Family medicine is in decline(thewalrus.ca)
thewalrus.ca
Family medicine is in decline
https://thewalrus.ca/your-doctor-wont-see-you/
216 comments
I've been experiencing this exact issue in the US. Lately a medical issue of mine has been getting worse, and the earliest I can see a new PCP is in May 2025. I managed to get a referral to a specialist by visiting urgent care, but they referred me to a different specialist, and I won't be able to see the latter until late January 2025. Meanwhile my medical issue is continuing to get worse, and I have no one I can talk to about it. I'm looking into alternative options but things are looking bleak. I'm probably going to have to go out-of-network and drive 2 hours to find a doctor that has wait times on the order of weeks (as opposed to the in-network providers, that have wait times on the order of months).
> I won't be able to see the latter until late January 2025
Where are you? This is unusual.
In America, the "average wait time for a [cardiologist, dermatologist, og/gyn, orthopedic surgery or family medicine] appointment for the 15 large metro markets surveyed in 2022 is 26.0 days" [1]. In Canada, the "median national wait time 1 was 78 days," with wait ime "defined as the period between a patient’s referral by a family physician to a specialist and the visit with said specialist" [2].
Broadly speaking, American medical wait times are quite good, particularly for specialists [3]. But PCPs/capita vary greatly from state to state [4].
[1] https://www.wsha.org/wp-content/uploads/mha2022waittimesurve...
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC7292524/
[3] https://worldpopulationreview.com/country-rankings/health-ca...
[4] https://www.beckershospitalreview.com/rankings-and-ratings/s...
Where are you? This is unusual.
In America, the "average wait time for a [cardiologist, dermatologist, og/gyn, orthopedic surgery or family medicine] appointment for the 15 large metro markets surveyed in 2022 is 26.0 days" [1]. In Canada, the "median national wait time 1 was 78 days," with wait ime "defined as the period between a patient’s referral by a family physician to a specialist and the visit with said specialist" [2].
Broadly speaking, American medical wait times are quite good, particularly for specialists [3]. But PCPs/capita vary greatly from state to state [4].
[1] https://www.wsha.org/wp-content/uploads/mha2022waittimesurve...
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC7292524/
[3] https://worldpopulationreview.com/country-rankings/health-ca...
[4] https://www.beckershospitalreview.com/rankings-and-ratings/s...
I've seen this too, in the northeast US. I didn't go to our family doctor of 10+ years for 18 months during COVID-19. When I called for a new appointment, they said I had was no longer a patient and had to wait at least 90 days for an appointment to address a painful condition. I still haven't gone back, and now I just use urgent care if needed.
I had similar problems with a specialist. Their appointments are typically six months out, and if you need something more urgent, the answer is "sorry that's all we can do." My last actual appointment, after the ~six-month wait, was a simple 15-minute telehealth visit. It's insane.
I have great insurance and I've never had any problem paying. It's amazing to me that doctors seem to really push back against having patients, or their patients having appointments. Isn't this how they make money? What kind of weird market effect incentivizes this behavior?
It's interesting that dentists and oral surgeons seem to be the opposite. I've never had a problem finding one and they usually seem welcoming, happy to help, and glad to have the business.
I had similar problems with a specialist. Their appointments are typically six months out, and if you need something more urgent, the answer is "sorry that's all we can do." My last actual appointment, after the ~six-month wait, was a simple 15-minute telehealth visit. It's insane.
I have great insurance and I've never had any problem paying. It's amazing to me that doctors seem to really push back against having patients, or their patients having appointments. Isn't this how they make money? What kind of weird market effect incentivizes this behavior?
It's interesting that dentists and oral surgeons seem to be the opposite. I've never had a problem finding one and they usually seem welcoming, happy to help, and glad to have the business.
Every doctor I personally know is double booked at least a substantial portion of every single day. They count on last minute cancellations and no shows just like airlines do in order to maintain their schedules.
Making friends with folks in the medical field is eye opening to say the least. The system is operating redlined and has been since before Covid. Covid just caused the fractures to finally start showing to the average person.
The real thing coming for us is that every doctor I know other than some specialists are simply counting down the days until they can leave the field of direct patient care entirely. Whether this be early retirement, paying off student debt and bouncing, or making a lateral move to research or a tech firm. The field has gotten to be untenable for many, typically the ones who actually care. The profession as a whole has lost its personal agency to the administrative class. It’s not idle talk either - plenty have actually already executed on these plans.
Making friends with folks in the medical field is eye opening to say the least. The system is operating redlined and has been since before Covid. Covid just caused the fractures to finally start showing to the average person.
The real thing coming for us is that every doctor I know other than some specialists are simply counting down the days until they can leave the field of direct patient care entirely. Whether this be early retirement, paying off student debt and bouncing, or making a lateral move to research or a tech firm. The field has gotten to be untenable for many, typically the ones who actually care. The profession as a whole has lost its personal agency to the administrative class. It’s not idle talk either - plenty have actually already executed on these plans.
>The profession as a whole has lost its personal agency to the administrative class.
This has happened all across the American economy, in every business, every industry, every company.
My father was a grocery store manager for decades. He retired and went to be a contractor for a decade. The grocery chain recently tempted him back, by offering him top position (over other candidates, who kinda deserved the position, but that's just how much this company loved my dad, he was literally legendary in the company) in their "show off store" which they had purchased to scoop up the location from a competitor that they want to keep out of the market (yay capitalism) and spent millions to completely re-roof, rebuild, redesign as their premier location, to be used exclusively to lose money in a busy market, to show off for the C-Suite, and to shoot commercials in. My father was clearly super excited to get back to the company, to get back to management which he is very good at, and to get stable health insurance.
He gave up after a few months. Everything is that kind of awful "automated" that any software developer could immediately recognize, with KPIs and useless metrics created by someone inexplicably above you who has zero familiarity with what those KPIs even measure.
No more agency for lower management. Just shut up and follow the whims of the useless nepo-baby who runs your division as it continuously fails to do anything.
This has happened all across the American economy, in every business, every industry, every company.
My father was a grocery store manager for decades. He retired and went to be a contractor for a decade. The grocery chain recently tempted him back, by offering him top position (over other candidates, who kinda deserved the position, but that's just how much this company loved my dad, he was literally legendary in the company) in their "show off store" which they had purchased to scoop up the location from a competitor that they want to keep out of the market (yay capitalism) and spent millions to completely re-roof, rebuild, redesign as their premier location, to be used exclusively to lose money in a busy market, to show off for the C-Suite, and to shoot commercials in. My father was clearly super excited to get back to the company, to get back to management which he is very good at, and to get stable health insurance.
He gave up after a few months. Everything is that kind of awful "automated" that any software developer could immediately recognize, with KPIs and useless metrics created by someone inexplicably above you who has zero familiarity with what those KPIs even measure.
No more agency for lower management. Just shut up and follow the whims of the useless nepo-baby who runs your division as it continuously fails to do anything.
Definitely not the case in my area, my wife enjoys being a provider.
It is really frustrating but I've found that most doctors and hospitals have two systems. One for new or very infrequent patients. One for established or regular patients. The latter gets appointments fairly quickly in most cases.
It is rather messed up but One Medical (now owned by Amazon) and a few other services can be worth the money because they have access to the fast track appointment line.
I only know this because after many many months of searching for a primarily care doctor and waiting for an appointment I was told about this. New patient scheduling for my doc is months out. If I email and ask if I can come in next week they always say how about tomorrow/the next day?
It is rather messed up but One Medical (now owned by Amazon) and a few other services can be worth the money because they have access to the fast track appointment line.
