This could fit on a few boards, but because I think it got much worse during Covid, I'm dropping it here....

I'm middle age, and I've only had a couple primary care doctors over the years. The first one I could get in when I had a need for an un-planned visit. It seemed like he kept a certain percentage of his appointments open each day for people who got sick overnight (or over a weekend) and needed to see someone as soon as possible. My current one I've been with 7-8 years. He was always harder to get into for unplanned visits, but since Covid it has become virtually impossible to see him in under two weeks. The office offers to be seen by the PA, but it is becoming hard to see even her.

With all that said, it seem like PC doctors are trying to push all 'unplanned' visits to urgent care and similar facilities. I've had friends/family members have similar experiences with their doctors. Are any of you seeing the same thing? If so, what do you think is causing it?
- Shortage of doctors?
- Some side effect of Obamacare?
- More money can be made booking as close to 100% of your appointment slots as possible, so they've made the choice to not take 'walk-ins'.
- Some other reason or combination of reasons?

They are all employees now, instead of owning their own business.

So I can somewhat answer this.

1) most pcp are employees now, the scheduling is not something they are doing and the corpo people 100% want them 100% booked

2) people have exactly ZERO loyalty to their doctor as a group. Wait to long? Gone. $5 extra? Gone. 5 minuet longer drive? Gone

3) Pcp pay is just bad Unless your pushing people through the shoot. Ty are are very few fields that have CUT pat as a routine course over the last 40 years but medicine gets a cut every year unless congress specifically stops it.

4) COVID - lots of the older guys just… quit. It will take decades to replace them if we ever do.

5) Respect - the vast majority of patients don't know the difference between an np, an md, or a stump. And where is on your pretty hard.

The_Thinker said:

---

So I can somewhat answer this.

1) most pcp are employees now, the scheduling is not something they are doing and the corpo people 100% want them 100% booked

2) people have exactly ZERO loyalty to their doctor as a group. Wait to long? Gone. $5 extra? Gone. 5 minuet longer drive? Gone

3) Pcp pay is just bad Unless your pushing people through the shoot. Ty are are very few fields that have CUT pat as a routine course over the last 40 years but medicine gets a cut every year unless congress specifically stops it.

4) COVID - lots of the older guys just… quit. It will take decades to replace them if we ever do.

5) Respect - the vast majority of patients don't know the difference between an np, an md, or a stump. And where is on your pretty hard.

---

Interesting post. Thanks.

I knew that COVID drove some retirements, just like in every field.

The_Thinker said:

---

So I can somewhat answer this.

1) most pcp are employees now, the scheduling is not something they are doing and the corpo people 100% want them 100% booked

2) people have exactly ZERO loyalty to their doctor as a group. Wait to long? Gone. $5 extra? Gone. 5 minuet longer drive? Gone

3) Pcp pay is just bad Unless your pushing people through the shoot. Ty are are very few fields that have CUT pat as a routine course over the last 40 years but medicine gets a cut every year unless congress specifically stops it.

4) COVID - lots of the older guys just… quit. It will take decades to replace them if we ever do.

5) Respect - the vast majority of patients don't know the difference between an np, an md, or a stump. And where is on your pretty hard.

---

Good info. But this was written like a doctors rx script....hard to decipher...

Don't even get me started on how hard it is to see a family practice doctor.

Over 50 days in the hospital since April and still cannot see one until next May

That doesn't particularly surprise me. I basically just tried to space out a flow of consciousness.

Urgent care and the ER has replaced the PCP. I haven't been to one in almost 8 years.

Doesn't help that medical school is damn near impossible to get into if you're a white, straight, male

The ACA reforms highly "encouraged" PCPs to be part of overarching "healthcare homes." The thought was that it could increase efficiency if patients were being treated under one roof for everything. The goal was to increase communication and collaboration between specialties.

The paperwork requirements alone for billing and other regulatory things make it basically impossible for a primary care doctor to make good money working on their own. It's not unheard of but it's becoming increasingly rare.

Because these doctors now work for big companies instead of in independent or semi-independent practices they don't have the flexibility to squeeze patients in like they used to be able to do.

It's also very difficult to get a PCP.

Your insurance company says that there are hundreds in the area that accept your plan.

Call to schedule an appointment you get:

We no longer are taking new patients
We no longer are taking new patients for that plan
We no longer accept that plan …

I finally found a doctor that took the plan. But when my wife tried to see him it was the same. He eventually did take her since I was seeing him.

Apparently a lot of doctors have retired and few are replacing them.

And of course on top of all of that you have a lot of doctors retiring and medical school has become insanely expensive, way more than it even used to be. Primary Care does not pay well. It's the same thing the criminal law system is dealing with right now. People go to school and spend six figures on these specialty degrees and they simply can't afford to be primary care doctors or public defenders or prosecutors.

The pay just isn't good enough so there's a shortage.

