Our experience with doctors this year.

[Ally]

Last year, my husband and I had great doctors, both primary care and specialists. My husband has the retired state employees' insurance and I have one of the largest companies providing service. Last spring, our primary care Dr of 16 years went concierge. I stayed with her, because I have several things that need management. My husband looked for a new Dr. When calling, Doctors would tell him that they would look at his chart and call him in the evening for an interview. Two turned him down, saying that they were restricting their practices. I don't know what the interview was for, except they asked about his weight (slightly over) and high blood pressure. Now he has found someone who is building his practice and only 3 years out of med school. He likes him, so that's good.

I had 4 specialists that I have to see about 2x a year. One sent a letter that he retired, because practicing wasn't practical anymore with all the reductions in payments. Two others said they are no longer accepting our insurance or Medicare either (which I don't have, but will in a couple of years.) The last said that I will be moved to a physician's assistant for my care, unless there is an emergency or the PA determines the Dr's care is necessary. And then he gave me a list of Drs for referral, if I didn't want the PA.

Each specialist sent me my medical records on a disk and gave me lists of names for possible referral. In most cases, the referred doctors live in towns/ cities up to 3 hours away. As it has ended up, I have been able to get into to a local one here for the most important condition. The others, I haven't dealt with yet.

Is anyone else seeing these changes?







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[WhoDaresWins]

This is mind-boggling to me, Ally, and I have never heard any of my friends (who have assorted medical plans) mention it either. I don't know if it is because here in the Pittsburgh area we seem to have no shortage of doctors or what. I have a PCP (who I can see within a day or two usually) and the practice also has a walk-in Urgent Care option after regular office hours. I see an opthalmologist, gynecologist, cardiologist, and dermatologist all on an annual basis and there is never any talk of seeing a PA instead or of cutting back on their practices. I am 60 so not yet Medicare age, and I am covered under an employer-sponsored retiree plan (same as what I had when working only I pay half the group rate now).

[Brat]

Once you turn 65 Medicare is primary even if you have employer sponsored health insurance.

While I didn't have quite the level of issues you are having I did have a problem when I moved after 65, well before ACA - FWIW.

[Ally]

We were in your situation last year, feeling very secure. The specialists I saw were a retina specialist ( the one for whom I found a replacement), a kidney specialist ( who now wants me to see a PA), a urologist, and a gastric Dr. I think maybe my primary DR can take care of my urology and stomach RXs. Not sure what to do about kidney Dr.

We know some area family doctors and they say the insurance companies are really putting the squeeze on them and making them fight for every claim. I don't know how this relates to our situation. All I can say is that it seems like there is a lot of unhappiness in the practice of medicine here.


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[ERhoosier]

Not happening everywhere, but it clearly is becoming an issue in more and more areas of the country. Networks are getting more and more restrictive, particularly for Medicare, Medicaid, and Exchange HI plans.

[John Galt III]

I've noticed some of the specialist practices do have PA's on their websites, in addition to the doctors. Don't know if PA's are considered to be nurses, but my insurance co will not pay for an exam by a nurse and same exam by a doctor on same day at the same location. Have to choose one or the other. So if the PA examines me and I then request the doctor to also examine me, to verify PA, the insurance won't pay for both exams. But I guess the doctor's office could just bill for one exam.

[WhoDaresWins]

So far, none of my friends going on Medicare have had any problems keeping their doctors.

The only reason I keep seeing a cardiologist is because I want to stay in his practice loop so to speak. I only take a low dose anti-HTN drug and have no other heart problems. The gynecologist did not even do a PAP smear on me this year...just did a perfunctory exam, ordered my mammogram and told me he would do the PAP now every other year due to new ACOG guidelines for low-risk women. But I plan to keep going once a year just to keep a file active with his office.

[W2R]

We haven't had any trouble keeping our doctors and I don't know anyone here who has (although since Katrina it has become very hard to get a doctor here if you don't already have one, I'm told). I'm on Medicare as primary, and my federal retiree insurance as secondary. He has retiree insurance.

My present doctor keeps asking me how I like retirement, and grumbling about how he wants to retire. He is very unhappy with the changes in our medical system in recent years. He is in his mid 50's so I suspect it won't be long before he retires. I sure hope I can find another doctor when he does.

In the old days, it seemed like sometimes older, more established doctors would take a younger, beginning doctor into their practice. This probably worked out well for the younger doctor, and it would sure be nice for patients who might then be able to switch to the younger doctor when the older one retires. Unfortunately this no longer seems to be customary in my area.

[Rich_by_the_Bay]

Quote:

Originally Posted by WhoDaresWins So far, none of my friends going on Medicare have had any problems keeping their doctors. The only reason I keep seeing a cardiologist is because I want to stay in his practice loop so to speak. I only take a low dose anti-HTN drug and have no other heart problems...

Just curious as to why you feel you need a cardiologist.

[Walt34]

We haven't experienced any of those issues with the exception of DW's doctor going concierge about 15 years ago. Finding some one new was not a problem.

I am concerned about going on Medicare next year for this reason though. While I will keep the insurance I have it becomes secondary to Medicare at age 65. And I've seen several physicians on this board mention dealing with insurance companies as one of the major reasons they want to or did retire.