I only know this because after many many months of searching for a primarily care doctor and waiting for an appointment I was told about this. New patient scheduling for my doc is months out. If I email and ask if I can come in next week they always say how about tomorrow/the next day?
Maybe there are simply not enough doctors, so their waiting list is exactly that, months long?
Right, we have a shortage of physicians and the problem will only get worse as the population grows older and sicker. The first thing we need to do is get Congress to increase funding for residency programs in order to eliminate that bottleneck.
https://savegme.org/
https://savegme.org/
[deleted]
I think it's likely simply gotten worse since those studies.
A friend of mine needed a specialist. She called multiple offices across two different states, and the soonest appointment available was about 4 months out.
Four or five years ago, we didn't typically see wait times like that.
A friend of mine needed a specialist. She called multiple offices across two different states, and the soonest appointment available was about 4 months out.
Four or five years ago, we didn't typically see wait times like that.
Could this be a result of HDHP plans that allow "direct to specialist" appointments, as opposed to triage through a PCP?
I believe most of the offices she called actually required referrals for all initial appointments (regardless of insurance), so I don't think that's a factor here.
I see similar lead times simply trying to get a PCP.
OP is correct in my anecdotal experience. I live in a large urban area and wait time for PCP is several months out. Even longer for Women's health as I hear from my partner.
I don't remember it being this bad in the past. Perhaps things have changed in the several years since those publications were published.
I don't remember it being this bad in the past. Perhaps things have changed in the several years since those publications were published.
> I don't remember it being this bad in the past. Perhaps things have changed in the several years since those publications were published.
There are several reasons for this, but the gist of it is that pharmas have moved much of the actual work of running large clinical trials to contract research orgs (CROs) and the cost of recruiting patients for trials, training staff, records keeping, and administering the trial becomes out of reach for small independent sites where clinical trials are executed. It's also more efficient on the sponsor side to interface with one large entity rather than several small entities.
I suspect that the increasing demands of technology and burden of records keeping in both clinical trials and health insurance makes it difficult for small independent sites to operate profitably. So what happens is that many small, independent offices end up joining a larger entity that can consolidate some of the "system level complexity" more efficiently. The tradeoff is that it's no longer about the doctor-patient relationship; it's about efficiency and profits.
I also suspect that part of it is that PE realizes that consolidation lets them control prices. If they can control a network of trial sites, then they have more power to negotiate rates with sponsors and CROs for each patient they sign up to the trial. The bigger the network, the greater their leverage. I think this probably also holds true for healthcare and insurance providers in general.
[0] https://www.fiercebiotech.com/cro/private-equity-invests-tri...
I live just outside a large urban area, and my wait time for a PCP is weeks if I agree to see their PA (the PCP will review all findings anyway), or days if I put myself on their cancellation list. Maybe try calling around just outside of your urban area.
> This is unusual.
Is it? That's pretty normal in my part of the US, and that's assuming you already have a PCP. If you don't, then finding one that's accepting patients can take much, much longer.
Is it? That's pretty normal in my part of the US, and that's assuming you already have a PCP. If you don't, then finding one that's accepting patients can take much, much longer.
> Is it? That's pretty normal in my part of the US
Are you in a state with a shortage of PCPs [1]? If so, yes. But most Americans aren't in those states, and in at least a few of them the harm is closer to a political choice than an oversight.
[1] https://www.beckershospitalreview.com/rankings-and-ratings/s...
Are you in a state with a shortage of PCPs [1]? If so, yes. But most Americans aren't in those states, and in at least a few of them the harm is closer to a political choice than an oversight.
[1] https://www.beckershospitalreview.com/rankings-and-ratings/s...
I have heard the same comments from people in states all across the nation. It may very well be that it's a minority of states (I don't know), but it's certainly a very substantial portion of the population that's affected.
I'm not asserting that what I've experienced, seen, and heard represents the majority experience. As I mentioned, I don't know. But it's not exactly a rare experience.
I'm not asserting that what I've experienced, seen, and heard represents the majority experience. As I mentioned, I don't know. But it's not exactly a rare experience.
In FL. Been to 2 different PCP over the past decade. Was 90+ days before I could get my first appointment at both locations.
I’m in Southern California and it also is a bit of a wait
IME (SoCal) the 1st visit can take 2-3 months. After that you can get back in with only a 2-3 week wait, shorter if it’s urgent.
They seem to rate limit new patients so current patients can get in.
They seem to rate limit new patients so current patients can get in.
> This is unusual.
> In America, the "average wait time for a [cardiologist, dermatologist, og/gyn, orthopedic surgery or family medicine] appointment for the 15 large metro markets surveyed in 2022 is 26.0 days" [1].
I want to point out the important missing fact there that the "America average" time tells you nothing about variance across geography, specialty, or patient population, and you really need to at the very least look further down at the charts where they talk about shortest and longest times in the different cities and specialties.
For instance I see Boston's longest 2022 time for family medicine is 136 days, average 40 days. And Massachusetts is one of the top states on your list for PCPs per capita. At least that's better than 2017 where the longest time was "fuck you, get rekt, lmao".
> In America, the "average wait time for a [cardiologist, dermatologist, og/gyn, orthopedic surgery or family medicine] appointment for the 15 large metro markets surveyed in 2022 is 26.0 days" [1].
I want to point out the important missing fact there that the "America average" time tells you nothing about variance across geography, specialty, or patient population, and you really need to at the very least look further down at the charts where they talk about shortest and longest times in the different cities and specialties.
For instance I see Boston's longest 2022 time for family medicine is 136 days, average 40 days. And Massachusetts is one of the top states on your list for PCPs per capita. At least that's better than 2017 where the longest time was "fuck you, get rekt, lmao".
Connecticut. Everything is like this here. I have genuinely considered moving because of this. My current employer has another location in California, and as much as I hate the idea of moving back there, it might be necessary for my own physical well-being.
Wait times for certain types of appointments are just as long in much of California. But the variance is huge, so it could be better (or worse) depending on exactly where you go and which providers are in your health plan network.
USA/Bay Area here.
My surgery took months of specialist appointments and months to get an OR slot. There was a conflict and it was delayed again.
I changed networks and when searching for a new PCP I had to wait over a month for the first appointment.
My surgery took months of specialist appointments and months to get an OR slot. There was a conflict and it was delayed again.
I changed networks and when searching for a new PCP I had to wait over a month for the first appointment.
Sometimes a doctor is available but crappy scheduling software hides that.
I got a small scratch from a squirrel and since it did cause a little blood to appear I figured better safe than sorry and went to Kaiser's site to make an appointment with my PCP.
They had nothing for a few weeks.
So I changed to requesting an appointment with any doctor at the same facility. It then gave me an appointment with my PCP for the next day at 9 am.
I've seen similar problems with vaccine scheduling using their web site. It will sometimes only show appointments at a bigger Kaiser facility in the next town, or an even bigger one 30 minutes away.
But if I actually go in and talk to the people at the front desk at the Kaiser office in my town they can often make me an appointment at that facility.
I got a small scratch from a squirrel and since it did cause a little blood to appear I figured better safe than sorry and went to Kaiser's site to make an appointment with my PCP.
They had nothing for a few weeks.
So I changed to requesting an appointment with any doctor at the same facility. It then gave me an appointment with my PCP for the next day at 9 am.
I've seen similar problems with vaccine scheduling using their web site. It will sometimes only show appointments at a bigger Kaiser facility in the next town, or an even bigger one 30 minutes away.
But if I actually go in and talk to the people at the front desk at the Kaiser office in my town they can often make me an appointment at that facility.
