Ask HN: [USA] Why is it impossible to schedule a doctor's appointment?
22 comments
There is a doctor shortage that is set to get worse:
https://www.ama-assn.org/practice-management/sustainability/...
https://time.com/6199666/physician-shortage-challenges-solut...
The population goes up and the number of doctors hasn't kept pace. They're trying to replace a lot of doctors with cheaper & quicker to train NPs (Nurse Practitioner) for preventative care but that won't occur soon either.
While it is easy to point fingers at COVID-retirements, it isn't that simple. It may have quickened the effects of the shortage but it was coming down the pipe long before COVID. Much like the housing shortage it is failure to plan for and build for a larger population.
There isn't a shortage of people wanting to become doctors, there is a shortage of spots in specialties and a wealthy enough subset of the population who can support their children through their mid-late 20s while they make negative income (inc. residency).
https://www.ama-assn.org/practice-management/sustainability/...
https://time.com/6199666/physician-shortage-challenges-solut...
The population goes up and the number of doctors hasn't kept pace. They're trying to replace a lot of doctors with cheaper & quicker to train NPs (Nurse Practitioner) for preventative care but that won't occur soon either.
While it is easy to point fingers at COVID-retirements, it isn't that simple. It may have quickened the effects of the shortage but it was coming down the pipe long before COVID. Much like the housing shortage it is failure to plan for and build for a larger population.
There isn't a shortage of people wanting to become doctors, there is a shortage of spots in specialties and a wealthy enough subset of the population who can support their children through their mid-late 20s while they make negative income (inc. residency).
> Or is this the new normal?
Its the new normal! Doctors book out forever, and they overbook.
When you do go there, the actual doctor looks at you for 30 seconds and moves on, like you're on a factory conveyer belt. And the efficiency seems to really drop when you need more than one doctor.
Don't go to the ER either... Go to urgent care first if you can't find someone, and take their referral to the ER or a doctor.
Its the new normal! Doctors book out forever, and they overbook.
When you do go there, the actual doctor looks at you for 30 seconds and moves on, like you're on a factory conveyer belt. And the efficiency seems to really drop when you need more than one doctor.
Don't go to the ER either... Go to urgent care first if you can't find someone, and take their referral to the ER or a doctor.
I hate that I've come to this conclusion but urgent care has been quite a disappointment every time I go. When I broke my wrist they did nothing and told me to go to the ER since they don't xray. When I was very ill and suspected food poisoning they told me to go to the ER since they don't do IVs.
If you can't xray or IV then what can you do? So useless.
If you can't xray or IV then what can you do? So useless.
Yeah, that sounds like a pretty bad urgent care.
Most of the time these days, you get a nurse practitioner or similar. Their “Dr.” is increasingly a PhD, which is rather nuts.
They have only a small fraction of the training and experience that an MD has.
I recently discovered that my PCP organization is only good for billing “wellness” visits and is actually useless or worse for any actual illness.
They have only a small fraction of the training and experience that an MD has.
I recently discovered that my PCP organization is only good for billing “wellness” visits and is actually useless or worse for any actual illness.
If you can afford it, join a concierge medicine plan.
I get same day appointments with my doctors. They also respond to emails and text messages. It sucks that I have to pay an extra $4k/year for each adult in my house but we found it really hard to get medical care otherwise.
I get same day appointments with my doctors. They also respond to emails and text messages. It sucks that I have to pay an extra $4k/year for each adult in my house but we found it really hard to get medical care otherwise.
Unfortunately in many areas, these are not available.
I don't live in a city, and would have to drive over an hour to the nearest concierge practice.
I don't live in a city, and would have to drive over an hour to the nearest concierge practice.
> but it does require an in-person doctor visit
Are you 1000% positive about this? Check your insurance provider for some kind of Nurse Practitioner telehealth visit as an option.
Do you have https://www.zoomcare.com/ Or something similar in your area?
The other thing to do is ask about a waiting list. Or, like you mentioned, call right when they open and ask about cancellations for the day.
Yes, it sucks, but if you want the appointment you have to deal with it.
Are you 1000% positive about this? Check your insurance provider for some kind of Nurse Practitioner telehealth visit as an option.
Do you have https://www.zoomcare.com/ Or something similar in your area?
The other thing to do is ask about a waiting list. Or, like you mentioned, call right when they open and ask about cancellations for the day.
Yes, it sucks, but if you want the appointment you have to deal with it.
At least where I am, it is a combination of mass retirements and doctors being unwilling to work as much as before. My family doctor retired after COVID as he didn't want to deal with people anymore.
There are going to be many unanticipated social costs to the criminal overreaction to Covid-19 that we're all going to be paying for for decades. This is just one of them.
Is this a result of the reaction to Covid?
