t have one. That’s why I’m 93.
Well, that isn’t entirely true (he has a great heart doc) but I do know many people who do not have a regular doc.Dad is actually doing well doctor-wise.
I don’t have a regular doc since mine retired. Guess I’ll wait for something to go wrong and then hunt the specialist which seems to be the norm these days. Or land in the ER and see who they refer me to.
My H had a great doc but then the doc went “concierge” on him.
An ER nurse said she had gone through three docs in 6 months–two went out of insurance circle and the other one who was supposedly “accepting new patients” couldn’t give her an appointment for six months. And since she was actually SICK–she didn’t want to wait. So either got a doc to write her a script or went to the walk-in clinic. She was still looking for a regular doc.
I had a doctor I loved who went into a concierge-type practice and accepted no insurance. Theoretically, I could still stick with this doctor and submit the charges under my high-deductible PPO. I have very complicated medical issues, so I thought it would be worth it. However, it turned out to be totally untenable because the charges for tge visits were so much more than the insurance company would reimburse or would credit to the deductible or out of pocket max. So, for example, a $900 visit would have $150 credited to the deductible. Plus, he had a cadre of super high-quality specialists that he refered to who were all on the same type of program. My out of pocket expenses one January were in the $30K range and I hadn’t even met my $6000 deductible according to the insurance company. It was completely unsustainable. Sadly, I had to find other care and my health has suffered.
My previous doctor to that one was by far the best doctor I ever had – concierge-level service at normal charges // but he tragically died in an accident.
My husbands doctors seem to rotate. I’ve had the same one for 10+ years, but I seem to either get sick at weird times - hello kidney stone on a saturday night or I see a specialist - in my case, ortho, urologist, gynecologist oncologist. I see the pcp for my yearly thyroid check.
Theoretically, the advantage of having a PCP is that s/he can direct you to the correct kind of specialist if you need a specialist. Theoretically, s/he can also keep track of all of your medical care so that if two different specialists prescribe incompatible care (e.g. different drugs with have bad interactions), the problem can be noticed.
“Some PCPs don’t do flu shots any longer. I would assume its because they are easily obtainable at any pharmacy for not much $. I imagine there’s not much money made in providing them. Heck, I can stop by and get one in the grocery store on my way to the deli counter.”
For my H’s philosophy, It’s not so much about making money on the shots per se as it is about bringing them in for a visit and keeping himself top of mind. While they are there he can inquire about the “hidden problems” - eg are you having bladder issues, how is your mood, what are the stressors in your life, etc. He works with / refers to specialists the same way as a PCP would. The downside of course is the 24/7 for all of this stuff in addition to the women in labor! Do you REALLY need to call at 2 am because you’ve had constipation for a week? Yes, apparently!
My Gyn told me he could no longer prescribe thyroids meds, he was backing off to only do OBGYN stuff 
And now he is gone so I have to decide if I want a new one.
Dh & I have seen the same PCP for >15 yrs. He’s about our age and we hope he does not retire before dh retires and we move. Over the years we’ve realized he is not the sharpest knife in the drawer. On the other hand, he has no ego problems and is open to collaborating. If I question one of his recommendations, he’s willing to discuss the matter and doesn’t get all huffy unlike other doctors we’ve known. The only downside is that he sold his practice to a hospital group and now is their employee. That means more red tape and rules. He’d prefer to go back to being just a country doctor, but that wasn’t paying the bills.
I think some of the turnover I’ve experienced for my family relates to @silpat’s point about private practices vs. hospital groups. Pretty much everything around me is now part of one of two hospital groups in my area. It gives the PCPs more flexibility and less skin in the game which probably leads to the turnover. That’s why I think it might just be what I have to get used to going forward if we stay in this area.
What a complicated issue these days! I have gone through 4 primaries in the last 20 or so years. Two, who were very good, assertive and through family practice Drs, quit due to not being able to stand the demands of practice in the computer age. One, a part timer who was a professional musician as well, felt that her 20 hour a week job was essentially 40 hours, which is better than the 60 hours expected with full time practice. But the constant demands of the on line era wore her down. The second in the same practice, similar. One was too far away geographically. The new one, is a young woman who seems to be settled with young kids at home. I miss having a Dr. my own age, but want someone to see me into senior years and can remember me as something besides a old woman.
I work with Drs and know a number who have gone to being hospitalists rather than maintaining a practice as it can be more compatible with family life and allows some dedicated time off.
Pizza Girl’s H sounds like a treasure. For many years an OBGYN was my primary. When I had a head injury, I felt I had no one to turn to for advice, so switched to family practice.
