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Old 05-19-2017, 06:15 AM   #1
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Question for women

Now that we have ER'd, I'm thinking more carefully about how to manage healthcare costs without risking care quality. Currently I have an OB/GYN as well as a PCP. I'm 56, post menopause. No GYN problems other than a benign ovarian cyst. Keeping both docs vs letting my PCP doc do the GYN stuff is probably a $300-$500/yr cost difference for me, which is very minor to us but I don't like to waste money.

Do you still keep a separate GYN? What are your reasons for doing so or not?
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Old 05-19-2017, 06:35 AM   #2
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There's a long history in medicine of "women's issues" being minimized and us being told we just have to suck it up and deal with whatever crap hand our bodies are currently dealing us. Having a more enlightened attitude is the most important thing to me, so if one doc or the other was better with that, I'd lean towards the one that wasn't going to let me suffer "just because".

If you're thinking about dropping your Gyn, you may want to chat with your PCP about some of the evolving attitudes around menopause, to feel out where s/he is.
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Old 05-19-2017, 06:53 AM   #3
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I used to do a lot of benign gyn care for older women although I was an internist. I don't go to a gyn myself. I also follow the most recent recommendations for fewer screenings.
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Old 05-19-2017, 07:29 AM   #4
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I continue to have both, although my womens health provider is CNM/NP. I actually receive a more thorough yearly exam, lab work and overall health review , plus more time with her than my PCP.
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Old 05-19-2017, 07:45 AM   #5
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Probably discount because she is herself an OBG (for a couple more months), but DW is post-menopausal 56 and goes to only PCP.

/mansplaining
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Old 05-19-2017, 07:54 AM   #6
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Now that we have ER'd, I'm thinking more carefully about how to manage healthcare costs without risking care quality. Currently I have an OB/GYN as well as a PCP. I'm 56, post menopause. No GYN problems other than a benign ovarian cyst. Keeping both docs vs letting my PCP doc do the GYN stuff is probably a $300-$500/yr cost difference for me, which is very minor to us but I don't like to waste money.

Do you still keep a separate GYN? What are your reasons for doing so or not?
I keep both. I'm over 57 and not post menopause yet. I have a history of uterine fibroids, really beyond what a PCP can monitor. My GYN is more of a functional medicine guy and more aggressive about supplements, blood screening, monitoring hormones through transition into menopause, and thyroid issues. And the annual women's wellness exam and tests.

I rarely see my PCP - just for annual checkups/bloodwork and immunizations, but she's there for any little thing that might pop up, and if I need a referral to a specialist.

At the moment I don't mind spending several $100 a year for more comprehensive coverage. Maybe once my uterus shrinks enough and I'm well past the menopause changes I'll reconsider.
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Old 05-19-2017, 08:16 AM   #7
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I only see a PCP. I think it's been years now since I moved from the Bay Area to SoCal. I was too lazy to find another OBGYN. So if I have any problem, my PCP will send me to an OBGYN for surgery. Like a minor water cyst that I had a few years back that needed to be popped. But my PCP is the kind of guy that like to push for more things to get done, not the other way around. He has done may things my previous OBGYN did, I mean no difference. And he is much more pleasant to deal with. But I also don't see him that often, once a year. It's not a cost concern.
EDIT to add, I've been seeing this guy pre-menopausal, now I'm post menopausal. I never had any problem with menopause, I know lucky me.
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Old 05-19-2017, 08:38 AM   #8
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I only go to a PCP. I am post-menopause.
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Old 05-19-2017, 08:49 AM   #9
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I only go to a PCP, but my PCP is female, which is my personal preference for a variety of reasons, not the least of which is being perhaps a bit more understanding/empathy about matters pertaining to menopause, which I'm currently in the midst of.
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Old 05-19-2017, 09:05 AM   #10
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I'm the opposite. I'm 64 and go only to my GYN annually. She orders all the usual bloodwork so I'm not left totally in the dark about other parts of my body, and I get mammograms and colonoscopies on schedule. I'm darned healthy, though, so everything unrelated I've had to deal with over the last 20+ years has been something a Doc-in-the-Box can fix (typically poison ivy) or something where a consult with Dr. Google is all I need (muscle sprains/strains).
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Old 05-19-2017, 09:52 AM   #11
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Originally Posted by Scuba View Post
Now that we have ER'd, I'm thinking more carefully about how to manage healthcare costs without risking care quality. Currently I have an OB/GYN as well as a PCP. I'm 56, post menopause. No GYN problems other than a benign ovarian cyst. Keeping both docs vs letting my PCP doc do the GYN stuff is probably a $300-$500/yr cost difference for me, which is very minor to us but I don't like to waste money.