DrEvazanPhD said:

---

Doesn't help that medical school is damn near impossible to get into if you're a white, straight, male

---

At the time of my head injury in 2020, my PCP was in private practice, but after seeing him a couple of times, he changed the arrangement at his office. It's called consigliere practice, where you get to see the doctor anytime all year long, as long as you pay the $2000 annual fee. Otherwise, you get to visit with the nurse practitioner. I wasn't about to shell out that kind of money for a couple of visits a year, so I got the alternative.
She had no idea what was wrong with my head, so she noted it as an unexplained headache, prescribed Tylenol with codeine, and sent me on my way. Turned out to be a severe subdural hematoma. Many of you know the rest of the story.
My point is that had I been in the University Health system as I am now, this never would have happened. I would have been sent to the E.R. immediately instead of having to wait 5 weeks to get there. My present PCP said, at my first visit with him, that I am a walking miracle. He showed me the imaging from my injury where a fifth of my brain cavity was fluid, pushing my brain over to the left.
Sadly, he is so busy that our visits are rushed and last about 5 minutes, but I get my concerns addressed. Needless to say, I dropped the other doctor because they did nothing for me in a crisis.

StandUpforAmerica said:

---

This could fit on a few boards, but because I think it got much worse during Covid, I'm dropping it here....

I'm middle age, and I've only had a couple primary care doctors over the years. The first one I could get in when I had a need for an un-planned visit. It seemed like he kept a certain percentage of his appointments open each day for people who got sick overnight (or over a weekend) and needed to see someone as soon as possible. My current one I've been with 7-8 years. He was always harder to get into for unplanned visits, but since Covid it has become virtually impossible to see him in under two weeks. The office offers to be seen by the PA, but it is becoming hard to see even her.

With all that said, it seem like PC doctors are trying to push all 'unplanned' visits to urgent care and similar facilities. I've had friends/family members have similar experiences with their doctors. Are any of you seeing the same thing? If so, what do you think is causing it?
- Shortage of doctors?
- Some side effect of Obamacare?
- More money can be made booking as close to 100% of your appointment slots as possible, so they've made the choice to not take 'walk-ins'.
- Some other reason or combination of reasons?

---

I needed to go to the doctor one time with a serious infection and was told that they were booked up for the next week.

So I took a couple of books and a clipboard with some paper and went to the doctor's office and sat in the waiting room until they were available. I arrived shortly after noon and didn't get in until about 7:30 pm, but I got in.

One look at the infection and they got busy calling the pharmacy across the street which closed at 8 pm to send them the prescription and to make sure that they would wait a few extra minutes for me to be able to pick it up before they closed.

That's a bit dramatic.

I feel like we are being pushed to virtual care, not urgent care. We hit the virtual care saying we have a fever. They then send us to get lab tests and then call in prescriptions. I kinda like the system and then book any regular checkups with my pcp.

Our kids doctors office started a subscription plan. So you pay an annual fee for preferred status for all sorts of things. Like when it comes to booking appointments last minute or time slots on Saturdays. Then they instituted a bunch of fees for services. So if you need a prescription refill, you have to pay. But if you are preferred, the fee is "waived." Their reasoning is that insurance companies are paying less so they have to generate more income.

Needless to say people are upset.

Tanya 93 said:

---

Don't even get me started on how hard it is to see a family practice doctor.

Over 50 days in the hospital since April and still cannot see one until next May

---

PCP may be bad, but it is nothing when compared to seeing some of the specialists.

Tanya 93 said:

---

Don't even get me started on how hard it is to see a family practice doctor.

Over 50 days in the hospital since April and still cannot see one until next May

---

Sounds like we are moving towards the Canadian model.

Once the Dems get control and end the filibuster, it's Medicare for All. Gonna get real fun then. That's a 30% haircut for doc reimbursements right off the top.

slaughtr said:

---

They are all employees now, instead of owning their own business.

---

Not me. I own my own business. Check it out at dermdocsbmt.com.

As in most cases regardless of the topic, the cause of changes is never just one thing. My "specialty" is health IT and EMRs, so allow me to throw a few other things on the pile of challenges for PCPs:

• CMS (aka Medicare and Medicaid) has tried multiple incentive strategies over many years to boost adoption of EMRs, interoperability, and coordination of care across the entire provider landscape. Make no mistake, effective EMR systems are expensive in terms of FTEs as well as financing. Independent PCPs are often at a disadvantage. Merging or acquisition by a larger provider with its own EMR system is sometimes an attractive option.
• Reporting requirements for quality of healthcare are difficult enough with specialized software and staff. Again, independent PCPs are at a disadvantage.
• As mentioned above, patients have little incentive to be loyal to their PCP. So which PCP gets the performance contract benefit for a patient when multiple PCPs are involved? Roster management is more important than ever for independent PCPs to keep the patients with good measure numbers.

I could go on. In general, the enemy of affordable, quick, and effective healthcare is overregulation by both governmental and nongovernmental agencies. A lot of older physicians have consequently decided to retire early due to these burdens. Who will replace them?