[MRG]

One of wife's DRs.(specialist) passed away last year. Difficult to find a replacement, but she found a good one.

My DR. is less happy every time I see him. He's talked and asked some questions about retiring, he knows I ERed. I'd asked about a replacement for him he suggested their new PA, he thinks that's how medicine is evolving. Interesting to me he didn't suggest any of the other DRs. in the pratice.

[Meadbh]

Quote:

Originally Posted by Rich_by_the_Bay Just curious as to why you feel you need a cardiologist.

+1

[jerome len]

Sorry to hear about your problems with finding Doctors. One of the reasons I resist moving it the need to find medical doctors in a new community. Our health care system doesn't take away Doctors IF you had their insurance prior to medicare. And, I've had the same primary Doc for over 20 years and get good referrals to whatever specialist I might need. Am I wrong for believing it would be tough to duplicate medical treatment if I moved to a new area? And, should I worry although I haven't had a hard time getting in to see a specialist as long as I have a referral from my primary Doc?

[longranger]

The entire landscape of medicine is rapidly changing. As a practicing doctor in my later 50s I have the same concerns and potential problems with my own healthcare coverage as anyone else.

First a word on PA vs Dr. IMHO most people are very likely to prefer seeing the PA once they try it. The PA will spend a lot more time with the patient,do a more thorough history and physical, ask more questions etc.. The scope of what they can take care of themselves is substantial and very clearly defined. The modern PA is highly trained and capable. They are trained to essentially do 90% of what a family practitioner does,BUT!! always under the supervision of an MD. Anything that exceeds their scope generates a referral to the MD who then reviews data collected by the PA before seeing the patient. For patients with chronic conditions like diabetes, hypertension or heart disease many find the relationship with the PA is more personal and provides continuity of care over time. All this is a generalization as there is as great a variation in quality of PA's as Drs.

The financial squeeze on physicians is very real. It is far worse in some areas of the country than others. It is most acute in areas with high penetration by managed care, high numbers of patients on medicaid and major uninsured populations(legal and illegal). In the least favorable environments it is only possible to make a decent living by forming very large groups, sometimes over 100 MDs, to share facilities and overhead costs. Unfortunately these large practices are very impersonal. The most desirable Drs. and associated PA's in these megagroups have "full practices" meaning they will not accept new patients unless they meet specific criteria or are VIPs. They often also have a more favorable payor mix than less accomplished colleagues or new group members straight out of training.

Of course as a patient these matters mean little during an acute illness when the patient is simply trying to find good compassionate care from a provider that takes their insurance. I would advise any patient to really examine their insurance options carefully. Know the limitations ahead of time. Re-examine them as least once a year as covered physicians and preferred hospitals are changing constantly. It really is a total PITA for the patient but well worth doing as we get older and need more healthcare.

[Brat]

I think the cost and personal adjustment to electronic medical records is also an issue for older physicians, I know my husband (an architect) rants whenever I upgrade his computer operating system and 'upgrades' to AutoCAD drive him to distraction.

Back in the day a physician would dictate his notes and a medical transcriptionist would prepare a report for the physician to review, edits were made and then the final placed in the patient file. Now the physician must perform that recordkeeping process themselves, typically during the exam. I can understand why many are having issues.

I agree that PAs or a Nurse Practitioners are the way of the future except for acute or complicated care.

Then, insurers are reigning back on fees. Primary care physicians need a raise but the others, I am not so sure that they can expect the same level of income in the future.

[Another Reader]

Next up: Barefoot doctors, like China in the early 70's.

[Buckeye]

Quote:

Originally Posted by longranger In the least favorable environments it is only possible to make a decent living by forming very large groups, sometimes over 100 MDs, to share facilities and overhead costs.

This is a real question and not meant to be snarky. What is a 'decent living' considered to be nowadays for a primary care doctor?

Is becoming part of a large group considered a bad thing? Many other skilled, well-paid professionals work in large groups (i.e. megacorps) and it's considered 'normal.'

[bhoferp]

Instead of fully retiring, my primary care physician is going to 1/3 time along with two other doctors in his practice. I'm glad to be keeping him for a while longer.

[M Paquette]

I don't think it is even a matter of earning a decent living. Running a small practice is effectively running your own business in a trade with considerable overhead, including insurance and regulatory compliance, and practicing medicine on the side. (Not the only one like this. Civil and structural engineering as independent practices have a fair amount of overhead as well, for example.)

With a larger group, folks with the appropriate business skills, including management, marketing, and regulatory compliance can be hired and shared across all the physicians as employees of the group. That can free up time and energy for the doctors to practice medicine as their primary activity.

[WhoDaresWins]

Quote:

Originally Posted by Rich_by_the_Bay Just curious as to why you feel you need a cardiologist.

A few years ago I had some strange sporadic left-sided "hollow" feelings in my chest. I was not on any meds (my HTN is borderline and has been classified by the cardiologist as "benign"). Well, I consulted my PCP first who referred me to the cardiologist. He ran a bunch of tests (all negative) and put me on Vasotec 2.5 mg bid. My father died from a heart attack in his late 70's and my older sister is on 3 meds for her HTN so there is some family history there. I see the cardiologist annually, he renews my medication and sends a report to my PCP. My PCP seems content to keep things this way so I am, too.