In Search of a Doc

So, the Turkey needs a new doctor. I’ll describe my travails here but first I’ll give you a little history.

From 1982 to 2004, I engaged the services of one particular primary care doctor, Dr. M, and was completely satisfied with his services. Unfortunately, after having sold his practice to a large, money-grubbing local group, and after suffering two heart attacks, he wound up bowing out of private practice. (Fortunately, he’s doing well now and he is serving as a “cover physician” for the aforementioned money-grubbing group.)

Dr. M’s departure left me in a position of having to search for a new doc, which I obviously hadn’t needed to do for a long time. In the course of that long time, oh, how things have changed in the health care industry! The rise of HMOs, the advent of HIPAA, you name it—it’s a whole different world now.

So, in 2004, I found a new doc, Dr. C, a guy who was recommended by friends and also, independently, by my ophthalmologist. He turned out to be a dud for several reasons, some of which concerned him directly and others which concerned how his practice was run, so I dumped him.

In 2005, on the recommendation of my neighbor, I engaged Dr. F, who was a likeable guy, but who was less than thorough. In any case, at the end of May 2005, he announced that he was pulling up stakes and moving out of state, so I was back adrift on the stormy sea of health care uncertainty.

Dr. F had left me with enough prescriptions to get me through about a year of doctorlessness so, being the procrastinator that I am, I waited until I was getting close to the end of that run to re-initiate my search. The unpleasantness of the present state of health care in this country is certainly a de-motivator. I knew that I was in for a long, annoying process. In the end, it took me about a week.

My approach this time did not involve recommendations by friends and neighbors. It is not that I felt that I was burned by their well meaning opinions in the past; instead, I realized that we all have different criteria for what what we want from a primary care doctor, and perhaps mine were quite different from theirs. I’ll describe my methodology, which some of you might find to be controverial.

My insurance carrier has a “service provider” search utility on its web site, which allows me to search for providers within a specified radius of my ZIP code. I can further click on the resulting list of names to expand each individual name to a page of its own, on which is listed salient facts about the doc: board certification, year of med school graduation, name of med school, and whether they are taking new patients. Thus, it was possible to do my initial screening through this web site. My initial criteria were:

• Board certified internist (I exclude family docs because I don’t like waiting rooms full of sniffling kiddies)
• Graduated from a U.S. med school
• Graduated at least 10 years ago
• Taking new patients
• Participates in my PPO plan

I am fortunate to have a choice, given that I have a PPO plan, not an HMO. However, I pay dearly for that privilege, in that I am a self-employed Turkey.

So, having whittled down my list, I came up with one additional pre-screening criterion. The doc would have to live relatively modestly, in an average dwelling for a professional person in my area. (By “professional” I mean a real professional: doctors, lawyers, and CPAs, not the pseudo-professionals that are cropping up in all kinds of vocational areas in the past 10 years or so.) I can check on property values through the property appraisers’ web sites for each of the counties that comprise the local area. I figured that any primary care doc who lived in a $1 million+ house was more interested in building a practice and enjoying the trappings of wealth than he or she was interested in serving patients. In this area, in which real estate is pretty reasonable, $400K – $600K buys plenty of house.

Yes, I found some primary care docs who were living large. Let them hang out at the country club and rub elbows with Tiger and Shaq if they want, but they’re not getting my money, which wouldn’t even buy a tank full of gas for the Bentley. How interested could they be in a patient, with all that going on?

My friend Margie, an internist in Louisville, suggested that I might benefit by engaging a female doc, inasmuch as certain studies have shown that they spend more time with patients than men do. So, I worked down the list of women until I found one who screened successfully. Coincidentally, she had graduated from the same med school as Margie, in the same year! So, I asked Margie about her. It turned out that this was an individual who had a lot of flaws. So, I worked down the list and, having run out of women, proceeded to work on the men.

Once they had passed the pre-screening, the next step was to call their offices and chat with the receptionist. One can learn a great deal about the practice from such interaction. I also had some canned questions to ask, such as whether blood is drawn in the office for testing or whether patients are sent out to a lab, which I despise—I want my primary care doc’s office to provide all the necessary services, not send me one place for X-rays, another for blood testing, and yet another to get a damn flu shot—just what the hell are they there for, anyway? Change “primary care” to “primary don’t care,” if you will, but I digress…

The first doc’s office I called put me on hold for three minutes. That didn’t give me a very warm feeling. Then, when I asked the question about the blood drawing, the answer was, “We send everybody out to labs.” That was just what I expected from an outfit that would leave me on hold for three minutes.

The second candidate had already left the state by the time I called his office. Perhaps he saw me coming.

Next, I called the office of a doc that was within walking distance of my house. He was not the first on my list, but he was sure as hell the most convenient! So, I got my hopes up. His office confirmed that he was taking new patients. Great! They also did blood drawing. Terrific! So, I expressed the desire to make an appointment. The woman said, we can see you in two to three weeks. Excellent! Then she continued, “…unless you want to see Dr. T, in which case it will be September.” What? I thought Dr. T was who I was going to see. The receptionist (front office professional?) told me that “the way it works” is that they have two Physician’s Assistants who take care of most of the patients, most of the time. Yeah, right. So here you have a practice in which I get charged the usual fee, but get less than a doctor? The doc rakes it in, because he can charge full fees for people he pays half a doctor’s salary? I don’t care how much they know and how many people these PAs treat, when I want a doctor, I want a damn doctor who did the full four years of med school including an internship, completed a residency, and earned board certification in their specialty. Is that too much to ask? “Sorry, I don’t do PAs,” was my response.

I settled on Dr. D., who met all my criteria. The receptionist was quite pleasant and was willing to give me all the time I needed to ask questions. I was able to schedule an appointment within a month, which was originally going to be longer, but when she asked me what I would like to accomplish during my first appointment, one of the things I had mentioned was that I needed to get my prescriptions renewed—she picked up on that and decided to find me a better appointment time. Sounds good so far.

If this doesn’t work out, a friend has just advised me that her friend’s husband, who is a physician, is considering opening a boutique practice in this area. I had searched for such practitioners, but couldn’t find any within 100 miles. These practices, also called concierge medicine, charge anywhere from a couple hundred to over a thousand dollars per month retainer fee and in return, they give their patients 24-hour per day access to their doctor—not a receptionist, not a PA, but the actual doctor.The doctor sees far fewer patients, and can spend a more reasonable amount of time with the patient at each appointment (on the order of 45 minutes, as opposed to the seven minutes of the usual smoking-hinge primary doc appointment these days). Boutique doctors do house calls, too. How many of you are old enough to remember when doctors did that? I bet not many. Alas, there has been great opposition to boutique practices from our pseudo-egalitarian friends and the politicians who cater to them. They claim that boutique practices will allow “the rich” to get better health care than the poor. Well, first of all, the very rich will always get better health care than the poor—they’ll get better everything. That’s what money buys. So what? What this hits at is the middle class, the usual screwees, who might be able to afford better health care through boutique practices. Besides, it has been shown that po’ folks actually tend to get marginally better health care than we middle class screwees. Anyhow, should Dr. D not work out, I’ll be all ears about my friend’s friend’s husband’s practice.

Stay tuned here, as my candid impressions in the course the Great Doc Search unfold before your very eyes.