“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.)”
atomom, your husband is a gem. I can completely relate to why he left the practice. My hubby is not a doctor, but the endless influx of silicone MBAs who know nothing about his industry make him want to quit.
“Bigggest issues are medical records/administrative pressures.”
No kidding. It is business school 101: the NPV of hiring a scribe is > 0. It is a freakingpositivenpvproject! Take it. My hubby calculated how much $$-wise it costs the company to have a group of 5 PhD scientists to wash their chemical glassware and to keep the lab tidy. It was way more than $20/hr it cost to have a part-time lab assistant to do the same tasks.
The medical care cost monster and desire to limit fraud drives third party payers (government and private insurance companies) to require lots of record keeping. But that helps drive up costs even more.
Medical care spending in the US has passed $10,000 per person per year, and is expected to continue growing faster than general inflation.
I am very nervous. My favorite doctor is retiring next June at age 71. I just got him to promise to help me find a replacement. He’s a Pulmonologist but has helped me with cardiac, GI and swallowing issues as well as allergies, occupational medicine and infectious diseases (and had me see excellent specialists in all of these fields). I will miss him terribly and am hoping that he will find me a good replacement (especially since he wasn’t pleased with the team of docs I found on my own so far this year). Have been flying to see him in Denver for 16 years.
H and I have been going to the same internal medicine medical practice for the past 30+ years. It is a 2-MD partnership with no NPs and both docs are in their 60s and we have no idea how much longer they will keep practicing. We sure hope they will find us excellent docs when they retire.
My allergist is a dear friend and I’ve been seeing her for about a dozen years. She is nearly 60 and I have no idea how much longer she plans to practice. I’ve been seeing my OB/GYN about 12 years–believe he’s in his 50s or so and no idea when he will retire. My ophthalmologist is in his late 50s–have been seeing him a few years.
Atomom - this is why my H is a dinosaur, solo private practice, and will not join any of the big multi specialty groups around here. He wants to give the level of service he wants and not be bound to a corporate structure or have to answer to someone else administratively. He works way longer hours than those in the groups, but he also gets to keep what he earned.
I am always surprised to hear when someone says “I tried to make an appointment with an OB-Gyn and the next opening was two months out.” If you call H, he will make time for you right that day or the next. So what if that means he comes in early or stays late? It’s called a work ethic. He routinely sees patients at the office even on Sundays. People are so gobsmacked by this that they tell all their friends! On his “long days” at the office he might see 40-50 patients. He runs in between exam rooms but once he is in a room, he acts as though he has all the time in the world. We always get lots of homemade treats, etc from patients. We had one patient make a Northwestern quilt for our son (seriously) and another had her artist father do pencil drawings of our kids and framed them (she secretly took pics of our kids off H’s desk and gave them to her father, lol).
He’s now delivering the babies of some of the babies he delivered when he first started out. And some of those were women his father delivered. A lot of twin moms go to him since he had twins himself (well, OK, I did the brunt of the work on that one, lol). But he can’t keep up this pace forever. He’s going to go full blast 24/7 for the next few years then collapse. His personality won’t enable him to go half way or part time.
It drives me nuts how doctors sit there with their laptops when they’re treating you.
A word to anyone without a primary…it can be VERY difficult to find a doctor who will take a new medicare patient. Be sure before you get on Medicare, like a year or more ahead of time you find someone you like. When my mom came to rehab with me after a hospital stay for a few months not a single group in 3 counties would see her. I begged my doctors nurse to let her see a NP.
Thanks, BB. The downside is that if/when a patient leaves him (for a reason other than moving out of town), he takes it so personally. I have to tell him - get over it, some people aren’t going to like your style and that’s how life goes! He’s extroverted and gregarious. I wouldn’t go to him, lol, since I want an all-business, in-and-out relationship w a doctor.
I wonder if this depends on your location? I moved my mother and had no problem finding a new PCP. (Granted this is about 7 years ago…or maybe I just got lucky?). Never have an issue with finding specialist either…(which I’ve done plenty of times since then)
I haven’t seen that problem here (California), but then again, I don’t go to the doctor very often. Last time I was in for a physical though, I remember my doctor complaining quite a bit about Obamacare and how it will/is affecting many of the physicians he knows in more populated areas.
I don’t think salaries are the only issue here. I think many doctors just feel overworked and underappreciated. Top surgeons in some fields are making well over $500k a year… The problem is they have no time to enjoy it.
All of the legal issues/liabilities these days probably don’t help the situation either.