Do you still keep a separate GYN? What are your reasons for doing so or not?
I think you are doing just the right thing. Personally I'm not seeing an ob/gyn but I should. I just haven't had a pressing reason to do so. Still, maybe one reason for an older person like me to see an ob/gyn is that they do PAP smears and check for ovarian or uterine cancer and so on.
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Old 05-19-2017, 09:55 AM   #12
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They do PAP smears and the same thing as OBGYN. How do you check for ovarian cancer, I thought that's the silent disease. By the time you find out you have a problem, it's too late.
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Old 05-19-2017, 09:58 AM   #13
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I still have both, but my PCP suggested that I have my GYN take over monitoring my thyroid levels and doing my annual prescription for that to save me the cost of the PCP office visit which my insurance doesn't cover at all. (They are in the same large group practice.) I'm considering doing that this year.
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Old 05-19-2017, 10:18 AM   #14
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I've always had just a PCP. I'm 55, post-menopausal, and not doing HRT. My PCP is a woman and seems to take female health concerns seriously.

For example, I dealt with tachycardia episodes for several years, thinking they were just palpitations due to hormone imbalances and would eventually go away. When I mentioned them to her, she thought they seemed unusual and sent me to a cardiologist. Turned out I had an extra electrical pathway in my heart and needed an ablation.

She also noticed a lump on my ovary and sent me in for an ultrasound. It was just a fibroid, but I'm glad she found it and I got it checked out.

She seems on the ball, does my regular pap smears and makes sure I get regular mammograms and such. So I don't have a reason to see a GYN.
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Old 05-19-2017, 10:22 AM   #15
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Now that I am postmenopausal I no longer see a Ob-Gyn. Also the last pap smear you need is at age 65.
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Old 05-19-2017, 10:27 AM   #16
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Now that I am postmenopausal I no longer see a Ob-Gyn. Also the last pap smear you need is at age 65.
Do PCPs not usually do pap smears? Mine always has.
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Old 05-19-2017, 10:35 AM   #17
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Yes they all do. I had a specialist during menopause because I had a bunch of issues.
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Old 05-19-2017, 10:41 AM   #18
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Now that I am postmenopausal I no longer see a Ob-Gyn. Also the last pap smear you need is at age 65.
As long as your last two were negative
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Old 05-19-2017, 10:57 AM   #19
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DW (post menopausal retired RN) still keeps up with both the OB/GYN and her PCP. She feels (and rightly so) that the PCP has enough to look after,and a specialist should be consulted. We have always considered the PCP as the "overseer" of her care and the other Dr look over their specific area (GYN, neuro etc) with the PCP being on top of all meds each Dr is prescribing to make sure no conflicts. The additional $$ of the multi docs is minimal compared to the comfort she gets knowing everything is being watched.

Just a man's 2 cents.
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Old 05-19-2017, 11:12 AM   #20
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I let my primary doc do the pap screening when I go in for a checkup. I'll admit to not going in for a checkup every year... more like when Kaiser nags me that I need a pap and mammogram... I do the one stop shopping since the mammogram/radiology clinic is downstairs from my primary care, right next to the lab that does the bloodwork. I also get an ultrasound every other checkup (about every 5 years) because of my family history of breast and ovarian cancer. (Yes - I tested for the BRCAA gene and I'm negative... but the family history is enough that they want to do imaging just to check since ovarian cancer is often asymptomatic till it's too late.)

I'm not averse to seeing doctors - just don't see the need to go in more frequently.

FWIW - I'm 55 and menopausal

Edited to add: My sister sees her GYN or GYN NP for her checkups. Her GYN NP was able to figure out some issues down there (thinning walls that started during perimenopause) and prescribed a topical cream that solved the issue. Her PCP was great about everything else - but couldn't figure it out... her PCP's wife is the GYN Nurse Practitioner who figured it out.
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