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Has your doctor disappeared?

ann bauerAnn Bauer

I have excellent, relatively inexpensive, employer-sponsored health insurance, for which I am immensely grateful. Even so, I’m having a hard time getting decent primary health care. In fact, it’s been nearly two years since I saw a doctor who knows me. And I think I may be seeing a trend.

In 2004, I became a patient of a wonderful GP. Myra was in her 50s, a tiny, delightful good witch of an allopathic practitioner. She approached my care like one might a garden: She poked around curiously, spent a lot of time gazing at the sun, and leaned against a wall as she talked. I can count on one hand the number of times I left her office with a prescription; Myra’s style was to recommend hot, salt baths or homemade garlic remedies or lots more sex.

On one of the worst days of my life — when I had to accompany my son with autism from the group home where he’d been living to a locked psych ward — Myra went with us to do the pre-admission exam. She moved around my miserable, brain-broken boy and laid her hands on him, as if she were performing unction. After he’d left with his keepers, she stayed with me while I sobbed.

I wouldn’t say Myra and I were friends, but I knew all about her children. I had given her inscribed copies of my books. So it came as a jolt when I received a letter from her clinic, informing me that Myra was leaving the practice effective the following week.

***

Myra never sent a letter of her own explaining; she simply vanished. And I worried that perhaps she’d had a health crisis of her own, but there was no way to find out. The clinic manager recommended I switch to the young woman they’d recently hired, which I did for a while.

The new doctor was nice, but Myra’s polar opposite. She asked me a series of questions, rapid-fire, her head bent over a form. Before I left, she handed me a sheaf of prescriptions, every one to answer some idle response I’d made (heartburn every once in a while; a little hayfever; yes, trouble sleeping). On my way out the door, I threw them all in the trash.

Then I had a brilliant idea: my gynecologist! A lot of women use OB/Gyn’s for their primary care. Problem solved.

On the day of my appointment, I filled out the paperwork, was weighed, and showed to a room. Then I waited for an hour and a half. By the time the doctor rushed into the room, red-faced with hurry, I had just 20 minutes to get to a meeting. We talked briefly and agreed to call this an office visit. I would reschedule the physical because my insurance would pay for only one per year.

But on the new date I got a call saying my doctor had been called away. Appointment three, I again sat in a room waiting. This time, after 45 minutes, I heard a conversation in the hall. I poked my head out. It was my doctor, consulting at length with a woman in a white coat who seemed lost.

I ducked back in, assuming I was next. But no. My doc finished her conversation then turned and headed toward a room down the hall. After waiting another half hour, I put on my clothes and left.

The following month, when I had some sinus trouble, I made an appointment through one of the clinics near my office. The woman I saw was funny and helpful and slow to treat.

“Crazy question,” I said as I gathered my things to leave. “Are you, by chance, taking new patients? I’m looking for a primary care provider …”

But before I could finish, she was shaking her head. She was just a “floater” who works in clinics when there was a shortage, the doctor explained. She’d had her own practice but grew to hate it. All the paperwork and red tape.

So one day, she quit. Now she temps for six months a year and travels the other six; stopgap doctoring is so lucrative, she said, this is possible.

“It’s happening all over,” she said. “Doctors just get tired of all the stress and bullshit and” — she shrugged — ”we leave.”

***

I work in advertising on a medical device account. So I’ve been trained to think like a physician. And here’s what I know.

These are people who have spent 10-12 years and hundreds of thousands of dollars on school. They invested this time and money because they expected the long-term reward to be worth it. But with the recent increase in malpractice insurance premiums and federal regulations — as well as falling reimbursement rates — the payoff simply isn’t what they expected it to be.

What makes physicians buy certain products is messaging around how it will increase their practice efficiency, allowing them to see more patients per day, or boost their outcomes (patient stats) so they’ll be more sought-after and can charge higher fees.

I know this sounds cold. But I’m not making judgments. In fact, I understand. Being a doctor sounds really hard — people coming to you all day, in pain, begging you to help or understand or just let them talk. Who wouldn’t get tired of that?

Of course, I don’t believe Myra felt this way. But that’s the thing: Patients never do. Our research also shows that while physicians are looking at the bottom line, patients insist that their motives are pure. In other words, we expect our doctors to be saintly, selfless creatures. What a burden that must be.

