After recently switching jobs, my health insurance changed and required a search for a new primary care provider. Little did I know that finding a doctor would engender such difficulty. New York Times on December 20, 2012 discusses the shortage of doctors over the last several years. What’s worse is that the situation will worsen significantly over the next 15-20 years with a shortage of 90,000 providers by the year 2020.
Extent of the shortage problem
The Association of American Medical Colleges (AAMC) continues to supply physician workforce research. Almost every state in the U.S. expects an increase in the utilization of physicians, a change in work schedules with younger physicians working fewer hours and very little expansion of medical education capacity. The Balanced Budget Act of 1997 cut the funding to all physician residency training that further worsened the number of physicians being trained. The AAMC expects an increase in medical school enrollment by 30 percent by 2016, but residency positions still require federal funding for institutions to increase the number of positions for new doctors to finish training.
What to do about finding a physician in the meantime?
Using my health background, I laid out a plan to locate a new primary care provider. The steps below outline an easy approach to follow.
Health insurance restrictions
The first step in locating a physician requires reviewing one’s health insurance coverage. Some health insurance companies cover only doctors or hospitals in their plan (Kaiser Permanente) or cover (pay a higher percent of cost) for doctors or hospitals participating in their plan unless the visit involves a medical emergency. I prefer a physician participating with my insurance company so that I pay less out of my pocket for care.
The second step requires narrowing down the list from the health insurance companies to physicians in a location near to my home or work. Since I prefer planning my doctor’s visits on the way to or from work, I identify physicians within a five mile range to my work location.
Types of primary care providers
For primary care, one can choose from the specialties of family practice, general practice, internal medicine, geriatrics or pediatrics for care. In the third step, I determine the type of provider. The descriptions below clarify the types of primary care providers.
The History of General Practice Organization describes general practice (GP) as constituting 80 percent of American physicians in the 1930s and provided maternity care, care of children and adults, and some skills in surgery. By the 1960s, the number of GP physicians dropped to a low level and the American Academy of General Practice report recommended upgrading this classification to family practice. Other countries still train GPs and this category can still be found in practice in the U.S.
According to the American Academy of Family Practice, family practice or medicine refers to a physician who provides continuous, comprehensive care to an individual and their family. These providers provide care to all age groups, both genders, all organ systems and disease entities. Generally, family practice takes care of individuals with one or two health problems.
The American College of Physicians portrays internal medicine as a specialty taking care of the whole patient during adolescents, adults and the elderly. Internal Medicine practitioners take care of organ systems and disease entities like the family practice area, but also coordinate and manage patients with difficult or multiple medical problems.
According to the American Geriatric Society, geriatric medicine attends to the complex needs of older people and stresses maintaining functional independence despite chronic disease. Geriatrics generally takes care of individuals over the age of 65 years who possess at least one chronic disease with many exhibiting impairments in mobility and activities of daily living.
The American Academy of Pediatrics describes pediatricians as care givers to infants, children, adolescents and young adults. The pediatric physician provides physical, mental and social well-being to this younger age group.
After deciding on the location and the type of physicians, the fourth step involves selecting physicians with Board Certification. According to the American Board of Medical Specialties, Board Certification means the individual passed a rigorous process of testing and peer evaluation in their specialty area. This activity implies the physician stays up-to-date on the latest advances in medicine. All physicians obtain licenses in each state in which they practice, but Board Certification is a voluntary process above and beyond licensing.
Questions at the first visit
After choosing a couple names, I schedule an appointment and make a visit to each one on my list. While the doctor is assessing me, I also assess his/her bedside manner and ask a few key questions.
*Question one: What is their opinion about patient-centered care and the patient’s involvement in decision making?
*Question two: What is the usual wait time for routine and acute problem appointments?
*Question three: Do their patients have electronic access to make appointments, ask questions, order medications and obtain medical results?
My process involves visits to at least two providers and making a decision unless I am unsatisfied with the first two. If the first two fail to possess good bedside manners, I proceed to visit a third or even fourth physician. As a consumer, I deserve the highest quality care that I can find as the life I save will be my own.