Choosing a new doctor - MD, DO, PA, FNP?

[mountainsoft]

We just signed up on an ACA plan and need to choose new doctors. I've had a PA (physicians assistant) at Kaiser for many years and have been happy with him. But I'm not sure how all the different designations rank when searching for a new doc.

MD seems the obvious choice, but I haven't seen many locally, most aren't accepting new patients, and those that are have really long wait times.

Even PA's seem fairly slim and overbooked.

My wife just chose a DO doctor, which I've read is similar to an MD? I might choose the same doc, I'm not sure. Of course, she's booked out to mid-December too.

There's also an FNP doc available at the same clinic, but I don't know how good they are for basic care.

For basic routine doctor visits (aches and pains, colds and flu's, prescriptions and vaccinations, etc.) does it really matter what letters they have after their names? Personality matters a lot.

 

[Philliefan33]

For routine visits, I’ve had more luck with PAs and NPs. They seem to not be as rushed as the doctors in the office. If I had a complex medical issue I might prefer an MD.

PAs are trained in the medical model, meaning they treat the disease. NPs (FNP stands for “ family nurse practitioner”) in the nursing model, meaning they treat the patient. To get into NP school, one needs a BSN and at least a year of experience as an RN. To get into PA school, you need a bachelor’s degree but you won’t have direct patient care experience since you haven’t been licensed. PAs and NPs usually specialize in a specific area. For example, my DD is an NP who specializes in cardiac care and works in a hospital. My nephew is a PA who works with a neurosurgeon in his office and pain clinic. At a family practice you are going to encounter PAs or NPs who specialize in internal medicine/family medicine.

PAs and NPs can do the same things (there may be slight differences in prescribing rules, depending on your state of residence). Each need to be affiliated with an MD or DO, usually working in the same practice. In Pennsylvania, the providers that staff the Minute Clinics and such in the drugstores are NPs but I don’t think PAs are allowed to do that.

 

[OldShooter]

If you're shopping anyway I suggest that you see what concierge medicine programs might be available to you. We have been in one such program for five years or more and are very happy with it. There are essentially no wait times for appointments ("What time do you want to come in?") and everyone is on a first-name basis. There are three docs and one of them is always carrying a cell phone that we can call 24xl7 as needed. They monitor what's going on with our other doctors or when one of us in the hospital. They will also make house calls and hospital visits if necessary through we have never needed this.

When we were shopping we found that there was absolutely no standardization of offices, services, prices, or interaction with insurance and Medicare. Our docs are in a physically separate area of a large care organization, so we have instant access to all kinds of resources. Only two chairs in the waiting room and I have rarely seen anyone sitting there. Other programs we looked at were sometimes just one doc. So if you decide to investigate you'll really have to do your comparison shopping homework. It's kind of a BTD option but what a more important thing to spend on?

 

[tutan]

We just signed up on an ACA plan and need to choose new doctors. I've had a PA (physicians assistant) at Kaiser for many years and have been happy with him. But I'm not sure how all the different designations rank when searching for a new doc.

Mountainsoft, is Kaiser not available under ACA in your state? I signed up with Kaiser in California.

 

[Ian S]

My last two PCPs have been DOs and I've been very pleased with both. They seem to be willing to spend a little more time explaining things and answering questions. I have not had a PA or NP for primary care but have been seen by both when it was short notice and the doctor was unavailable. The experience has been generally good but there was one occasion when a couple of them were perplexed by my problem and finally called in the doctor. He immediately made the correct diagnosis of a neuroma and referred me to specialist.

 

[pacergal]

I have had experience with all.
NPs work independently, and have MDs in the practice to consult with.
PAs work under an assigned MD, who oversees their work.
In my experience, NPs and DOs have had a more holistic approach.

OP--ARE you not able to still sign up for Kaiser and keep your PCP? Kaiser is available through ACA in Oregon, my son has it.

 

[mountainsoft]

Tutan and PacerGal.

Yes, Kaiser is available on the ACA exchange here, but it costs more this year than other plans in our area. Kind of surprised me as they have always been one of the more affordable options (before we signed up with ACA).

So, we went with Regence. Cost less, better coverages.

 

[Act2]

I’ve had good and bad MD’s, good and bad DO’s (mostly good), good and bad NP’s and PA’s. They are all credible professionals. Patient experience varies more depending on the individual provider than title, in my experience.

 

[Out of Steam]

I've had all four for primary care at different times, with reasonable results.

The best was a DO. The Nurse Practitioner was just fair, though I have been seen by very good NPs in other settings. I have an NP monitoring medications for mental health issues right now, and it is working well. My daughter, who is often impatient with medical people, is doing well with a PA I recommended to her

My fairly new MD seems promising in my first two visits with him.

 

[REWahoo]

A few years ago an RN and her spouse bought the house across the road from us. She was working on her MSN when Covid hit and I just happened to have an unopened box of N95 masks I had purchased from a bargain bin to use when mowing. I offered them to her as I knew how important they were for medical personnel and they were almost impossible to find at the time. She was very appreciative and started checking in with us every week or two to be sure we were OK.

