# Is My Primary Care Physician's Practice, er, Normal? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [April 25, 2016, 9:41pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128 "2016-04-25T21:41:43Z")\ **Posts on this page:** 17\ **Page:** 2
**Author:** ![Lsura](https://avatars.discourse-cdn.com/v4/letter/l/7993a0/32.png) [@Lsura](https://boards.straightdope.com/u/Lsura)\ **Post date:** [April 26, 2016, 5:00pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/21 "2016-04-26T17:00:19Z")
> [@Qadgop\_the\_Mercotan](#): > > I can do 90% of my patient’s healthcare needs. And I hate that so many generalists like me and my fellow internists are reduced to ‘triage’ for systems and patients that demand a specialist for everything. > > That’s what I love about my job; I get to practice to the level of my skills. And my skills are pretty high, frankly. And breaking the referral habits of my new minions by saying ‘we can do that here’ is fun. And this is part of why I wanted a true primary care physician. I hoped I was getting one when I switched to Major University Hospital, but I learned that lesson - everything there was a referral or another drug. I love that I was able to talk to the doctor I’m seeing now, bring in my home BP monitor so we could compare it to the office readings - and then recommended that I buy a new one because the cuff was too small and my readings were a good 10pts higher with it. And I loved that it was a conversation that ended with “buy the new cuff. Take some readings. If your numbers, especially in the afternoon, stay where they are (~140/80), start taking this new med along with the one you’re currently on. If they drop as I expect them too with the new cuff, feel free to hold off taking it. But pay attention to the afternoon readings in particular.” ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [April 26, 2016, 5:25pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/22 "2016-04-26T17:25:58Z")
> [@Qadgop\_the\_Mercotan](#): > > That’s pathetic. > . Yep. I totally agree. But some idiot insurance company got this idea about “managed care,” and 10 minute appointment windows, and here we are. Beats me how any of this actually saves money. Not to mention the increased chances for adverse medication issues when there are too many cooks in the kitchen. ---
**Author:** ![Caffeine.addict](https://avatars.discourse-cdn.com/v4/letter/c/f475e1/32.png) [@Caffeine.addict](https://boards.straightdope.com/u/Caffeine.addict)\ **Post date:** [April 26, 2016, 5:45pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/23 "2016-04-26T17:45:57Z")
I go to a practice associated with a hospital and medical school. For sick visits, you can get urgent care where you are seen usually by a young Dr. For regular appointments, I see my physician who has been in practice for a while. The visits are usually fairly quick, maybe 20 minutes. Follow ups are shorter at maybe ten minutes. ---
**Author:** ![BeeGee](https://avatars.discourse-cdn.com/v4/letter/b/b5a626/32.png) [@BeeGee](https://boards.straightdope.com/u/BeeGee)\ **Post date:** [April 26, 2016, 6:08pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/24 "2016-04-26T18:08:28Z")
I’ve been with my doctor for 25 years. His PA has been there for 20. I’m perfectly comfortable seeing her instead of him. A few years ago, BCBS decided we could self refer to specialists. That’s saved me a nice wad of cash and time since I have to see my sleep doctor twice a year. He’s moved to a different practice and boy am I glad to see the back of his old office staff. If they answered the phone, I swear you got a bill for $20. ---
**Author:** ![treis](https://avatars.discourse-cdn.com/v4/letter/t/bc79bd/32.png) [@treis](https://boards.straightdope.com/u/treis)\ **Post date:** [April 26, 2016, 7:07pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/25 "2016-04-26T19:07:58Z")
> [@Qadgop\_the\_Mercotan](#): > > That’s pathetic. > > In my practice as a Family Medicine specialist, I do rashes, up through biopsying them and even treating psoriasis with methotrexate; I do CV stuff, ordering stress tests, managing heart failure and stable angina (with referrals for procedures when necessary), don’t send my renal patients to nephrology until they’re stage III renal failure (if the etiology of their disease is understood), rip out the toenails of my own patients with ease, manage moderately severe asthma and COPD on my own, handle chronic liver failure, and combinations of all those diseases. I can do 90% of my patient’s healthcare needs. And I hate that so many generalists like me and my fellow internists are reduced to ‘triage’ for systems and patients that demand a specialist for everything. > > That’s what I love about my job; I get to practice to the level of my skills. And my skills are pretty high, frankly. And breaking the referral habits of my new minions by saying ‘we can do that here’ is fun. If we cloned you many times and started sending rash patients to QtM-A, heart patients to QtM-B, renal patients to QtM-C, etc. we would expect each clone to get better in their area of expertise. Collectively, they should be better than the same number of QtM clones working as you do. So it’s not pathetic to have problems addressed by specialists. It’s simply a different strategy for distributing work. ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [April 26, 2016, 7:09pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/26 "2016-04-26T19:09:03Z")
> [@Mama\_Zappa](#): > > Yeah, it sounds strange to me. I mean, I have zero issue with seeing a nurse practitioner for routine stuff, or nonroutine stuff like, say, an asthma flare. But to _never_ see a doctor, and to have the NP not treat _anything_?? Then why are you even going to that practice, since they aren’t _doing_ anything? > > I’m a firm believer in having the primary care doc do most routine maintenance stuff - I go there first for any oddball symptoms; I’ll go there for followup after an evaluation by a specialist if the condition isn’t something the specialist NEEDS to be hands-on for, and so on. For example when my asthma was misbehaving a few years back, I visited a specialist a couple of times, ruled out some stuff, and went back to the primary care doc for the ongoing management. > > The one practice where I do NOT see the doctor - ever - actually annoys me a bit. It’s a specialty sleep clinic (I have an assortment of sleep / wake issues, and they really ARE a bit outside the purview of a general practitioner - I personally found that I knew more about the topic than my primary care doc). I saw the doctor there once. Since then I’ve seen one of their on-staff physicians’ assistants. I’d think they’d have me see the doc every couple of years just to check in but oh well. Well I used to go because they prescribed the drugs I need to maintain health. But now that my heart doctor is handling almost all of that, I guess I should think about that a little more. They do see me quarterly and conduct yearly exams and look for general health issues. But they never treat them. ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [April 26, 2016, 7:10pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/27 "2016-04-26T19:10:29Z")
> [@dizzee\_dee](#): > > To the OP, you probably can request to see only the MD. But that will likely increase your wait time for the appointment. Instead of a week or less, you might wait a month for an appointment. I suppose I could but the nurse told me that it’s the clinic’s policy to never prescribe painkillers. Which is also kinda weird, to my way of thinking, which is why I thought the DEA getting all up in doctor’s grills might be the issue. ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [April 26, 2016, 7:11pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/28 "2016-04-26T19:11:46Z")
> [@MandaJo](#): > > Just for clarification . . .the only reason I see my doctor is for a sinus infection once every 18 months to two years. Ecen for something like that, they’d refer you? Because if I got refered for a sinus infection, I’d be livid. I dunno, never had such a problem. But I was taken aback over the referral for a skin rash. ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [April 26, 2016, 7:13pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/29 "2016-04-26T19:13:23Z")
> [@kayaker](#): > > I’ve discussed this issue with my PCP. He handles my hypertension meds and that is it. If I come in with a rash, he sets up a derm referral. Joint pain? Ortho referral. Gastrointestinal issues? Internal med specialist. All of this without any real exam, other then asking about symptoms so he can route me correctly. > > According to him, it’s the way his group practice wants him to do things. Ten minute appointments; volume, volume, volume. Sounds very much like my practice. ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [April 26, 2016, 7:21pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/30 "2016-04-26T19:21:00Z")
> [@Qadgop\_the\_Mercotan](#): > > So come sign up as my patient, **Evil Captor**! You’ll get the majority of your healthcare right from one spot, from myself or my associates, generalists all of us! > > Caveat: I refer out all the psychiatry stuff. I’ve read your posts, Qadgop, I’d love to have you as my doctor, but there is the little circumstance of where you practice, i.e., in jail. Other than that, if you take CoventryOne, maybe we can work something out! ---
