Several years ago, after a close relative was diagnosed with two kinds of cancer over the course of two years, I decided it was high time to find a primary-care doctor.
My odyssey might give you an idea of what options consumers may flock to in this brave new world of managed care.
The last primary-care doctor I found about five years ago via word of mouth. He had come highly recommended and would spend an hour on visits. The downside was that he was hard to reach for appointments. It seemed like his voicemail would spin me around in an endless loop, never allowing me to touch down and leave a message. No one live ever answered the phone. Access clearly was a problem.
But chances were good that I would find a replacement. After all, I am lucky to live in a state with the second highest ratio of doctors per residents after Massachusetts, which ranks No. 1. There are 421 doctors per 100,000. By comparison, the ratio for the U.S. overall is 271 per 100,000.
To search for a new doctor, I researched a local "best of" magazine that listed doctors recommended by doctors. Then I asked my dentist for leads. His staff suggested vastly different doctors who had practices on the same floor of their medical building. When I walked down the hall and peeked into the first office, a bare bones waiting room packed with people greeted me. Some were old, others young and restless. They were in for a long wait. The doctor was clearly in high demand.
Down the hall, a whole different world awaited me. The other doctor's office looked more like the waiting room of a law firm. Dark wood paneling. Subdued lighting. A well-appointed interior. I later learned that the doctor limited his practice to 400 patients and required an annual retainer that bought access to him 24/7, 365 days a year. Same- or next-day appointments were at least 30 minutes. He sometimes made house calls. The doctor had opted out of Medicare and any other kind of insurance. His yearly retainer was around $1,500.
For a few weeks, I puzzled over my options. The doctor on retainer sounded tantalizing, but seemed a bit expensive. I ultimately decided (or hoped) I wouldn't need that level of care for a while. Knock on wood. It seemed the doctor was targeting an older demographic that's more likely to be sick.
And the doctor with the crowded waiting room? She got good reviews, but I wondered how long it would take to just schedule an appointment with her.
Time passed. My paranoia about getting sick faded, and I simply stopped looking for a doctor.
For the last few years whenever I got sick with something more serious than a cold, I would make a beeline for the nearest CVS drugstore and visit the MinuteClinic.
The nurse practitioner would do a quick check up, but never seemed to be in a huge hurry to rush me out the door. One time she diagnosed walking pneumonia. Another time bronchitis. And one Sunday before a Monday holiday I really lucked out, because the MinuteClinic had recently added shingles to its list of conditions the nurse practitioners are allowed to diagnose and treat. I left with a prescription for an antiviral.
Now I know nurse practitioners can't do all the things a doctor can, but they filled a critical need for basic primary care when I needed it most.
I can only applaud the attention the Department of Health and Human Services head Kathleen Sebelius seems to be lavishing on promoting the education and training of NPs and pointing them toward work in underserved areas. With millions expected to enter the healthcare system in the coming years, we need NPs to fill the gaps now more than ever. - Sandra