G Martin 87 said:

---

As in most cases regardless of the topic, the cause of changes is never just one thing. My "specialty" is health IT and EMRs, so allow me to throw a few other things on the pile of challenges for PCPs:

• CMS (aka Medicare and Medicaid) has tried multiple incentive strategies over many years to boost adoption of EMRs, interoperability, and coordination of care across the entire provider landscape. Make no mistake, effective EMR systems are expensive in terms of FTEs as well as financing. Independent PCPs are often at a disadvantage. Merging or acquisition by a larger provider with its own EMR system is sometimes an attractive option.
• Reporting requirements for quality of healthcare are difficult enough with specialized software and staff. Again, independent PCPs are at a disadvantage.
• As mentioned above, patients have little incentive to be loyal to their PCP. So which PCP gets the performance contract benefit for a patient when multiple PCPs are involved? Roster management is more important than ever for independent PCPs to keep the patients with good measure numbers.

I could go on. In general, the enemy of affordable, quick, and effective healthcare is overregulation by both governmental and nongovernmental agencies. A lot of older physicians have consequently decided to retire early due to these burdens. Who will replace them?

---

And I am 69 and do not want to retire until I can not work.

Most derms I know are still business owners. PCP, not so much.

Everyone was warned about government intrusion during the Obamacare debates. The government ****s everything up because policies are built to better them, not us. Stop voting for more government.

dermdoc said:

---

G Martin 87 said:

---

As in most cases regardless of the topic, the cause of changes is never just one thing. My "specialty" is health IT and EMRs, so allow me to throw a few other things on the pile of challenges for PCPs:

• CMS (aka Medicare and Medicaid) has tried multiple incentive strategies over many years to boost adoption of EMRs, interoperability, and coordination of care across the entire provider landscape. Make no mistake, effective EMR systems are expensive in terms of FTEs as well as financing. Independent PCPs are often at a disadvantage. Merging or acquisition by a larger provider with its own EMR system is sometimes an attractive option.
• Reporting requirements for quality of healthcare are difficult enough with specialized software and staff. Again, independent PCPs are at a disadvantage.
• As mentioned above, patients have little incentive to be loyal to their PCP. So which PCP gets the performance contract benefit for a patient when multiple PCPs are involved? Roster management is more important than ever for independent PCPs to keep the patients with good measure numbers.

I could go on. In general, the enemy of affordable, quick, and effective healthcare is overregulation by both governmental and nongovernmental agencies. A lot of older physicians have consequently decided to retire early due to these burdens. Who will replace them?

---

And I am 69 and do not want to retire until I can not work.

---

Same here, but I suspect that it is likely that I will end up having to retire at some point so I am making plans.

My plan is to spend my retirement relearning all the math I have forgotten and learning the math that I should have learned the first time, but didn't -- I don't think that I ever had a math course where we went all the way through the textbook, so I'll have plenty to learn.

By the way, a couple of years ago, I announced that I would retire the day before I turned 100 so that I can have a big retirement party one day and a big birthday the next day.

The best response -- how many years are we going to have to keep paying you after you're dead?

lj801 said:

---

Tanya 93 said:

---

Don't even get me started on how hard it is to see a family practice doctor.

Over 50 days in the hospital since April and still cannot see one until next May

---

PCP may be bad, but it is nothing when compared to seeing some of the specialists.

---

I am seeing a kidney/liver specialist next Friday.

That one was surprisingly quick.

I am now seeing a new Primary Doc next April. Will still keep calling every week to see if there are canceled appointments

I lost my hearing in my right ear 24 years ago. I have been having some issues with my left ear and call my PCP every week until my appointment in 6 weeks. Standby list for ENT, urgent care twice with no diagnosis.

Life with 1 ear is annoying, I don't want to think about what may happen

Thanks Obama

Getting harder to see an actual M.D.

Likely you'll see a nurse practitioner first.

NPs are not medical doctors, but they think they are.

I only see my PCP now like 2x a year for routine medical check in, run the basic blood works and reup my prescriptions for the next 6 months. Everything else i either schedule with a specialist or go to a walk-in clinic for things like a sinus infection or ear ache. Telemed works too for those but getting a refill or followup when first fix didnt work sucks ass with telemed. Rather see a doc in person i can walk in a chat with if I am paying the same amount. Now if its after hours time, telemed is great for things I dont need to be seen in person for.

Finding a good and non burned out PCP is a diamond in the rough. Hang on and be thankful if you find one.

Our primary care stopped seeing sick people. Can only get in for physicals or the like. Sick? Tough luck we can't see you until week after next. Haven't seen an actual Dr in years. If I am sick we have a clinic with a PA that takes care of that stuff. So frustrating as we'd really like to have a doctor that we have a relationship with

Think of the change in population since you saw your first doctor, probably up 25-50%

Think of the change in the number of doctors, probably 1-10 percent

Now think of all the extra paperwork caused by Obamacare and the reduction in support staff caused by electronic records


Now think of all the people who now have access to doctors and never paid a dime for that access


That is the problem with socialism, it attracts the victim class who believe that healthcare is a right they don't have to work for

Completely counter to the traditional US culture that believed even God given rights had to be fought for because they realized that idle fools could be bought and destroy freedom with idleness bought for by corrupt politicians

Thanks Obama.

"If you like your doctor, you can keep him."