Add to this the army of baby boomers, some 76 million, now in that high-maintenance age range of 49-66. They’re being bombarded with messages that they can feel younger with sex-enhancing drugs and hormone patches and treatments for low testosterone. It’s no wonder they’re willing to wait the two hours it takes to be seen.

At the same time, there are now more female doctors than ever before (they’re due to outnumber males by 2017), and study after study shows that women tend to work fewer hours because even if coupled, they also take primary responsibility for their children, social life and home.

What it all comes down to is this: Doctors are disappearing. Especially the ones who provide holistic primary care.

***

None of this really mattered to me, because I’ve had the good fortune to be healthy for most of my life.

But after 20 years of daily keyboarding, I developed a repetitive stress injury so severe it’s begun to degrade the cartilage on the right side of my body. To put it bluntly, I have arthritis. At 46.

I discovered this during a visit to a very kind doctor I’d never met, who spent 15 minutes more than her allotted time doing finger and wrist tests and reviewing X-rays of my spine. She gave me a cervical collar and a wrist brace, a referral to a physical therapist and a note to come back and see her in a month.

“Does this mean you’ll be my doctor?” I asked.

And I watched as conflict crossed her face. No doubt she already had too many patients and the smart thing would have been to decline. But I saw her look at my crazily tilted neck and soften.

“Sure, I can do that,” she said and rushed out the door to someone who was waiting down the hall.

Ann Bauer is the author of “The Forever Marriage,” a novel coming out in June. This article originally appeared on her blog.

Comments (17)

  1. Submitted by Dennis Tester on 04/27/2012 - 07:48 am.

    You think it’s bad now?

    Wait until they add 40 million more people with “free” health care and clinics are paid what the government says their services are worth.

    • Submitted by Rachel Kahler on 04/27/2012 - 11:25 am.

      Yes

      Because, as long as YOU can afford it, no one else needs it. How callous.

      My opinion is that the solution is a government program. Yes, I know, that’s AWFUL. But, really, it’s not. Offer free schooling to qualified students, and then, just like in the army, they’re required to “pay back” that schooling for a set term in a needy area–rural, GP, or other–for a nominal stipend. Following that, they can practice however they want and how much they want. We get more doctors trained. We get more doctors exposed to (and maybe liking) GP. We fill a need in those areas that most doctors avoid. We overall increase access to care, and probably reduce expense, as well as doctor quality of life. A similar program should be available for nurses, too.

  2. Submitted by rolf westgard on 04/27/2012 - 08:22 am.

    Gender medicine

    Ann seems to require a female physician which may limit her selection.

    • Submitted by Rachel Kahler on 04/27/2012 - 11:26 am.

      That may be true

      But, many women simply feel more comfortable with a female doctor. Still, with about half of all doctors being female, and what should be half of all patients being female, you’d think that wouldn’t be a problem.

      • Submitted by rolf westgard on 04/27/2012 - 10:22 pm.

        Fixing blame

        If I insisted on a male physician when a perfectly competent female was available, that would be my problem, and not a justification for a 700 word complaint.

  3. Submitted by mark wallek on 04/27/2012 - 10:30 am.

    Not about patient need

    Both doctors and patients are at the effect of a whimsical, profit driven “health” corporation, where the “health” is determined by what the CEO and CFO take for themselves. Medicine is no longer about patient need, it’s about the fiscal health of the non human institution.

  4. Submitted by rolf westgard on 04/27/2012 - 12:34 pm.

    We don’t have to wait, Dennis

    We can observe health care in Western Europe where universal coverage leads to superior health care data versus the U.S. We rank about fortieth in WHO rankings.

  5. Submitted by Greg Kapphahn on 04/27/2012 - 03:11 pm.

    As Long As Our Goal Is Making The Most Money Possible

    For physicians, CEOs, and investors, our health care industry will continue to attempt to leave behind all those who are not at the top of the income scale.

    “Free market” healthcare means exactly and ONLY that.

    It is NEVER “cost effective” for the private sector to provide care for the elderly, the differently abled, nor for those least able to pay “out of pocket.” Furthermore, the lack of general practitioners is driven more by the low rates set for GP services (as compared to the much higher rates for “specialist” care) than anything else.