**Author:** ![Johnny\_Bravo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_bravo/32/493_2.png) [@Johnny\_Bravo](https://boards.straightdope.com/u/Johnny_Bravo)\ **Post date:** [April 26, 2016, 7:24pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/31 "2016-04-26T19:24:59Z")
My GP is a crusty old dude who handles all my stuff personally and doesn’t hesitate for even the slightest moment to refer me to a specialist if he feels the need. I really, really like him. On the other hand, my Endocrinologist is a PA-C and I really like her, too. If your needs are being taken care of then so much the better. If I was going to the OP’s office, I probably would find a new doctor because I’d feel like I was getting shuffled around way too often. I don’t want to go to a specialist unless I feel like my PCP has truly exhausted his or her options. If I complain to my doctor about back pain, I would not expect his first move to be to refer me to a pain management clinic. OP: when you make an appointment, have you tried making it with your actual doctor? I have a recurring 3-month visit with mine and it’s always with him. I only see a nurse if I have to go in for something quick and he’s not available short-notice. ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [April 26, 2016, 9:54pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/32 "2016-04-26T21:54:20Z")
> [@Johnny\_Bravo](#): > > My GP is a crusty old dude who handles all my stuff personally and doesn’t hesitate for even the slightest moment to refer me to a specialist if he feels the need. I really, really like him. > > On the other hand, my Endocrinologist is a PA-C and I really like her, too. If your needs are being taken care of then so much the better. > > If I was going to the OP’s office, I probably would find a new doctor because I’d feel like I was getting shuffled around way too often. I don’t want to go to a specialist unless I feel like my PCP has truly exhausted his or her options. If I complain to my doctor about back pain, I would not expect his first move to be to refer me to a pain management clinic. > > OP: when you make an appointment, have you tried making it with your actual doctor? I have a recurring 3-month visit with mine and it’s always with him. I only see a nurse if I have to go in for something quick and he’s not available short-notice. Obviously not, as i have never met the doctor. I suspect I have not been referred to the doctor because I don’t have any serious ailments that aren’t already being treated by a specialist (I had a cardiologist before I sgned up with the clinic, which I mainly did because the insurance company I had at that time was an HMO and insisted I have a primary care physcian. Basically all I have had is minor complaints, because the meds I take to keep me healthy are working, along with my own semi-stringent health and diet regimen. ---
**Author:** ![lisiate](https://avatars.discourse-cdn.com/v4/letter/l/f05b48/32.png) [@lisiate](https://boards.straightdope.com/u/lisiate)\ **Post date:** [April 26, 2016, 10:06pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/33 "2016-04-26T22:06:56Z")
> [@dizzee\_dee](#): > > To the OP, you probably can request to see only the MD. But that will likely increase your wait time for the appointment. Instead of a week or less, you might wait a month for an appointment. Wait, I thought such long wait times were the preserve of socialised medicine systems where the limited amount of doctor’s time has to be rationed? My family’s last three doctors visits in New Zealand. Me - I had a lump on my leg from a collision playing soccer that hadn’t gone down in a couple of weeks - rang doctor’s at 9 (hadn’t been in a decade), was seen by doctor at 11:30. Cost $31 Wife - wasn’t feeling well over the weekend - went to the all hours medical centre which her GP is affiliated with on a Sunday morning, was seen by a doctor within half an hour. She’s pregnant so no charge. Two-year old son - has a bit of a cold, rang GP in the morning, was seen at 2pm that afternoon. He’s under 6 so no charge. Waiting a week fro a simple GP appointment is just unheard of here. ---
