If you do not have a doctor, you may have a problem.
The Journal of Medicine reports: There is a scarcity of doctors, both specialists and general practitioners. The problem worsens as the population decreases, so “The shortage is critical in rural areas.”
A local physician, now retired, concurs, “If you are without a doctor and cannot find one, your story is, regrettably, a common one.”
The Journal of Medicine suggests, “Possible solutions to the problem of physician shortages in rural areas include changing the medical education system so that it trains more physicians who choose rural practice and changing the reimbursement strategies of Medicare and Medicaid.”
In April 2018, the Association of American Medical Colleges reported increasing physician shortages in both primary and specialty care. “This year’s analysis reinforces the serious threat posed by a real and significant doctor shortage.”
If nothing is done, the AAMC predicts, “The United States could see a shortage of 120,000 physicians by 2030.”
The AAMC predicts shortages in all areas, urban and rural. To avert catastrophe, some medical schools are switching to free tuition, with post-graduate practice in needy area contingencies.
A doctor responds: “I doubt that will solve the problem. Today’s doctors do not know how to work to respond to need. Two [doctors] trained the old-fashioned way could do the work of five [doctors] trained using today’s benchmarks. Today’s doctors take off a lot, send their patients to the ER, and need nurse practitioners to pick up the slack.”
When a local woman fell ill and called her doctor, she was referred to the ER because “we don’t have a doctor available today.”
“Wasn’t there another doctor in the practice available in an emergency?” she asked. The answer was no—go to the ER.
At the ER she was administered an X-ray to eliminate pneumonia, checked by a doctor, and sent home with an eight-day course of antibiotics. Ironically, she was told to follow up with her primary care physician in eight days. She tried but, two weeks later, still suffering, she was shunted off to the ER once again.
In addition to fewer doctors entering the field, and possibly working fewer hours, more doctors are retiring early. One retiring doctor explained, “Today the profession is directed more by the payers than the providers.”
One patient lost her doctor when the doctor left the area. Before she left, the doctor administered an annual checkup, made an appointment for the checkup a year hence, and assured the patient she could continue with another doctor in the practice. A year later, the patient arrived for her appointment but found she was booked for a “wellness visit” with a nurse.
Why? Because Medicare does not pay for annual checkups; Medicare pays for wellness visits.
The patient asked, “Might you have told me? Given me a choice?”
“No, we don’t book what Medicare does not pay for.”
The patient had concerns about prescriptions and tests administered annually. When she asked what to do, she was told, “Make an appointment with a doctor. A doctor might do an annual checkup but would bill it as something else.”
The patient asked for an appointment and was told the first available for new patients was four to six weeks away.
“But I have been a patient of this practice for years.”
“Yes, but your doctor left. You would be a new patient to another doctor in the practice, therefore, the four- to six-week wait.”
If you ask Blue Cross Blue Shield to recommend a doctor, they attempt to be helpful. They supply names of individual practitioners and medical practices in the area. When contacted, these doctors and practices explain they are not accepting new patients, or they are but are booking initial appointments six months out.
One such practice, overwhelmed but caring, generated a list of possibilities. It was kind and kindly meant, but it was the same list of overextended physicians and practices plus an emergency care facility in Pittsfield.
The severe shortage is a function of fewer training to be doctors, doctors working fewer hours, and retiring early. There is another issue. One Berkshire woman explained, “A few years ago, our doctor sent a letter saying he was becoming a concierge doctor.”
She didn’t know the term. When she called, she was told: A concierge doctor was available 24/7, no waiting. The primary care physician becomes fully familiar with patients, and they develop a relationship of trust. For this service, once commonplace, there was a price. There were four members in her family, and the price was $3,000 per patient annually.
“The annual fee was equal to the down payment on my first home,” she said,” It was a price I could not afford, and I said ‘no, thank you.’”
According to recent reports, 10 percent of practices nationwide are planning to switch to the concierge model. A survey found the fee ranged from $1,000 to $25,000 per patient per year. It is a retainer and, in addition, the patient pays for tests, medications, visits and other services.
A couple new to the area said it took a year to find a doctor. “So many said they were not taking new patients, I began to wonder: If everyone else is fully booked, what is wrong with the practitioner who has availability?”
At the end of the year, they gave in and paid the price of concierge medicine. For those who cannot afford to make that choice, it may be sad, even scary, to be without a doctor. It may be irritating to hear the constant reports about the superiority of American medicine when you cannot get access to it.