It's also much faster to get in front of a NP than a doctor.
As it should be. One of the few levers we have to control costs across the healthcare system is shifting much of routine primary and urgent care to PA/NP practitioners. I understand that might mean a loss of quality in some cases (have been on the receiving end of that myself) but we'll have to lower our expectations and be content with good enough.
I'm in Oregon - in the Portland metro area - and a cardiologist appointment for me was about 3 months, neurologist about 4 months, and sleep lab 3 months. My PCP is usually a 1-3 weeks wait, but sometimes I get lucky and he's available in like 2 days.
In my experience it depends on the speciality you need.
If you need to see an Otolaryngologist (ENT), you might be able to get an appointment within a few weeks. If you need to see an Endocrinologist, it might be 4-6 months.
If you need to see an Otolaryngologist (ENT), you might be able to get an appointment within a few weeks. If you need to see an Endocrinologist, it might be 4-6 months.
There is a specialist shortage. Refs I've sent to Endros take months. I've even had to refer patients to places nearly 150 miles away.
I had this issue due the consolidation of medical networks.
Luckily I have a BlueCross PPO. So I’ll get fast access to a specialist in NYC in Boston then transfer the records back to the local dude if needed. My wife had an issue with a complication, and I found a doctor who was a contributor to a major study on it and we got treated by him. Epic makes managing this trivial.
It’s the best of both worlds, but only if you have the privilege of legacy insurance and PTO.
Luckily I have a BlueCross PPO. So I’ll get fast access to a specialist in NYC in Boston then transfer the records back to the local dude if needed. My wife had an issue with a complication, and I found a doctor who was a contributor to a major study on it and we got treated by him. Epic makes managing this trivial.
It’s the best of both worlds, but only if you have the privilege of legacy insurance and PTO.
If you think it’s worth it, you can fly to a few places in East Asia or Southeast Asia where you can see a medical specialist in private hospitals on the same day, especially if arranged a couple of days in advance.
These include Singapore, Thailand, Malaysia, Hong Kong, Taiwan, etc.
The quality of care in these private hospitals is usually high as well.
For some cases, the costs in more affordable locations among the above—even after including economy flights—could be cheaper than treatment in the US.
https://chatgpt.com/share/e/671fb198-2a34-8011-a2e8-e0b4aa45...
These include Singapore, Thailand, Malaysia, Hong Kong, Taiwan, etc.
The quality of care in these private hospitals is usually high as well.
For some cases, the costs in more affordable locations among the above—even after including economy flights—could be cheaper than treatment in the US.
https://chatgpt.com/share/e/671fb198-2a34-8011-a2e8-e0b4aa45...
I visited an international hospital in Saigon to have a skin infection drained and cleaned and bandaged. I remember them charging me around $14. Strange, as surely the nurse used more than $14 in PPE and bandages.
International hospitals in Singapore and Malaysia will be more normally priced, but still a small fraction of what you'd spend in USA.
International hospitals in Singapore and Malaysia will be more normally priced, but still a small fraction of what you'd spend in USA.
Which metrics are you using to measure quality of care?
The city of Merida in Mexico might also be an option.
I live in Asia. I can see any specialist within the week, and if it is urgent, possibly that evening. I needed surgery once and they told me to come back at 6pm, the same day.
10 years ago I could see my doctor when I was sick. Like, the same day. Now if it can't be done at the Target or CVS, it's the emergency room. I didn't even get an annual checkup last year because my doctor had to cancel, and the earliest I can be seen again is this summer. I'm now at the age where this is probably starting to matter.
And I pay like... $30,000 a year minimum for this?
And I pay like... $30,000 a year minimum for this?
> 10 years ago I could see my doctor when I was sick. Like, the same day
Have you tried telemedicine? I've done it through One Medical, and it's a charm for little things that require a quick check-up.
Have you tried telemedicine? I've done it through One Medical, and it's a charm for little things that require a quick check-up.
I sort of find telemedicine to a be a scam. I’m sure it has its use case, but most of the time it feels like they are trying to limit liability so they just tell you to go see a doctor in person.
I think they are hugely valuable if/when people are in the drivers seat for their own medical care.
If someone wants bloodwork done, to try a drug, or change dosage, it is a faster way to get an appointment.
If they want to get a general inspection and tune-up, it seems less fit for purpose.
If someone wants bloodwork done, to try a drug, or change dosage, it is a faster way to get an appointment.
If they want to get a general inspection and tune-up, it seems less fit for purpose.
Most routine bloodwork you can order yourself if you want to without going through a physician.
https://www.questhealth.com/
https://www.questhealth.com/
do you still get insurance coverage if it isnt requested by a physician?
Edit: answered my own question. Per questhealth.com "Tests purchased on questhealth.com are only for individuals who intend to pay directly for testing and do not want to submit a claim for reimbursement under their health insurance. "
I was excited for a minute
Edit: answered my own question. Per questhealth.com "Tests purchased on questhealth.com are only for individuals who intend to pay directly for testing and do not want to submit a claim for reimbursement under their health insurance. "
I was excited for a minute
You can still submit your own claim to your health plan even if the provider doesn't do billing. They may or not pay depending on coverage policies. You can also probably use an HSA or HRA to pay for these services.
Anecdotally, I prefer telemedicine for my PCP other than yearly physicals. I can usually get an appointment in the same week, often same day if I am willing to go to another provider in a different nearby office.
YMMV I guess.
YMMV I guess.
I know insurance can be pricey, but $2500/month? Who's your provider? Do you have a family of 6 or something?
I pulled insurance quotes for my wife and I recently. Both of us are young and with no known health issues. Our monthly premiums for the cheapest plan was around $800 per month, but that was with very limited coverage and a deductible of around $15,000 before they would cover any major expenses.
The premiums would be $9,600 a year but all in we could spend around $25,000. We had options for higher premiums and lower deductibles as well, but the total max out of pocket was almost identical.
The premiums would be $9,600 a year but all in we could spend around $25,000. We had options for higher premiums and lower deductibles as well, but the total max out of pocket was almost identical.
Make sure you are fully aware of federal subsidies for your insurance premiums.
It's a bit complicated to explain the details, but basically you won't pay more than about 8.3% of your AGI for insurance, no matter what your income level is.
Alas, these subsidies may expire next year if Congress does not renew them (they don't actually vanish, they are just income-capped at 400% of the federal poverty level).
It's a bit complicated to explain the details, but basically you won't pay more than about 8.3% of your AGI for insurance, no matter what your income level is.
Alas, these subsidies may expire next year if Congress does not renew them (they don't actually vanish, they are just income-capped at 400% of the federal poverty level).
To save people a lookup, 400% of the federal poverty level in 2025:
From 133% (if you are below 133% you are supposed to use extended Medicaid instead of a subsidized marketplace plan) to 400% the amount of the subsidy goes down bit is still substantial at 400%.
This can result in a situation where if your income is a little over 400% FPL you might come out ahead by taking a pay cat to get under.
Household
Size 400% FPL
1 $60240
2 $81760
3 $103280
4 $124800
5 $146320
6 $167600
From 133% (if you are below 133% you are supposed to use extended Medicaid instead of a subsidized marketplace plan) to 400% the amount of the subsidy goes down bit is still substantial at 400%.
This can result in a situation where if your income is a little over 400% FPL you might come out ahead by taking a pay cat to get under.
There is no abrupt drop at this time. There is a smooth gradient in the percentage of AGI that "the 2nd most expensive silver plan in your state" can cost.
Next year, if Congress does not renew the expansion above 400% that was started during COVID, then there will the most abrupt drop possible at 400%: from something to absolutely zero.