I’ve been going to the same PCP every year since 1981. But my guess is he is about to retire (my dentist too). I’ll probably switch to the PCP my daughter goes to here…if she takes Medicare patients. Some don’t!
Dentist is in a large group. I already have my new doc there.
Eye doc retired…and my new one is about ths same age as my son. At least I know he won’t retire before I die.
For many years my OB/GYN was my primary Dr. She was a 1 person operation and it was a pleasure to go to her. Her receptionist knew who you were when you called. When she decided to cut back her practice she decided she could no longer be a primary care provider. She also decided to not contract with the major insurance companies. I saw her for several years till I needed. Surgery that she no longer did. She referred me to an excellent internist and a younger excellent GYN who did my surgery. The GYN is on my insurance. She is great but she is extremely busy. My internist took my insurance till Anthem decided to not have her be a preferred provider for individual plans. I see her anyway. Most of the other options on my insurance are with a large clinic. My internist is a 1 woman show. She answers email, sits and talks with you during your appointment. She is also a great diagnostian and is great at figuring things out.
My main complaint is that when Anthem decided to lump all the private PPO policies with California Care they severely reduced the number of independent practioners who are preferred provider in my city. My internist, urologist and dermatologist are no longer on my “list”. I continue to see the internist and urologist and pay the out of network charge. I have a long complicated urology history and I don’t want to start over.
My H doesn’t have a Primary Dr. When he needed a pre-op prior to neck surgery my internist did me a favor and saw him at short notice.
I don’t know if I would go to a PCP who can’t be bothered to administer flu shots. That seems very short sighted.
I haven’t lost a doctor in forever. My primary is in the Internal Medicine department of one of the big medical groups here. Over the years I’ve occasionally seen one of the other internists or PAs, so if mine left, the rest aren’t strangers at least.
All of my specialists are in the same big medical group as the primary, so every doc knows what every other doc is doing. I’ve come to value that a lot, and I have good rapport with all of my doctors. I actually feel better cared-for than when I was going to a bunch of unconnected private practices.
Docs seem to be playing musical jobs–just trading around from one to another that they think won’t have the problems their last job had. H is a geriatrician who recently changed jobs. It’s complicated, but when you spend 40+ hours seeing patients, and another 30+ feeding the medical records monster, week-in, week out, not to mention calls, not to mention never being “off” for 8 1/2 years, and your company is managed by MBAs who know nothing about medicine, but just want you to go faster/make more money by milking the codes to the edge of whatever is legal and won’t trigger an audit. . .when you’re an old guy who can’t type very fast, who refuses to type in front of elderly patients because they think it is rude when the doc pays more attention to the machine than to them, but the management says, “All other docs do this. . .what’s the matter with you?” Well, it’s time to see if the grass is greener somewhere else. H asked for a scribe, he asked for assistance with new patient loads from nursing home/rehab, but out of state management refused/wouldn’t listen. The sad/ironic thing is that in order to replace H, they had to give new doc what H asked for, plus even more perks, and more $$. H was one of the top docs with that company for nearly a decade and they wouldn’t do anything to keep him/thank him for service. Just doubled the work-load and stood over him with a whip. But they had to pay up to get someone to take that job. Then, as soon as H was hired by another local hospital, his new boss asked him if he’d consider taking not the urgent care job he was hired for, but the job another geriatrician quit to take H’s job! A lot of people don’t have primary docs any more. Many just go to urgent care because their docs are booked up. Or they are generally healthy people who never go to the doc. (Except for colonoscopy, I haven’t been to the doc since the last time I was pregnant.) H is still looking for a “better” job. He is not cut out for urgent care. (He likes long-term relationships with patients. His patients loved him and were devastated when he left–he misses them and feels bad about leaving, but the job was killing him.) OTOH, I (and the kids) love his new schedule. He never brings work home. He has actual days off–3 or 4 a week. Never on call. He knows a lot of docs who are changing jobs. Bigggest issues are medical records/administrative pressures.
Thanks for your post, @atomom. It hits on some of the stuff I think I am witnessing. One doctor I loved left and had complained about the medical record pressures.
“when you’re an old guy who can’t type very fast, who refuses to type in front of elderly patients because they think it is rude when the doc pays more attention to the machine than to them,”
I’m not elderly (at least I don’t like to think so in my early 50s) but this bothers me as well. Some docs can do it well, but I had one specialist who just typed away staring at his computer the whole time. It was very impersonal, he wasn’t a good listener and it came across as zero bedside manner. My current PCP(an older doctor) takes notes the old fashioned way, doesn’t rush, but I’m sure she has to spend much time later typing things into the “system”. Funny thing is, I’ve seen mixed reviews on her. She has an accent and comes across a little abrupt, but I appreciate her directness, the time she takes and her old school ways.