She completed her MSN, passed her certification as a NP, and the practice she worked for opened a new office in our area with her as their first NP. DW and I were some of her first patients in what has turned out to be a very busy clinic. We get near concierge care from her as she insists we text her directly whenever we need an appointment, prescription refill, have a question, etc.

She is the best "doc" we've ever had, by far.

 

[braumeister]

For basic routine doctor visits (aches and pains, colds and flu's, prescriptions and vaccinations, etc.) does it really matter what letters they have after their names? Personality matters a lot.

That's my view of it. I've used every possible type of medical practitioner and never noticed any difference based on their credentials. General practice or specialty is the only real differentiator, so I just find someone I'm compatible with and hope they don't retire too soon.

 

[OldShooter]

We are in a concierge program. The office has three MDs, an RN, and an LPN. Our PCP is one of the MDs but get get shots and work administrivia from the RN or the LPN. Everyone is on a first-name basis.

The concierge program is within a large health care organization (including several hospitals). Our feeling when we signed up was that only the best staff would be assigned to the concierge program. In maybe five years we have always felt that to be the case. So ... no selection process necessary.

 

[Car-Guy]

Since I really don't know any of them, and since they are all licensed to practice, I pick them based on their "years of experience", medical school credentials and on line reviews. I prefer those that have been in practice at least 20 years but have gone to some with less. If I find on my first visit that I don't like the doctors demeanor, I'll drop them like a hot rock. I have switched later too because I lost confidence in their judgement. Right now I like my PCP. He doesn't push me into things and listens to me. OTOH, I see a specialist that is on shaky ground with me and I'm considering switching or at least getting a second opinion.

 

[braumeister]

The last couple of times I've needed a new PCP I found that many were happy to schedule a 10 minute "meet & greet" conversation to let me see if we were compatible. I found that really useful and was able to conclude a couple of those meetings in less than five minutes.

 

[friar1610]

We are in a concierge program. The office has three MDs, an RN, and an LPN. Our PCP is one of the MDs but get get shots and work administrivia from the RN or the LPN. Everyone is on a first-name basis.

The concierge program is within a large health care organization (including several hospitals). Our feeling when we signed up was that only the best staff would be assigned to the concierge program. In maybe five years we have always felt that to be the case. So ... no selection process necessary.

Are you on Medicare? And a supplement? If so, what are the mechanics of using Medicare/Supplement in a concierge practice. (If you have a link to an explanation that would be fine).

Thank you.

 

[OldShooter]

Are you on Medicare? And a supplement? If so, what are the mechanics of using Medicare/Supplement in a concierge practice. (If you have a link to an explanation that would be fine).

Thank you.

Well, the first thing to know is that there is no standardization of concierge programs. When I was shopping, I ran into a couple that would not deal with insurance at all. Strictly patient-pay. Another thing is that Medicare has some strict rules to keep providers from billing patients additional amounts beyond what Medicare pays. So the legal designs vary, but where the concierge bills medicare, the concierge contract is carefully written to keep the patients' payments from looking like payments on illegal billings.

All that said, we are on Medicare and a BC/BS Advantage program. As far as I can tell, when we get some service from the concierge group, they bill BC/BS just like any doctor visit and we get the usual wad of incomprehensible paperwork. It's totally friction-free for us.

 

[braumeister]

Are you on Medicare? And a supplement? If so, what are the mechanics of using Medicare/Supplement in a concierge practice. (If you have a link to an explanation that would be fine).

This is how one such program (MDVIP) handles it:
Frequently Asked Questions - Patient Memberships - MDVIP

 

[youbet]

All that said, we are on Medicare and a BC/BS Advantage program.

Did you mean to say that you are on Medicare and a supplement (not Advantage). You're not allowed to be on traditional Medicare and an Advantage plan simultaneously, or so I was told. Or maybe "Advantage" is the name of that particular BCBS supplement and not Medicare Advantage?

 

[OldShooter]

Did you mean to say that you are on Medicare and a supplement (not Advantage). You're not allowed to be on traditional Medicare and an Advantage plan simultaneously, or so I was told. Or maybe "Advantage" is the name of that particular BCBS supplement and not Medicare Advantage?

Well, maybe we are not technically on Medicare then. I don't follow the details of this stuff.

 

[friar1610]

This is how one such program (MDVIP) handles it:
Frequently Asked Questions - Patient Memberships - MDVIP

Thanks very much. Very interesting. I remembered that I have a friend in FL in a concierge practice. I think I’ll find out how his plan links up with MEDICARE and TRICARE (the supplement for military retirees).

 

[ShadowBloom]

I'm expecting my PCP to retire soon. One new doc I considered has closed his regular panel but is open to "about 100" concierge patients. I asked, and his fee is $5,000 per year! That's way more than I'd be willing to pay now, but also, I can't see how a mixed concierge/regular patient setup can offer fair treatment to either. Has anybody else run into this?

 

[OldShooter]

We pay $5K/year for the two of us. In addition to the concierge program, this office also runs the company's "Executive Health" program. In maybe 5 years we have never seen any interference from this alternate clientele. The key to this is probably that the docs are never trying to see four patients per hour. Our concierge appointments are typically scheduled for an hour and I'd guess the Executive Health appointments are similar.