    Without major public sector intervention and support, the problem described in this article will only grow much, much worse, but of course, some among us don’t care as long as a very few of us are making very big bucks off the system the way it is.

  6. Submitted by Eileen Weber on 04/28/2012 - 05:48 pm.

    you still have choices

    Try a nurse practitioner. As a writer, you surely check out the facts, so check out the September/October 2011 issue of Nursing Economics or http://www.healthleadersmedia.com/print/PHY-269597/ to see the research on the quality care they provide. Lots of people prefer nurse practitioners because they feel they get more personal attention.

    • Submitted by rolf westgard on 04/29/2012 - 06:53 pm.

      Nurse practitioners

      And those nurses are certainly qualified to provide Ann’s favorite medical treatments, hot baths and garlic. I’m too over the hill to comment on the third remedy.

      • Submitted by Pat Berg on 04/30/2012 - 08:09 am.

        MinnPost guidelines

        Whatever has happened to MinnPost’s commenting guidelines? How is this an acceptable comment that in any way adds to a productive and respectful discussion?

        • Submitted by rolf westgard on 05/01/2012 - 04:51 am.

          Who started it?

          Our extended family’s experience with area medical services in general, and physicians in particular, is far more positive than that experienced by Ann Bauer. I suggest that it is appropriate to point out that her own preferences for holistic and gender specific treatment contribute to the problems she outlines in her attack on local medical srvices. My feeble attempt at humor was in response to her own.

  7. Submitted by susan smith on 05/01/2012 - 06:47 pm.

    Get the patient well

    This is the sad example of our health care system because of how we pay doctors. The incentive is not there to get the patient well; but rather it’s about seeing as many patients as possible in one day. But that is slowly changing. Between national and state laws and a strong push by the public demanding more accountability, focus on outcomes and quality and transparent prices, there is a shift upon the health care landscape. We patients need to keep pushing for affordable access and the necessary time it takes with a provider to help make us well. http://whatstherealcost.org/video.php?post=five-questions

  8. Submitted by Beryl John-Knudson on 05/02/2012 - 07:11 am.

    Initially I thought the story here was a spoof, but so it goes..

    Is alternative health care covered under most health care plans?

    Is garlic considered a controlled substance?

    This story demands a little humor…smile somebody!

  9. Submitted by rolf westgard on 05/03/2012 - 02:59 am.

    Thank you, Beryl

    At last I get it. I was simply too dense to grasp that the article is satire – mocking those who struggle to get the medical establishment to deliver garlic and hugs, versus FDA approved medicines. Thank you Ann Bauer for a well written essay.

    • Submitted by Pat Berg on 05/05/2012 - 12:51 am.

      That’s quite an assumption

      I saw nothing in either Ann’s article nor in her link to indicate that she meant her piece as satire. She was making a very serious point – due to the downward price pressure and increased scheduling pressure exerted by insurance companies and Medicare, many general practice doctors (be they male, female, holistic or allopathic) are finding it difficult and no longer rewarding to remain in practice. And for those who prefer to keep the pace of their doctor/patient interactions at a slower, more human-oriented level, these pressures make practicing medicine the way they want to darn near impossible. So they’re leaving.

      I’ve experienced the same thing (and no garlic or hot bath prescriptions were involved). For probably better than ten years, each time I’ve found a friendly, compassionate GP in the clinic I go to, they start getting so heavily scheduled that it’s impossible to get an appointment (which makes having them as your “designated primary care physician” essentially meaningless when you have a time-sensitive malady that needs to be attended to). This continues for a time until the day you call and are told that this doctor is no longer in practice at this clinic.

      This identical scenario has happened to me three times now. And when I’ve taken whatever doctor was available (because I was in so much discomfort that I couldn’t wait) my experience has not been good.

      It’s discouraging and disheartening. And believe me, there’s absolutely nothing funny about it.

  10. Submitted by rolf westgard on 05/05/2012 - 11:16 am.

    Genuine concerns

    Both Ann and Pat have expressed very real concerns about the way we are currently delivering medical care. If it is not too far away, may I suggest the Fairview Clinic in Highland Park. I called Friday for an appointment, and I am booked for 1PM on Monday. As far as I know there will not be a bill collector at the door.

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