My wife and I save at least $6000/year thanks to these subsidies, which put our health insurance into the same general realm as most other industrialized nations (typically 8-12% of AGI on health insurance of some kind).
Next year, if Congress does not renew the expansion above 400% that was started during COVID, then there will the most abrupt drop possible at 400%: from something to absolutely zero.
My wife and I save at least $6000/year thanks to these subsidies, which put our health insurance into the same general realm as most other industrialized nations (typically 8-12% of AGI on health insurance of some kind).
Yeah, I was assuming that the COVID stuff will not get renewed.
This is ultimately the route we'll likely end up in. I was surprised to see we could make around $75k and the cheapest plans ($800/month) would be fully covered. That said, that opens a much bigger conversation related to tax subsidies and whether the ACA accomplished enough for the pros to outweigh the cons.
I appreciate the details you shared here by the way, very helpful for me and anyone else coming by seeing similar premiums and isn't aware of what subsidies do exist.
I appreciate the details you shared here by the way, very helpful for me and anyone else coming by seeing similar premiums and isn't aware of what subsidies do exist.
Absolutely. Even though the subsidies have been extremely beneficial for my wife and I, I seriously question whether or not the policy of handling excessive medical costs by paying private insurance companies money to make their insurance premiums affordable to everyone makes much (if any) sense.
If medical costs are indeed so high that our insurer needs $X from us each month to make health insurance viable, how does it help anything to make sure they get $X pretty much no matter what?
Do feel free to ask if you have any other questions about this. I do my own taxes, and have had to do a deep dive into the rules/forms for this stuff for several years now.
If medical costs are indeed so high that our insurer needs $X from us each month to make health insurance viable, how does it help anything to make sure they get $X pretty much no matter what?
Do feel free to ask if you have any other questions about this. I do my own taxes, and have had to do a deep dive into the rules/forms for this stuff for several years now.
My employer pays $3,575.49 per month for my HDHP ($12,000 deductible). Family of 3. It's Aetna, through one of the large small-business payroll providers. Are we getting ripped off?
That seems high. Family of 4 and I pay $447, employer pays $1,342 (so total $1,789).
My plan is Anthem Silver Preferred Blue PPO 4000/10%/7250 w/HSA - in other words $4000/person deductible (or 8k for whole family).
This is through Gusto, company is in New Hampshire.
My plan is Anthem Silver Preferred Blue PPO 4000/10%/7250 w/HSA - in other words $4000/person deductible (or 8k for whole family).
This is through Gusto, company is in New Hampshire.
You're probably not getting ripped off (relatively speaking). When I quit my job to take some time off 3 years ago, and signed up for COBRA, the out of pocket expense for 2 adults came to around $2000 per month, also for an HDHP plan.
Kaiser's "platinum-level" (90% average coverage, no deductibles) plan for a young nonsmoking adult runs about $450/mo in my state marketplace, and most of that is further subsidized for someone who isn't making middle class wages. The medium-deductible, 70%-average-coinsurance "Silver-level" plan is about half that.
I don't even understand the concept of a $12,000 deductible when the ACA established maximum out of pocket at:
> "For the 2024 plan year: The out-of-pocket limit for a Marketplace plan can't be more than $9,450 for an individual and $18,900 for a family."
What are you even paying for?
I don't even understand the concept of a $12,000 deductible when the ACA established maximum out of pocket at:
> "For the 2024 plan year: The out-of-pocket limit for a Marketplace plan can't be more than $9,450 for an individual and $18,900 for a family."
What are you even paying for?
The individual marketplace plans seem to exist in a totally different world from employer-provided plans. When I went from my old employer's COBRA to an MD Health Connection plan, my premium dropped nearly fourfold even with no subsidies.
> What are you even paying for?
I have no idea! High-deductible plans give you access to HSAs, which are the "don't pay taxes" cheat code (you put in pre-tax money, it gets invested in the market and grows tax-free, and you can spend it tax-free if it's on medical expenses; if you're over 65 you can use it for anything and pay regular income tax). But I'm paying 42,000 per year pre-tax for that privilege + insurance; maybe it's better to just get paid that as salary, take the income tax hit, buy coverage on the open market for far less, and then invest the leftover money.
I have no idea! High-deductible plans give you access to HSAs, which are the "don't pay taxes" cheat code (you put in pre-tax money, it gets invested in the market and grows tax-free, and you can spend it tax-free if it's on medical expenses; if you're over 65 you can use it for anything and pay regular income tax). But I'm paying 42,000 per year pre-tax for that privilege + insurance; maybe it's better to just get paid that as salary, take the income tax hit, buy coverage on the open market for far less, and then invest the leftover money.
So your premiums aren't being spent on healthcare, they're essentially being invested in a retirement plan?
You still pay the premiums. You just have access to an HSA account you can make separate pre-tax contributions to. Sometimes your employer puts some amount in as well on some regular interval.
Premium + deductible + prescriptions + out of network care
I believe 30k is possible for a healthy single American.
I believe 30k is possible for a healthy single American.
I didn't think so back when I was in a startup insurance program where it literally covered stuff.
But i've been on a "normal" health plan through my wife's job for the last 5 years.
The American health system is experienced totally differently by different classes of people.
But i've been on a "normal" health plan through my wife's job for the last 5 years.
The American health system is experienced totally differently by different classes of people.
Just because it's possible, doesn't mean it's typical, or even common.
I mean my wife and I pay $700/mo premium, we both hit our $2500 deductible this year already, my physical therapy is out of network and costs me $800/mo
That's $23k already before prescriptions and we are in our 30s with no major health issues.
That's $23k already before prescriptions and we are in our 30s with no major health issues.
> my physical therapy is out of network and costs me $800/mo
That part doubles what you are paying yearly and is EXTREMELY uncommon. For most Americans, an appointment that costs $800/mo is one you don't schedule because you quite literally cannot afford that and will go through bankruptcy attempting to.
That part doubles what you are paying yearly and is EXTREMELY uncommon. For most Americans, an appointment that costs $800/mo is one you don't schedule because you quite literally cannot afford that and will go through bankruptcy attempting to.
You literally proved my point.
You spend $11500 per person, while the original statement alluded to $30k for a single adult.
Do you honestly not see the difference or are you that well off that $18500 is not a significant amount of money to you?
You spend $11500 per person, while the original statement alluded to $30k for a single adult.
Do you honestly not see the difference or are you that well off that $18500 is not a significant amount of money to you?
I said I believe 30k is possible
You are free to argue against whatever strawman you desire... Chasing your own shadow though
You are free to argue against whatever strawman you desire... Chasing your own shadow though
[deleted]
I think Taiwan is worth adding to the list of healthcare systems that folks study. I believe it may be similar to the Swiss system.
Everyone has national health insurance, but you also get to choose where to go, and some doctors also offer non-insured services that you can pay for out of pocket.
The result is universal coverage combined with a competitive market that drives prices down and encourages innovation.
I know this is just anecdata, but having held an insurance card there for a while, our family was always able to see our family doctor the same day we called. And the one or two times a specialist or emergency room was needed, there was minimal hassle.
I'm sure there are problems with it, too -- I just don't know what they are. As a customer/patient, it seemed to work far better than the American system I'm used to.
Everyone has national health insurance, but you also get to choose where to go, and some doctors also offer non-insured services that you can pay for out of pocket.
The result is universal coverage combined with a competitive market that drives prices down and encourages innovation.
I know this is just anecdata, but having held an insurance card there for a while, our family was always able to see our family doctor the same day we called. And the one or two times a specialist or emergency room was needed, there was minimal hassle.
