I Have Insurance But No Doctor!
Kendra Campbell -- As I alluded to in my recent post, I have a health insurance plan provided by my medical school, but have been unable to find a primary care physician. It seems that whenever I make calls to find one, they are either not accepting new patients, or the first available appointment is so far into the future that I can’t even guarantee that I’ll be able to make it. I live in New York City, so can you imagine what it would be like if I lived in a small town somewhere in rural America?
The unfortunate consequence of this situation became even more real to me a few weeks ago when I became sick and needed to see a doctor. Since I was unable to locate one, I ended up going to the Emergency Department of the hospital where I’m currently rotating. You can imagine how silly I felt sitting in the waiting room for many hours, clogging up the system, wasting the doctor’s time, when all I really needed was for someone to take a quick listen to my lungs, check out my throat, and write me a prescription for some antibiotics.
At least I was lucky enough to have access to a doctor at all. Not everyone is always this lucky. So many people out there don’t even have health insurance at all. What is going on?!
I’m sure most of the readers of this blog already have a good idea of how broken the U.S. healthcare system is. I could rant for many hours on this topic. However, I’m just going to focus on one specific part of the problem right now.
- 78% believe there is a shortage of primary care doctors in the U.S.
- 49% said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely
- 94% said the time they devote to non-clinical paperwork in the last three years has increased, and 63% said that paperwork has caused them to spend less time per patient
- 82% said their practices would be “unsustainable” if proposed cuts to Medicare reimbursements were made
- 60% would not recommend medicine as a career to young people
Now, the results of this study must be taken with a grain of salt, as there was only a 4% response rate, and there is obviously some self-selection bias at play. However, I don’t think anyone would disagree that “the proof is in the pudding.” I was unable to find a primary care physician in New York City, one of the largest cities in America, in a reasonable amount of time. There is something seriously wrong with the system, and with the future of primary care in this country.
I encourage you to read some of the actual responses from physicians at the end of the report. It was pretty eye opening for me, and it might just make you want to get out of your chair, go to the window, and scream, “I'm mad as hell and I'm not gonna take this anymore!”
I found this response to be particularly saddening:
“I put everything I have into treating my patients. I’m about to lose my family for nothing. Just because I try to take good care of my patients – but it’s just too much work and nothing in return. My children have suffered because of time without their dad.”
What are we to do?
You are so right and this is so true. Many of the doctors I know are not encouraging people to get into the field now because of all the red tape.
Even a very close relative of mine was very discouraging when I expressed interest in becoming a primary care physician because of all the cuts, overhead costs and risks of malpractice suits that are increasing with each passing day.
This is sad because it is detrimental to the people that need the assistance of physicians the most.
Posted by: Latha | Dec 8, 2008 1:53:42 PM
Seems like the hurricane on the rock was yesterday. That said, I think that a better indicator of Physician dissatisfaction is attrition. After all, there are other jobs.
A study, "No Exit: An Evaluation of Measures of Physician Attrition," indicates that the number one correlate with attrition was an older age. In short, despite dissatisfaction, a lot of docs aren't so put off that they quit medicine; instead they work until they retire. If you read further in the study, you find that physicians talk a lot, but don't follow through. Also, I'm pretty sure self-reporting is a poor measure of the time that doctors spend on patients, doing paperwork, etc. And I imagine your wait would have been much less in rural America. But that's just my report- I don't have any numbers to back it up.
EDs have triage to pick up the gap. Your incentive to be there is that you don't have a doctor and you're sick. Your incentive to leave is the amount of time you have to wait to see the doctor. While I don't like it anymore than you do, I don't think that indicates that our system is "broken."
I didn't have health insurance for six years, the whole time I was working as a nurse. Whenever I would have a small problem, I'd ask the doc on duty if he could take a look at it. When I had a large problem, I'd call one of the IM or FP guys I liked and make an appointment. When I had an emergency, like the time I had kidney stones or the time I cut off the tip of my thumb, I'd go to the Emergency Room. And I always paid cash from my savings. Best investment, yet!
I'm sorry to hear that fellow didn't spend enough time with his family. That should be a warning to all of us, that we use our time wisely before it is gone.
Posted by: Tom | Dec 10, 2008 12:37:34 PM
Hi Kendra, I'm a 6th year medical student at Bogotá, Colombia, I really think you would like to know more or less how the system works in a "developing country".
RURAL AREAS: The Government requires you to practice 1 year as a primary care physican in rural/underserved areas as soon as you graduate from the 6 years it takes med-school here, most of these areas have guerrillas-war issues). The big difference here is that during medschool we are basically trained under the premise of "Not screw it up during the rural year" since we will be the only attendings in those rural towns everything is focused to this premise, rather than "Get a general picture of medicine so you can pick a residency" which as far as I know is the idea of the medical education in the US (I find the latter better).
PRIMARY CARE PHYSICIANS IN BIG CITIES: It's not mandatory to get residency training here, since under the premise we are trained we are supposed to be able to manage a wide variety of medical conditions without "screwing it up", we can practice as Primary care physicians with no further training in family medicine residencies (a residency program that doesn't even exist here), the thing is that salary is extremely low (as low as US$6.000/YEAR). Furthermore, if you ever intend to get residency training you are supposed to pay to the university who's gonna train you, may sound ridiculous but that's how it is, residency is not a "paid job" as it's in the USA or Europe, but it still has the same responsibilities, duties, and work hours, this is actually one of the reasons why I intend to apply for residency in the States. So these primary care physicians working in cities can be divided in 2 groups, the ones that really enjoyed the primary care (less than 4%), or the ones that simply couldn't pursue residency training because they weren't wealthy enough to pay thousands of dollars to a university for residency training and couldn't keep depending on their parents' money for the 3-9 years it can take a residency as well.
I think the mandatory rural year is a good strategy to keep a reasonable staff of physicians in these areas, but the fact that most of the primary care physicians in my city (Population: 9 million) are colleagues who didn't make it into a residency because of money issues is very sad. I couldn't imagine such a frustration, nevertheless, it's pretty easy to get primary care appointments in both big and small cities, and rural towns.
It was surprising for me to read this blog, since I never imagined such a problem in a country like the USA... but nevermind, when it comes to residency it's better than Colombia, so I'm still going to apply there :)
Greetings from Colombia!
Posted by: Diego Nova | Dec 10, 2008 6:08:15 PM
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