**Author:** ![Doug\_K](https://avatars.discourse-cdn.com/v4/letter/d/b5ac83/32.png) [@Doug\_K](https://boards.straightdope.com/u/Doug_K)\ **Post date:** [April 26, 2016, 10:29pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/34 "2016-04-26T22:29:40Z")
> [@WhyNot](#): > > Yep. I totally agree. But some idiot insurance company got this idea about “managed care,” and 10 minute appointment windows, and here we are. Beats me how any of this actually saves money. > > Not to mention the increased chances for adverse medication issues when there are too many cooks in the kitchen. When I am king of the world, any insurance company that tries to dictate what treatments are available will be prosecuted for practicing medicine without a license. ---
**Author:** ![Ranger\_Jeff](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ranger_jeff/32/2065_2.png) [@Ranger\_Jeff](https://boards.straightdope.com/u/Ranger_Jeff)\ **Post date:** [April 26, 2016, 10:57pm UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/35 "2016-04-26T22:57:11Z")
My PCP has CRNPs (Certified Registered Nurse Practioners). My visits go like this: 1. RN calls me in from the waiting room, weighs me, takes my temp, leads me to the exam room. B. CRNP comes in, asks me questions, takes my bp, consults/fills in the chart (on an iPad), writes orders for tests and prescriptions. III. PCP comes in, we chat a bit, he reads the chart, looks me over and listens to my heart and chest, looks at the orders/scripts the CRNP has written and signs them. If my insurance didn’t require it, the PCP probably would have been a no show. :: shrug :: ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [April 27, 2016, 12:12am UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/36 "2016-04-27T00:12:06Z")
> [@WhyNot](#): > > Yep. I totally agree. But some idiot insurance company got this idea about “managed care,” and 10 minute appointment windows, and here we are. Beats me how any of this actually saves money. > > Not to mention the increased chances for adverse medication issues when there are too many cooks in the kitchen. Really I understand the desire to beat up the boogeyman of “managed care” but none of this has ANYTHING to do with any insurance company idiot deciding on 10 minute appointment windows. The odd practice model described in the op is one of the last gasps of a small independent practice, trying to survive by milking and milling things the best they can. The variety of large group models have squeezed them out of the market and there is no possible way for them to compete for managed care contracts or even be part of them in any way that makes sense for anyone involved. Those contacts are going to large organized groups of physicians minimally collaborating with other parts of the delivery system to provide care that be measurably demonstrated as high quality and of value on population level metrics. Unable to be part of that some of them instead try to survive by leveraging mid-level providers to provide volumes of quick visits. Succeeding in medicine today both in providing the best possible care and financially means functioning as part of coordinated teams, with each member of the team functioning at the top of their skill sets as much of the time as possible. Mind you mid-levels have roles in value based compensation systems too, but not as referral sieves. Value would have been either avoiding the visit and sending directly to the specialist if it is clear that such care will not be handled at the office, or having a PCP who can and will handle the stuff that PCPs are trained to handle. Of course only a few of the larger systems (including university systems) are managing the doctors well. (The common errors are forgetting that doctors are actually motivated both by doing _good_ as well as doing well, irrational and/or unachievable incentives, and not taking proper advantage of our competitive natures). Hence many are not hitting those quality and value metrics too well. I am of the belief that doctors will be best motivated if they own that which owns them, i.e. in large multispecialty medical groups that are owned by those physicians practicing within it. They need to literally own the process and understand that care delivery is a team sport. Gawd, why _be_ a doc if all you are going to do is refer out? ---
**Author:** ![Morgenstern](https://avatars.discourse-cdn.com/v4/letter/m/f9ae1b/32.png) [@Morgenstern](https://boards.straightdope.com/u/Morgenstern)\ **Post date:** [April 27, 2016, 12:20am UTC](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128/37 "2016-04-27T00:20:57Z")
Whenever I make an appointment, I see my MD, a board certified Internist. I go to the nurses clinic for things like flu shots, BP checks, etc. What amazes me is how my MD remembers things, not just medical things, but things like my dog’s name. [Previous page](https://boards.straightdope.com/t/is-my-primary-care-physicians-practice-er-normal/753128.md?page=1)