50 (ish) Ways to Lose Your Doctor
Written by Liz Fischer
Paul Simon writes that there are 50 Ways to Leave Your Lover – although he only actually gives 5, there are many more than 5 for patients to leave (or be left by) their doctor, and one good way for patients to keep their doctor.
Slip through the crack, Jack
Choose a new plan, Stan
Change your employ, Roy
Or see the NP
What’s all the fuss, Gus
You don’t need to discuss much
Just drop off the fee, Lee
And get your EOB
DPC solves for most of the reasons that people “leave” their doctor and it is one of the best models for preserving the continuity of the doctor-patient relationship because the relationship is, in fact, between the doctor and the patient. DPC for the win, again!
How might a patient lose their doctor –
- You just slip through the crack, Jack –
At Fischer Clinic when people call asking to become a member, we often hear that they feel forgotten or neglected at their insurance-based doctor’s office. Their calls and portal messages go unanswered, they can never get anyone on the phone, and they can’t seem to get attentive medical care. These patients are not wrong, they may HAVE a doctor, but that doesn’t mean that they have a responsive doctor. Even if that doctor WANTS to be responsive, overburdened doctors often don’t have a moment to go to the bathroom, much less respond to patients other than the ones double-booked to see them that day.
- Choose a new plan, Stan –
When patients choose a new health insurance plan one or more of their doctors may not be in network on the new plan. Even if they keep the same plan, their doctor might drop the plan. Negotiations about these payor contracts don’t place any value on doctor-patient relationships. Medical practices and physicians like college athletic departments and college athletes make moves based on financial realities, not emotional and relational ties. Your 5-star physician may be entered into the transfer portal faster than you can say – NIL. In reality, losing your doctor because of a health plan change is always about money because the patient still COULD see their doctor, the only change is the financial difference between seeing and in-network or out-of-network doctor. Patients don’t LOSE their doctor, they lose in network coverage for their doctor, which might not be the best therapeutic relationship anyway.
- Change your employ, Roy
See above – your job, your employer’s plan, and your doctor being in network for that plan all must stay the same. A new job might mean different insurance and different network that doesn’t include your doctor.
With DPC, even if your membership is paid by your employer, you can typically keep your DPC doctor if you change jobs by paying the monthly fee yourself. One of my favorite moments so far in our practice was when a member who initially had their membership paid by their employer changed jobs but decided to stay a Fischer Clinic member.
- Or see the NP
Maybe you have a doctor that you have had for a long time. Your doctor might be substituted by a lesser-trained (fact, not opinion) nurse practitioner or physician assistant. If you are like most people in insurance-based practices, it is hard to get in to see your actual doctor. Seeing an NP or PA may be fine for some acute visits, but too often I hear of well-child visits and annual visits being done by a “provider” other than the patient’s primary care physician. One pediatrician I know who now has direct peds practice, said that her patients weren’t even allowed to schedule 3-month follow-ups for well-child visits for infants with her. Many patients don’t realize that having your doctor get to know “in sickness and in health” over the years helps them to more easily recognize patterns in your health that may result in better, more informed care because they know you well.
- What’s all the fuss, Gus
When it’s easy to get in the same day or next day with your doctor, there is no reason for clinical staff to act as an inflexible gatekeeper for the DPC doctor. The patient doesn’t have to lose access to their doctor because the doctor’s time doesn’t have to be heavily guarded. Of course, as you get to know the finite panel of DPC patients in your practice you know who has a very low or very high threshold to request an appointment. The barrier to coming in is low and sometimes this leads to a quick visit that results in a good clinical outcome.
One day when our regular nurse was out, one of our members called to say that he had been seen at an urgent care on Sunday, and he wanted to let us know and see if Dr. Fischer would want to check him out personally. The nurse gave him some appropriate advice on managing his symptoms and told him to call back if his symptoms worsened. When she hung up, I asked who the patient was and realized that it was someone who NEVER calls or comes in, so I called him back to invite him to come in. He came the next day and, sure enough, he was really sick we directly admitted him to the hospital. When your time is your own to control and give, it’s wonderful to be able to go the extra mile to care well for patients who aren’t fussy, as well as those who are.
Other reasons that patients might lose their doctor are changes that doctors make which due to the pressure of ever shorter visits, billing and coding requirements and, the lack of autonomy. This may look like:
- The doctor doesn’t get to discuss much (because they don’t have time)
- The doctor gets burned out and quits practicing medicine, or worse
- The doctor gets burned out and commits suicide
- The doctor realizes that they want to get out of practicing medicine as quickly as possible, so they join the FIRE (Financial Independent Retire Early) movement and retire early
- The doctor shifts away from primary care to practicing some form of wellness, integrative, functional medicine or coaching. This type of care is generally not covered by any third-party payer and typically is highly limited in scope. Ie. does not include taking care of you when you have an injury, a chronic disease or acute illnesses. *not everyone who practices using these terms is a “partialist” but generally they don’t function the same as general practitioners and something is lost.
How Can Patients Not Lose Their Doctor?
DPC.
Amazing summary and marketing for DPC with the anecdotes!
Ahhhhh, Don’t give’em the narcs they want. I had patients that had true pain that no one could help them with but they kept their narc use down as low as possible. Was a pleasure taking care of them as I had moonlighted as a resident doc in an a methadone clinic for heroin addicts and oh man they wanted to get clean and taught me so much about addiction. It’s a witch to be under addiction.