I'm sure there are problems with it, too -- I just don't know what they are. As a customer/patient, it seemed to work far better than the American system I'm used to.
Most of Europe has a similar model to what you've described: some form of mandatory state-backed insurance combined with a mix of private and public healthcare providers. In many countries, however, the biggest hospitals in Europe are owned by the government.
Unfortunately the healthcare systems are in the process of collapsing across the UK and the majority of the continent too.
My pet theory is I don't think it's actually anything to do with the overall funding model. I think it's to do with our inability to adapt to an increasingly elderly population. People's kids here are scattered around the country, often many hours of travel away, living in small apartments, and can't easily look after their elderly relatives in a way that's much more common in East Asia. As a consequence, we are offload that responsibility onto the healthcare system, which treats them as patients with medical issues, when often they are just old people with broadly normal age-related disease. Our systems were never designed to be capable of handling millions of elderly people, and it's not an efficient way of providing the required care, so it's falling apart.
Unfortunately the healthcare systems are in the process of collapsing across the UK and the majority of the continent too.
My pet theory is I don't think it's actually anything to do with the overall funding model. I think it's to do with our inability to adapt to an increasingly elderly population. People's kids here are scattered around the country, often many hours of travel away, living in small apartments, and can't easily look after their elderly relatives in a way that's much more common in East Asia. As a consequence, we are offload that responsibility onto the healthcare system, which treats them as patients with medical issues, when often they are just old people with broadly normal age-related disease. Our systems were never designed to be capable of handling millions of elderly people, and it's not an efficient way of providing the required care, so it's falling apart.
This is an interesting theory. I just came back from Thailand where I needed to make an ER visit for a grand total of $89 USD, including the price of three prescriptions. I was touring with one of the natives who made a comment around the lines of, "We don't abandon our elderly parents here like you Westerners do." This was in a conversation around their multi-generation households.
It's not necessarily a correlation, but your comment reminded me of the conversation.
It's not necessarily a correlation, but your comment reminded me of the conversation.
This is my understanding of the US situation.
It used to be that doctors were running their own small medical offices a lot. Unfortunately, due to insurance overhead it's no longer profitable for individual doctors to do that, especially without existing patients, so the remaining offices are mostly from doctors near retirement age.
So as doctors retire and new doctors don't want to start their own practices those practices have been getting bought out by large medical networks or private equity. Some offices are also going out of network with insurance companies. It doesn't help that PE is willing to pay a ton more than any new doctor could for the practice.
I'd recommend picking medical plans with out referral requirements and with good out-of-network coverage.
It used to be that doctors were running their own small medical offices a lot. Unfortunately, due to insurance overhead it's no longer profitable for individual doctors to do that, especially without existing patients, so the remaining offices are mostly from doctors near retirement age.
So as doctors retire and new doctors don't want to start their own practices those practices have been getting bought out by large medical networks or private equity. Some offices are also going out of network with insurance companies. It doesn't help that PE is willing to pay a ton more than any new doctor could for the practice.
I'd recommend picking medical plans with out referral requirements and with good out-of-network coverage.
I wrote a more detailed post elsewhere in this thread, but I also think this is the case and you can see an analogue with consolidation of clinical trial sites by private equity.
https://www.fiercebiotech.com/cro/private-equity-invests-tri...
https://www.fiercebiotech.com/cro/private-equity-invests-tri...
> Private equity dollars are flowing toward clinical trial sites as industry conditions demand larger site networks, PitchBook's analysis of first quarter 2024 deal activity shows.
>
> For CROs, scooping up trial sites is one aspect of a greater movement toward vertical and horizontal consolidation, a long-standing trend that is still playing out in the space, the PitchBook report confirmed. CROs continue to combine with contract development and manufacturing organizations to establish end-to-end drug development capabilities under a single roof, making them more competitive in the outsourcing market.My brother was a Family Medicine doctor and he got burned out and retired early and is now a potter lol. His ex gf was a doctor and did the same. I suspect this sort of thing is behind a lot of the issues this article is explaining. After Covid, a large portion of the world that could retire did so and never came back. Those that are left and stuck in that world working or trying to use it, are not happy about it.
I'm intrigued by this line from the article:
> Before the pandemic, she says, she might have done two disability tax credit forms; last year, she did twenty
Did Covid cause massive disability? Did legislation change to make claiming a disability easier or more lucrative? Are people claiming disability in response to inability to get jobs that meet their expectations?
It's not the point of the article, but a 10x increase in requests for "disability tax credit forms" seems like a very significant sign of something deeply concerning.
I wonder how many people seeking disability are more accurately described as disenfranchised. If people are looking at bleak prospects of low-paid jobs with limited possibilities for advancement, alongside soaring housing and other costs, how many people with previously manageable impairments are throwing in the towel and using a disability designation to escape the rat race.
> Before the pandemic, she says, she might have done two disability tax credit forms; last year, she did twenty
Did Covid cause massive disability? Did legislation change to make claiming a disability easier or more lucrative? Are people claiming disability in response to inability to get jobs that meet their expectations?
It's not the point of the article, but a 10x increase in requests for "disability tax credit forms" seems like a very significant sign of something deeply concerning.
I wonder how many people seeking disability are more accurately described as disenfranchised. If people are looking at bleak prospects of low-paid jobs with limited possibilities for advancement, alongside soaring housing and other costs, how many people with previously manageable impairments are throwing in the towel and using a disability designation to escape the rat race.
Yes, Covid did cause massive disability. The colloquial term for it is Long Covid. I know at least three people suffering from it —- along a spectrum from slight to severe impairment of daily functioning.
> Covid did cause massive disability. The colloquial term for it is Long Covid
I know a previously-healthy guy who got an early variant that went for his pancreas. He now has Type 1 diabetes, a condition one is normally born with and for which there is no cure, just chronic, expensive and time-consuming treatment.
I know a previously-healthy guy who got an early variant that went for his pancreas. He now has Type 1 diabetes, a condition one is normally born with and for which there is no cure, just chronic, expensive and time-consuming treatment.
> He now has Type 1 diabetes, a condition one is normally born with
Type 1 Diabetes isn't something someone is born with. Rather, it's something that you generally get when young (and, in fact, it used to be called Juvenile Diabetes, vs Adult Onset, which is what Type 2 used to be called), but it can happen later in line, all the way into the 20s (or later, I believe).
There is a genetic component, but it's also completely possible to get it with no family history.
Type 1 Diabetes isn't something someone is born with. Rather, it's something that you generally get when young (and, in fact, it used to be called Juvenile Diabetes, vs Adult Onset, which is what Type 2 used to be called), but it can happen later in line, all the way into the 20s (or later, I believe).
There is a genetic component, but it's also completely possible to get it with no family history.
Didn't realise it was autoimmune. Nevertheless, in his case it was directly caused by Covid attacking the pancreas. That said, he got it in 2020. The virus got milder over successive generations. (Intrinsically and due to broader vaccination and antiviral administration.)
There's actually a couple different "types" of Type 1 Diabetes. For example, you can get it during pregnancy (Gestational Diabetes), etc. So it doesn't surprise me that it's possible to get it from Covid. I seem to recall someone getting it from an injury that damaged the Pancreas enough to prevent it from generating insulin. I don't know if that still "counts" as Type 1; but it certainly has the same effects.
> an injury that damaged the Pancreas enough to prevent it from generating insulin. I don't know if that still "counts" as Type 1
It does. Type 1 is fundamentally about an inability to produce insuline. Type 2, an inability to respond to it.