I have lost 2 PCP’s between 2009 and 2015. We are in the Philly area. The first was middle-age-ish and moved to another state (retirement friendly) with her physician husband, I believe to take a research opportunity. The second one, who I was just getting comfortable with, is young and left this suburban practice to go to a center city teaching hospital where she is practicing and teaching residents. My H started with a homeopath 3 years ago who was hugely successful in getting his reflux under control without OTC medications. He paid out of pocket for his visits, which was ok for us because we are self-employed and have a high deductible plan/HSA account. He got a letter 2 months ago saying that she is moving her practice out of state. So yes OP, my experience matches yours. I have been dragging my feet about looking for a new PCP, wondering how I find one I click with who won’t leave in the next few years! And the homeopath will be even harder to replace. I’m also in the market for a new GYN for both me and my daughter (mine is close to retirement), so it’s all a mess for our family right now!!
@fractalmstr, PCPs reimbursement rates are very different from a specialist’s reimbursement rates even if they see the same problem.They have very different billing codes.
If I see a dermatologist for a cyst and she freezes it, she can charge 2-4X times what a PCP can charge doing the identical procedure.
We lost our PCP when she joined a different insurance network. Our new PCP, we’ve had for two years now. We run into trouble when looking for a specialist. Our HMO network is narrow, and quite frankly, I have not been very impressed with the specialist providers we’ve been referred to.
For one of our kids, we are going out of network for care, which means paying out of pocket because there is “no” out of network coverage (for all practical purposes).
There are definitely some things I like about the new health care law, such as not charging more if you’re sick, not denying coverage if you’re sick. Some things I don’t like is the coverage is so expensive, and on top of it, we have to pay for health basics like dental and vision for the entire family.
We definitely don’t feel like we have a “relationship” with our PCP. Not like the old days when I was a kid!
We have not lost our PCPs, but my H and S find it very hard to get an appointment for urgent matters (sore throat, rash, etc) … they are told to go to the medical group’s urgent care, which is not close (and always has a REALLY LONG wait). My PCP will get me in with the PA or NP for that sort of thing, but holy cow, do you have to schedule an annual exam early (like a year early). It’s really, really hard to get in with her, because you have to have an exam before you can be seen for anything.
D has several friends who recently graduated from med school. Some went in wanting to be GP or family physicians. All became specialists, instead. The bottom line is money. We need to somehow subsidize PCPs … loan repayment, rebate of tuition, higher reimbursements, or something.
I agree with @Midwest67 about the relationship being different than in the past. H and I left a PCP we had for years, because he stopped listening — too much of a hurry, I guess. We are fortunate to have found PCPs we like, but it was hard to find them (and hard to get in for the initial visit).
^^
When the ACA first took effect it offered grants to med students and PA residents who promised to remain in primary care. Saved my kid $40K in loans.
She loves primary care and a bunch of the patients prefer her to the doc.
IMO the only folks who have relationships with their PCPs are folks who go to see them often. I see my PCP once a year–thankfully, I don’t have any chronic illnesses or minor issues that require medical care. I don’t think my PCP would even recognize me outside of the office. I don’t particularly like to make chit chat with doctors–mostly I want the smartest doctor who can solve my problem.
I tried to make an appt yesterday for my PCP to sign some forms for me to use my medical equipment on the plane and the staff begged me to just fax or leave the forms and he’d sign them and I could just pick them up because he’s swamped covering for his partner who is on vacation for 2 weeks. He normally will fit me in whenever I need him, that day or the next.
He is very caring and sees multi-generations of many patients–eg, my folks, me and my kids. He does make eye contact but also uses electronic medical records. He says the EMRs have added many hours to his daily work.
We have no idea what folks will do when he and his partner retire. They have a huge practice and no young docs or NPs they are training.
My favorite Pulmonologist just gives me his undivided attention and hand scribbles notes and later writes up a very thorough electronic clinic notes and summary. He is the most thorough and amazing physician I know, bar none. He sees very few patients (due to his other varied duties being chief of medicine and running two large research labs) and I am very grateful to be among the few he chooses to continue to see and treat. When he retires, he will have been treating me for over 17 years and is the reason I’m still alive.
“. I don’t think my PCP would even recognize me outside of the office. I don’t particularly like to make chit chat with doctors–mostly I want the smartest doctor who can solve my problem.”
I don’t either. H gets a kick if his patients recognize him at the grocery store, etc. In those situations, I smile and make nice-nice but truth be told I don’t like it all that much. The problem is that then they feel they can call him and just go on and on about their issues at all hours. Obviously women in labor are a different story but if I had a nickel for every woman who decided that she needed to refill her birth control at 10 pm on a Saturday night (to start on Sunday) I’d be rich. Really? You couldn’t have figured that out a couple of days ago?
