Of course that sped up the process. Docs who in past times would have likely worked into their 70s hung it up before 65 let alone 67. And some smaller independent practices folded under Covid strains to their usual and customary. Staffing was hard for example. Others who felt they had an obligation to their patients and communities to serve during the crisis, and could, are just done on the other side.
But even without the Covid accelerant it would be happening, and has been predicted for a long time: there is simply a much larger cohort of primary care docs of retirement age than there is of newer docs coming in, and the consolidation of healthcare into larger corporate structures (which leaves docs with less autonomy and authority as well as less pay) is decreasing the desire to keep working longer for the fun and satisfaction of it. We are realizing we can still develop hobbies and interests outside of work after all!
Going to urgent care for primary care is a horrible model for many reasons, but what choice do many have? On Peds side we keep schedules open for same day sick*, but even if you have an adult primary care provider you often cannot get an acute visit appointment scheduled for a month …
(That should be an asterisk.) And even then some families just have work schedules that they go the urgent care after hours rather than take off work to make the openings we have.
I had a family PCP for a while and she complained endlessly about how she never signed up for a bunch of insurance and admin bullshit, and she was tired of being a doctor because of it.
I wonder if this affects FM/GP disproportionately. Maybe specialists make enough money to take the sting out of it.
My pcp works with some nurse practitioners who can do same-day sick visits. Or next week “routine care” visits. He’s also salaried and works for a major hospital.
He assures me he doesn’t plan to retire soon, but I’m anxious about it.
For myself and my wife, it’s just easier to do 99% of all our PCP needs through the “in-house” physician on-site at her business. Since they exclusively handle employees on the company health plan and immediate family only, I bet it simplifies their billing immensely.
Of course, that leaves you with the “and what if she gets laid off” worries, but it’s a lot better than the rotating doctors of the closest affiliated PPO option we had in the past where I ended up seeing a different doctor every time I visited for a routine checkup.
Granted, we’re still young enough to not have a great deal of need for dedicated care yet. If we do have a major medical change and/or when we hit 60, we’re planning on serious revisions. Maybe I can finally convince (since they’ll have their kids done/almost done with college by that point) my brother and the sister-in-law to move out of Texas (as I’ve been suggesting for years now) and open a private practice I can impose on!
The analogy I’ve come up with is that of a car dealership. Us doctors are like the mechanics. We’re trained for and enjoy that type of work. If the management of the dealership sends up to the showroom to try to sell cars, we’re not going to be happy about it.
If you are serious I will offer the unsolicited opinion that using close family for medical care is better avoided. Biases come into play that impact objective judgment and how we interact.
Thanks for the concern, no, I was not serious. Just any excuse to get them out of Texas, especially as my sister-in-law is/was an OBGYN specialist prior to being pushed into ever-more administrative work.
For the record though, my brother has done a fantastic job of convincing our father, who is in far poorer health than he wants to admit or tolerate to actually go ahead with the medications, treatments, and surgery that his PCP and specialists recommend. Which considering how stubborn our old man is, is quite an achievement.
OMFG - years back when I was doing Tech Support for a major Cellular company, that’s what killed our department. Ever more demands that we cross sell new services and upgrades, when all I wanted to do was identify problems and FIX them. And of course, they also wanted us to handle overflow of all the customer service calls as well, which, well, considering volume, meant before I left we found ourselves doing mostly customer service because that was the metric the execs were looking at (and it brought in money, fixing issues COST money).
My father, an excellent doctor for others, was mediocre at diagnosing his family. And he used to say that a doctor who treats himself has a fool for a patient. On the other hand he was an awesome medical advocate for his family.
Definitely. Although in my area of nursing home care, they have a clever and nasty work around. They use NOMNCs (notice of non-Medicare coverage) when they don’t want us to do something that is indicated / want us to do something that is contra-indicated. In other words they tell us “you don’t have to send that patient home if they aren’t ready - that’s a medical decision and we don’t practice medicine, but if you keep them in the nursing home we aren’t going to pay you or the facility”.