It does. Type 1 is fundamentally about an inability to produce insuline. Type 2, an inability to respond to it.
> He now has Type 1 diabetes, a condition one is normally born with
This is simply untrue. You can be born with it, but it's certainly not the common type of type 1.
This is simply untrue. You can be born with it, but it's certainly not the common type of type 1.
How old is he? Type 1 can show up in your 20s-30s, it's not always the case that you're born with it
Even for the first person described in the story, her search for a doctor is not primarily described a search for medical care, but a search for someone who can create a paper trail to ensure her child's eligibility for benefits.
I think it's a combination of long covid and the effect covid had on people's mental health.
Being "disenfranchised" can very easily lead to major depressive disorder, anxiety disorders, etc.
Being "disenfranchised" can very easily lead to major depressive disorder, anxiety disorders, etc.
An interesting thing I'm seeing happening in primary care is that doctors are being replaced by doctor adjacent professions like Nurse Practitioner, Physician Assistant, etc.
A doctor spends a decade working 60 to 80 hour weeks studying medicine whereas an NP is a Master degree, I think which can be obtained online.
There doesn't appear to be clear results yet in studies on the outcomes of NP's vs MD's (see reference).
Another argument is that maybe all that medical school training is overkill in Primary Care and this is perfect setting for NP's or PA's. And also maybe most doctors are not ambitious and forget most of the training they're not using on a daily basis anyway.
I think it would be pretty funny if after more studies NP's showed no different outcomes than MD's.
Interesting write up on NP outcomes.
https://pubmed.ncbi.nlm.nih.gov/18766097/
A doctor spends a decade working 60 to 80 hour weeks studying medicine whereas an NP is a Master degree, I think which can be obtained online.
There doesn't appear to be clear results yet in studies on the outcomes of NP's vs MD's (see reference).
Another argument is that maybe all that medical school training is overkill in Primary Care and this is perfect setting for NP's or PA's. And also maybe most doctors are not ambitious and forget most of the training they're not using on a daily basis anyway.
I think it would be pretty funny if after more studies NP's showed no different outcomes than MD's.
Interesting write up on NP outcomes.
https://pubmed.ncbi.nlm.nih.gov/18766097/
A lot of the problems in medical care have nothing to do with the system (Canada vs US) and everything to do with doctor supply.
It’s simply not a great career choice anymore. You start work very late in life, and make only OK money. Some specialists make a lot but they start even later. Some GPs make a lot but they run patient mills. For most GPs, it’s an extreme slog without extreme reward.
The same career issue goes triple for nurses. Young nurses are quitting in droves.
It’s simply not a great career choice anymore. You start work very late in life, and make only OK money. Some specialists make a lot but they start even later. Some GPs make a lot but they run patient mills. For most GPs, it’s an extreme slog without extreme reward.
The same career issue goes triple for nurses. Young nurses are quitting in droves.
It's a broken system. Years of training, very selective, highly expensive... only for a lot of it to be telling people common sense things like eat less and excercise more.
Never mind that half your patients will swear to your face that your entire decade of training was part of a global conspiracy by Bill Gates to put microchips in your arm or other bullshit.
And half of your nurses will agree with them!
And half of your nurses will agree with them!
> and make only OK money
Sounds like it has a lot to do with the system.
In the US, because of employer insurance, the cost of insurance is mostly hidden from patients. The cost of medical care is similarly opaque -- consumers expect routine checkups to be essentially free, and sick visits to cost next to nothing. Insurance companies are always trying to drive down their costs, and control access for a huge set of patients.
Sounds like it has a lot to do with the system.
In the US, because of employer insurance, the cost of insurance is mostly hidden from patients. The cost of medical care is similarly opaque -- consumers expect routine checkups to be essentially free, and sick visits to cost next to nothing. Insurance companies are always trying to drive down their costs, and control access for a huge set of patients.
I know it would be political suicide, but I do believe that we could still have a very good medical system if the level of education we demand of doctors was reserved for surgeons and leadership and the front-line work of GP-style treatment was 100% left to people who were qualified by a normal nurse-style process of undergrad + apprenticeship + test.
That's kind of how it works outside of North America. Students go into medical school right out of high school, and medical school is about 6 years - maybe including residency. They graduate with a degree that allows them to practice general and family medicine. If they want to become specialists, they keep studying and more residency.
North America seems to be alone in requiring a 4 year degree before letting a student anywhere near a medical school.
North America seems to be alone in requiring a 4 year degree before letting a student anywhere near a medical school.
Also "rest of the world" the medical professionals do not get into massive debt and hence do not need massive compensation upon graduation to offset. One issue of getting more supply of doctor would, I believe, be the resistance from the current system since more supply means lower prices...
Additionally since a lot of our healthcare is managed by Private Equity or other forms of investors that are looking for a profit, I suspect with cheaper staff they will just keep prices the same and increase their profits.
Additionally since a lot of our healthcare is managed by Private Equity or other forms of investors that are looking for a profit, I suspect with cheaper staff they will just keep prices the same and increase their profits.
On replacing doctors with RNs or NPs I think the comment I replied to was removed with mine, so I'll put it here instead. The point is elevating midlevels really is worse care, whereas cutting out years of schooling for doctors would be fine. Again the fact that there's a conflict of interest doesn't falsify these examples - https://old.reddit.com/r/Residency/comments/1geiamv/icu_np_t...
Previous comment:
If you said "Where applicable, level up folks with the desire and aptitude from IT support->senior engineer. This specific pain point is a talent pipeline health and structure challenge. SWE feelings around this are going to be something to consider, to note when preparing for the opposition" people would go wait, maybe the occasional fresh bootcamp grad or ITsupport technician has the potential to do strong work or manage a team, but in general their education has not prepared them. Of course if you ask a doctor "could the RN or NP run this floor" there's a conflict of interest when they tell you "no", but they're also correct.
Having a nurse is probably better than no medical care at all, so a tiered system where poor people get nurses without realizing they're worse than doctors would have that advantage, but the right overhaul imo would be reducing the years of schooling required to become a real doctor (undergrad, med school, residency, maybe fellowship, finally attending). If doctors skipped undergrad and cut out some med school or fellowship requirements, they'd start working earlier and could afford to choose specialties that pay less. As well as expanding residency slots and moving insurance compensation to family medicine and pediatrics.
edit - here's a good example, https://old.reddit.com/r/medicine/comments/1f6m5i9/its_scary... the good news is they'd agree with you that midlevels do have a role, the problem with scope creep is defining what that role is, and the assumption that the training is 80% or even 50% there
Previous comment:
If you said "Where applicable, level up folks with the desire and aptitude from IT support->senior engineer. This specific pain point is a talent pipeline health and structure challenge. SWE feelings around this are going to be something to consider, to note when preparing for the opposition" people would go wait, maybe the occasional fresh bootcamp grad or ITsupport technician has the potential to do strong work or manage a team, but in general their education has not prepared them. Of course if you ask a doctor "could the RN or NP run this floor" there's a conflict of interest when they tell you "no", but they're also correct.
Having a nurse is probably better than no medical care at all, so a tiered system where poor people get nurses without realizing they're worse than doctors would have that advantage, but the right overhaul imo would be reducing the years of schooling required to become a real doctor (undergrad, med school, residency, maybe fellowship, finally attending). If doctors skipped undergrad and cut out some med school or fellowship requirements, they'd start working earlier and could afford to choose specialties that pay less. As well as expanding residency slots and moving insurance compensation to family medicine and pediatrics.
edit - here's a good example, https://old.reddit.com/r/medicine/comments/1f6m5i9/its_scary... the good news is they'd agree with you that midlevels do have a role, the problem with scope creep is defining what that role is, and the assumption that the training is 80% or even 50% there
Anyone looking for a solution to physician quality or availability can find it through direct primary care / concierge care. Personally I pay $60/month to have unlimited access to my physician in Austin.
