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.”
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.
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.
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.
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.
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.
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.
I dunno, never had such a problem. But I was taken aback over the referral for a skin rash.
Sounds very much like my practice.
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!
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.
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.
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.
My PCP has CRNPs (Certified Registered Nurse Practioners). My visits go like this:
- 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 ::
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?
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.