Back when I was living in Chicago my wife and I found a doctor we liked at a local HMO that was part of my health plan. Then he left and we had to find another doctor at the HMO, but didn’t really care for the service we got. At the next open season I checked into health plans, with the primary criteria being one that our old doctor was a member of. I found him on one of the directories, changed health plans, and arranged for him to be our PCP.
When we had been notified that he was leaving the HMO, we were given no information on why he had left, or how to find him elsewhere. We later found out that he had left because he didn’t like the way the HMO had been pushing him to spend less time with his patients, and that he had not been allowed to tell his (now former) patients how to contact him after he left.
We stayed with him through Patti’s death, and then until I left Chicago. I was lucky enough to find a doctor here in NC who had the same attitudes towards patient care as him, and I’ve stuck with him.
Mine are also. But I noticed that when the dentist is getting ready to retire, and sells some of the practice to a new dentist, they start getting aggressive with upselling and finding things to fix - and fees go up. I don’t have insurance so I’m sensitive to this.
I feel like I have the dental version of Seinfeld’s “rooting for laundry” joke. I just keep going to the same small office, and whatever dentist happens to be running a practice out of it is my dentist.
The State of Hawai’i has a health care provider shortage just about everywhere in the state (certainly on Hawai’i Island, where I live). Our governor is a physician and is implementing a “we’ll pay your student loans” deal to encourage more providers to locate here - so I was interested and disappointed to read @Qadgop_the_Mercotan 's post that the data don’t support this as being effective.
I’m continuously surprised that we have a shortage, because, you know … HAWAI’I. But I’ve asked people why they think it is such a problem, and the usual answer is because our education system sucks, so people don’t want to raise their kids here. I guess that makes sense, but we do have some good private schools (I seem to remember a certain former US president being a graduate of Punahou), so I still find it a bit counter-intuitive.
I wonder if it’s like the “New Zealand problem”. I’ve been to New Zealand a few times, it’s amazing - but I perused a bookstore, the books cost at least double what they did back in (contiental) North America. Cars are all shipped in from elsewhere, travel is expensive unless it’s Australia. My impression was that pay was not as good as some places in North America, etc. basically distance and the cost asociated. (How’s Amazon delivery times/costs?) There was a joke once that it was cheaper to send building materials to remote Alaska communities by mail, since they charged a uniform national freight rate…
I lived in a small town for a while, and you forget how much variety is available shopping in a big city, and entertainment options, etc.
Not sure how relevant this is to some, but I suspect this is a factor driving urban concentration too, and medical professionals are not immune to it. (Perhaps it influences teachers too.)
Retiring is not “disappearing.” A lot of providers are retiring, nearing retirement. One reason for that is the mandatory adoption of EHR (Electronic Health Records.) Providers who graduated after 2015 or so didn’t have much problem adjusting. A lot of older providers where being forced into data entry instead of doctoring. Many of them decided that retirement was preferable.
Then comes the pandemic with all of it’s hardships and changes.
And honestly, medical providers are actual human beings. They have lives, and families and can even have their own health problems. They are not indentured servants, they can actually have days off, and retire or move when they need to. It isn’t all about the patient.
Pretty spot on, and true for all health care providers, not just physicians. In most ways, it is not as bad as it seems - excellent recreation is free, there are no heating bills, and you can save a fortune on dress-up clothes and shoes (and for women, make up) because the dress code is so casual. Cars last quite well, too - accident reports on the Big Island often say something like “A 2006 Nissan Sentra swerved to miss a 2002 Ford truck that had just struck a 2009 Subaru Forester.” As for books, we have a thriving library system and Kindles reduce purchase costs.
BUT - housing is insanely expensive. It’s hard to save enough money on business suits to account for monthly mortgage payments. (Especially if you need to pay for private schooling.)
Amazon delivery is usually fantastic! In my case a prime membership easily pays for itself, as I constantly order stuff through Amazon.