The physician, in turn, rather than having 40% overhead, has no overhead from billing or insurance. They have simple monthly cashflow that they can allocate to cover rent and wages for their practice. This means that the physician can choose how many patients they have relative to their expenses, and decide how much time they have available on average for each patient.
The result is great for the patient, great for the provider, and the sort of thing that will help increase availability of doctors, and their satisfaction with their work.
You can find more on this from https://www.dpcare.org. Here's a map of direct primary care practices: https://mapper.dpcfrontier.com.
The physician, in turn, rather than having 40% overhead, has no overhead from billing or insurance. They have simple monthly cashflow that they can allocate to cover rent and wages for their practice. This means that the physician can choose how many patients they have relative to their expenses, and decide how much time they have available on average for each patient.
The result is great for the patient, great for the provider, and the sort of thing that will help increase availability of doctors, and their satisfaction with their work.
You can find more on this from https://www.dpcare.org. Here's a map of direct primary care practices: https://mapper.dpcfrontier.com.
I wonder what percentage of medical issues we could tackle by better analyzing and categorizing the existing medical studies that are out there.
And then attaching a user interface to the data that guides the user through a step-by-step self-diagnose process.
And then attaching a user interface to the data that guides the user through a step-by-step self-diagnose process.
There is too much "medical students syndrome" - you learn about some symptoms and they decide you have the issue because the symptoms match even though they don't match in the right way.
There are also a lot of rare things that need expensive procedures that shouldn't be done on a whim. Many medical tests increase your odds of cancer for instance - if you really need that test done to figure out your issue it is worth it, but those tests shouldn't just be done - it is often better to treat the most common causes without verifying that is really the root cause and then only if those treatments fail do the tests to see what you really have.
There are also a lot of rare things that need expensive procedures that shouldn't be done on a whim. Many medical tests increase your odds of cancer for instance - if you really need that test done to figure out your issue it is worth it, but those tests shouldn't just be done - it is often better to treat the most common causes without verifying that is really the root cause and then only if those treatments fail do the tests to see what you really have.
I am a PCP who runs utilization reviews for our provider group. I review every ED utilization for every patient attributed to a PCP in our network. My job is to try to reduce inappropriate ED utilization.
I have no idea what reduces utilization.
There's major shortage of primary care doctors. Most med students don’t want to go into primary care. Plus, hiring new doctors is not as easy as it sounds… even if there were an excess of doctors looking for jobs, you have to have clinic space and staff in order to run a practice.
Specialists are in the same boat, post-COVID. Having to ref some pts to neurology with a 6+ month wait.
I have no idea what reduces utilization.
There's major shortage of primary care doctors. Most med students don’t want to go into primary care. Plus, hiring new doctors is not as easy as it sounds… even if there were an excess of doctors looking for jobs, you have to have clinic space and staff in order to run a practice.
Specialists are in the same boat, post-COVID. Having to ref some pts to neurology with a 6+ month wait.
[deleted]
>If family doctors’ compensation is going to be the lowest of all physicians’, they at least want to rein in their hours and responsibilities. And they want to be able to take a vacation.
The article is relevant, but it is a case of "you get what you pay for".
The article is relevant, but it is a case of "you get what you pay for".
Satirist Chris Morris on the state of general practice in the UK:
https://www.youtube.com/watch?v=vECEz1E0HWg
https://www.youtube.com/watch?v=vECEz1E0HWg
I’ve heard what the article describes about specializing being the way to go. In the US, insurance is also a huge pain in the ass; doctors have to fight to get paid as often as we have to fight to have things covered. There’s also the overhead of insurance for their practice, the costs of running a clinic or being part of a clinic group, maintaining compliance with everything, paying Epic’s extortionate fees, etc.
The last two doctors I’ve had have gone to “concierge” services to help mitigate this. They stabilize their income with annual membership fees that sidestep the insurance company horseshit. They constrain their roster a bit. They can see people more quickly. But you have to be a member.
It’s sad for me, but I get it from their perspective. “Retail” healthcare in the US is by all accounts a nightmare.
The last two doctors I’ve had have gone to “concierge” services to help mitigate this. They stabilize their income with annual membership fees that sidestep the insurance company horseshit. They constrain their roster a bit. They can see people more quickly. But you have to be a member.
It’s sad for me, but I get it from their perspective. “Retail” healthcare in the US is by all accounts a nightmare.
Why are you using PCPs? The urgent care route seems more efficient, scales, and takes advantage of electronic medical records.
I personally have not had a PCP singular doctor or doctor group in years. I use an urgent care franchise as my PCP.
I have a chronic ailment that requires daily medicine and the medical staff at the urgent care has been more than capable of providing care, writing scripts, and providing referrals to specialists.
I personally have not had a PCP singular doctor or doctor group in years. I use an urgent care franchise as my PCP.
I have a chronic ailment that requires daily medicine and the medical staff at the urgent care has been more than capable of providing care, writing scripts, and providing referrals to specialists.
The idea of an ongoing relationship with a single doctor has always felt to me like a relic of that mythic past when people would spend 40 years working for a single employer before retiring with a pension.
In my life, as a generally healthy person working in the software industry, I have switched health insurance plans almost as many times as I've needed medical attention. What's the point of going through the trouble to establish a relationship with a PCP when you will see them at most twice, likely only once, before you have to start over after taking your next job?
Urgent care is much easier.
In my life, as a generally healthy person working in the software industry, I have switched health insurance plans almost as many times as I've needed medical attention. What's the point of going through the trouble to establish a relationship with a PCP when you will see them at most twice, likely only once, before you have to start over after taking your next job?
Urgent care is much easier.
> Why are you using PCPs?
For primary care. I believe that's where the name Primary Care Provider comes from.
The difference from urgent care is long term. Having the same PCP for long periods of time provides an opportunity for deep insight and developing a personal relationship.
For primary care. I believe that's where the name Primary Care Provider comes from.
The difference from urgent care is long term. Having the same PCP for long periods of time provides an opportunity for deep insight and developing a personal relationship.
Urgent care is often a 1-4 hour wait and insurance tends to have a higher copay. If you have a patient profile at a large health care provider's facility, you can often get appointments same or next day if you're willing to be flexible about the specific provider that sees you, with the normal (~15 minute) wait and lower copay.
it sounds like you've never been around old people or an aging parent. When they get old, and start having serious health issues, it’s very important to have a PCP who can play “coach”. They coordinate care with various specialists, and old people typically see many specialists.
You expect an 80 year old to go to urgent care and spent 30 minutes chatting with a random urgent care doctor to get them up to speed on their medical history? lol.
Due to aging population, this PCP shortage is a big problem. Urgent care is fine for a younger person with a simple medical history, or for simple issues.
You expect an 80 year old to go to urgent care and spent 30 minutes chatting with a random urgent care doctor to get them up to speed on their medical history? lol.
Due to aging population, this PCP shortage is a big problem. Urgent care is fine for a younger person with a simple medical history, or for simple issues.
It's so frustrating. We signed up for a pediatric practice in Atlanta that has 8 doctors.
We saw a great doctor on our first visit, then our next visit we didn't even get to see a doctor, just a nurse practitioner... Kinda annoying I don't want parenting advice from a nurse... So on our way out when scheduling we asked if we could see the same Dr next time.