Anything large usually has many contributing factors, but I can see at least a few ways that the overreaction to Covid has contributed to worse healthcare today and for many years to come.
> One of the biggest causes of health problems in America is excess weight, and officials tried to scare healthy people to do nothing other than sit at home for a time, which caused a lot of people to gain weight they otherwise wouldn't have and caused a lot of future problems that should have been prevented. As a small anecdote to illustrate this, the local government here chained up the outdoors playground and gymnastic equipment to prevent people from exercising. This was the McNamara fallacy applied to healthcare in its purest form.
> A lot of basic healthcare shut down for a long time. So not only was there a normal healthcare backlog, but when issues were finally caught later on, they might have been far worse at that time than they otherwise would have been. I'm sure this has an ripple effect on the future.
> Some healthcare professionals lost their careers over vaccine mandates. Anecdotally, I know a Doctor that had a very bad reaction to the first Covid vaccine and was still forced to choose between subsequent doses or lose his career. And I know many people have been discouraged from entering the healthcare field because of this loss of bodily autonomy. Certainly, a greater supply of doctors and nurses would help ease any healthcare shortages.
> This is harder to illustrate with any kind of data, but I think a lot of normal civil society has broken down because of the unnecessary disruption from Covid. People are less pleasant, less accepting of their neighbors, more impatient drivers, more stressed out, etc. I think this is the kind of thing that has some overall health impact on the community as a whole. I acknowledge that it's almost impossible to measure this point in an objective way.
> One of the biggest causes of health problems in America is excess weight, and officials tried to scare healthy people to do nothing other than sit at home for a time, which caused a lot of people to gain weight they otherwise wouldn't have and caused a lot of future problems that should have been prevented. As a small anecdote to illustrate this, the local government here chained up the outdoors playground and gymnastic equipment to prevent people from exercising. This was the McNamara fallacy applied to healthcare in its purest form.
> A lot of basic healthcare shut down for a long time. So not only was there a normal healthcare backlog, but when issues were finally caught later on, they might have been far worse at that time than they otherwise would have been. I'm sure this has an ripple effect on the future.
> Some healthcare professionals lost their careers over vaccine mandates. Anecdotally, I know a Doctor that had a very bad reaction to the first Covid vaccine and was still forced to choose between subsequent doses or lose his career. And I know many people have been discouraged from entering the healthcare field because of this loss of bodily autonomy. Certainly, a greater supply of doctors and nurses would help ease any healthcare shortages.
> This is harder to illustrate with any kind of data, but I think a lot of normal civil society has broken down because of the unnecessary disruption from Covid. People are less pleasant, less accepting of their neighbors, more impatient drivers, more stressed out, etc. I think this is the kind of thing that has some overall health impact on the community as a whole. I acknowledge that it's almost impossible to measure this point in an objective way.
Being a PCP isn’t very profitable and pcps don’t really generate large profits for the hospital system so they don’t staff those positions well. The hospital system would prefer that you went to urgent care because they can charge 3-5x as much for the service if it’s urgent. That’s why urgent care clinics are popping up everywhere.
Urgent Care is probably your best option. I think the name implies a bit more than what it actually is; it's basically a corporatized group practice for general/family docs who don't want the hassle of running their own thing. At least that's been my experience, and I've talked to some quite helpful docs in them.
And for my soap box to anyone reading this - remember it when someone tells you that free/public healthcare creates long waiting times. It may, but we don't seem to be doing great here either.
And for my soap box to anyone reading this - remember it when someone tells you that free/public healthcare creates long waiting times. It may, but we don't seem to be doing great here either.
I have a primary care doctor now, but there was a time where I would exclusively go to urgent cares (usually the same one, and got to know the people there). Often they have better testing capabilities than primary care doctors (mine has to send me to a nearby hospital for anything more than taking blood). I've gotten X-rays, ultrasounds, and even MRIs (imaging center was next door) without even leaving the building before.
Yes. Check out solvhealth to find urgent care places.
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A very populated metro area can be a part of the problem, in that the demand is so high. Certain specialists like neurologists seem to have months-long waits as a given, ime... driving a distance, telehealth, or waiting have been my options. I hope you find some luck on the internet today, sometimes a video chat with a curious foreign doctor can be free.
Travel to Mexico and back if its something not too serious
I have kaiser and never had these problems.
Foreign resources might actually be helpful.
I've been looking to schedule an appointment for a minor issue, and have called over a dozen offices in a very populated metro area. The answers I get range from "there are 0 appointments, try to call back to get lucky for a cancellation" to "Our first available is 6+ months out"
Am I going crazy? Or is this the new normal? I really don't want to go to urgent care or the ER for such a minor issue (but it does require an in-person doctor visit)