"Oh sorry she only works Tuesdays"
"Okay weird but this is 2 months out though so that should be fine"
"Actually Tuesday would put you over a week away from when the appointment was requested I can schedule you with ..."
3 visits later and we still haven't seen a doctor once. Not even a 30 second pop in the room to say hi.
We've gotten like 20 immunizations from nurses and can't ask doctors about any of it..
Like cool cool all for these peopl advancing their careers without med school but like ... Usually you want your doctor's to have gone through medical school
We saw a great doctor on our first visit, then our next visit we didn't even get to see a doctor, just a nurse practitioner... Kinda annoying I don't want parenting advice from a nurse... So on our way out when scheduling we asked if we could see the same Dr next time.
"Oh sorry she only works Tuesdays"
"Okay weird but this is 2 months out though so that should be fine"
"Actually Tuesday would put you over a week away from when the appointment was requested I can schedule you with ..."
3 visits later and we still haven't seen a doctor once. Not even a 30 second pop in the room to say hi.
We've gotten like 20 immunizations from nurses and can't ask doctors about any of it..
Like cool cool all for these peopl advancing their careers without med school but like ... Usually you want your doctor's to have gone through medical school
> our next visit we didn't even get to see a doctor, just a nurse practitioner... Kinda annoying I don't want parenting advice from a nurse
Is your kid sick? If not, you don't need a doctor.
Is your kid sick? If not, you don't need a doctor.
For a baby you have regularly scheduled appointments through the first year to make sure developmental milestones and for the correct immunization schedule.
The amount of bad and actually hazardous parenting advice I've gotten from nurses and PA's is staggering.
When we were discharged from the hospital, the pediatric nurse actually told us it was safe to feed him in the car seat on the drive home.
The amount of bad and actually hazardous parenting advice I've gotten from nurses and PA's is staggering.
When we were discharged from the hospital, the pediatric nurse actually told us it was safe to feed him in the car seat on the drive home.
> a baby you have regularly scheduled appointments through the first year to make sure developmental milestones and for the correct immunization schedule
Sure. None of this requires a doctor, though.
> pediatric nurse actually told us it was safe to feed him in the car seat on the drive home
This is bad advice. But I'm failing to find studies that quantify the risk. You're correct that they shouldn't have said this. But I'm not convinced no doctor would advise similarly.
If everyone wants their kid to be seen by a doctor, we either need to lower the standards of doctor or normalise perfectly-well kids being seen by NPs. (That or a higher billing code if a patient demands a doctor for routine care.)
Sure. None of this requires a doctor, though.
> pediatric nurse actually told us it was safe to feed him in the car seat on the drive home
This is bad advice. But I'm failing to find studies that quantify the risk. You're correct that they shouldn't have said this. But I'm not convinced no doctor would advise similarly.
If everyone wants their kid to be seen by a doctor, we either need to lower the standards of doctor or normalise perfectly-well kids being seen by NPs. (That or a higher billing code if a patient demands a doctor for routine care.)
>Sure. None of this requires a doctor, though.
When literally googling your question is more reliable than asking your 'doctor', something is in need of fixing.
When literally googling your question is more reliable than asking your 'doctor', something is in need of fixing.
> When literally googling your question is more reliable than asking your 'doctor', something is in need of fixing
Google can't administer vaccines. It also can't fill out a chart that might be important in an emergency.
Google can't administer vaccines. It also can't fill out a chart that might be important in an emergency.
By the way I'm curious how long ago you had your children, as I'm finding that advice from previous generation parents does not age well at all.
I find this to be true also. But how can this be? Either feeding a baby in a car is not that big of a deal, or something about the cars or carseats changed? I think it's more like the former.
I'm sure you can get all kinds of dated advice from board-certified physicians too.
I'm sure you can get all kinds of dated advice from board-certified physicians too.
Not that big of a deal, grand scheme of things - accidents are rare. It's just that our tolerance for risk has gone down a lot over the last 50 years - likely because of decreased other-cause mortality. When children were dying of disease, the relative risk of a car accident seemed small; now (with a safer world), it seems proportionally bigger.
There's roughly 1/366,000 chance of getting into a car accident on any given mile driven (not a great thing to average out, but still, back of the hand calculation). I'm sure that adjusting for weather conditions could get that number down further (if you assume good weather).
Let's say feed a child over the course of 10 miles: 1/36,600 chance of anything happening (hypothetically). Sure, if you do it every day that would be different - or if you live in an accident prone area that somehow skews the estimate. But the absolute risk, while there, is small.
In many cases it's kind of like texting while driving - it surely increases risk, but it can't increase it a crazy amount given how much texting while driving we observe with only a slightly elevated accident rate. But on a nationwide scale, every accident is a tragedy.
There's roughly 1/366,000 chance of getting into a car accident on any given mile driven (not a great thing to average out, but still, back of the hand calculation). I'm sure that adjusting for weather conditions could get that number down further (if you assume good weather).
Let's say feed a child over the course of 10 miles: 1/36,600 chance of anything happening (hypothetically). Sure, if you do it every day that would be different - or if you live in an accident prone area that somehow skews the estimate. But the absolute risk, while there, is small.
In many cases it's kind of like texting while driving - it surely increases risk, but it can't increase it a crazy amount given how much texting while driving we observe with only a slightly elevated accident rate. But on a nationwide scale, every accident is a tragedy.
what does "feed in the car" mean? a bottle or breast-feeding? Obviously the kid should be in a carseat and restrained and protected, so i'm assuming bottle?
What reason would you not give a baby a bottle in the car?
"no pillows no blankets in the crib" was the newest info when we had our last child. I'm trying to remember other things that were different between the kids, but funny thing about having children is there's amnesia about the whole process.
What reason would you not give a baby a bottle in the car?
"no pillows no blankets in the crib" was the newest info when we had our last child. I'm trying to remember other things that were different between the kids, but funny thing about having children is there's amnesia about the whole process.
If there is a crash or sudden braking the child can aspirate formula or milk and suffocate or develop lung infection.
I just assumed bottle. To be totally honest, I'm not even sure why it's a bad idea. I'm just going along. Infant in arms in a moving vehicle is bad because of the lack of restraints. That's all I know.
I live in Atlanta and I wonder if it's due to the influx of out of state families moving in. It didn't use to be like this. My child was sick recently and we couldn't get an appointment for a sick visit for several days. This too is an office with a dozen docs/NP.
We ended up going to another one of their offices 30 minutes away which had availability (i.e. lower population density?).
For the receptionist that said "it would put you a week away"...that's when you should just push back and say that's fine. There are very few appointments that need to be exact. And you know what, if you're not sure and you're there, ask the doctor if it's ok :)
Also because I'm trying to spread awareness and you'll likely encounter this: Be aware of "hospital/facility fees".
https://www.theguardian.com/us-news/article/2024/jun/09/pati...
This happened to us, with a Northside Imaging center in a shopping plaza. A chest x-ray that's normally $50 at a regular center is costing us $500.
We ended up going to another one of their offices 30 minutes away which had availability (i.e. lower population density?).
For the receptionist that said "it would put you a week away"...that's when you should just push back and say that's fine. There are very few appointments that need to be exact. And you know what, if you're not sure and you're there, ask the doctor if it's ok :)
Also because I'm trying to spread awareness and you'll likely encounter this: Be aware of "hospital/facility fees".
https://www.theguardian.com/us-news/article/2024/jun/09/pati...
This happened to us, with a Northside Imaging center in a shopping plaza. A chest x-ray that's normally $50 at a regular center is costing us $500.
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I want an AI doctor so at least there is some information I can get between the months delay it takes to get an appointment.