Saturday, January 10, 2009

Doctor Shortage = Really Crappy Medical Care for Me

I know I usually blog about trips and dogs and fun stuff like that, but once in a while I feel the need to ramble and complain about other crazy things that happen......

I recently heard on the local Southern New England NPR station about the shortage of primary care doctors in this area. This factor combined with the new legislation that requires everyone in Massachusetts to have health insurance, means big problems and long waits for new patients to see a doctor.

Lately I have been feeling fatigued with muscle weakness, so I figured I should probably go to the doctor. When I went to find a doctor and make an appointment, I had that NPR story in the back of my mind. I figured I would be able to find SOMEONE that would see me. I couldn't believe that there were NO doctors taking new patients.

I spent two hours calling every MD, NP, PA, and DO (NDs aren't licensed here) within 1/2 hour drive from where I live. One doctors office asked me if I wanted to make an appointment in July!! What am I supposed to say to that? Yeah how about July 15th....I'm available that day...and whatever my health concern is will be fine until then. Calling all those doctors was very disheartening and frustrating.

I really wanted to get some lab work done and I NEEDED to get some vaccinations for my internship. So....I braved the urgent care clinic. I hate to be judgemental about the quality of care in these places, so I went with an open mind. It turned out to be a million times worse than I could have imagined! It was extremely unprofessional and I'm pretty sure they have no clue about patient privacy laws.

When I went the first time I saw a PA and told her about my situation and asked that she check my Vitamin D, ferritin, Thyroid Panel, Lyme Disease and CBC. She asked me a bunch of questions took my blood and I was on my way. I called a few days later and they "couldn't find" my lab results.

I went back to get my first Hepatitis B vaccination and a bunch of titers. While they were busy sticking me with needles, they were looking for my first set of results. When the finally found them, they reported that my Vitamin D is normal and that I'm not pregnant (the most unhelpful test they could have chosen to do by mistake). The PA that I saw on my first visit is either mentally deficient or was sleeping when she filled out the lab requisition. This PA told me that checking my ferritin was unnecessary and I didn't feel like arguing, so I'll deal with that some other time.

They didn't take enough blood for the titers to run all those labs, so they had to stick me again! A few days later I left for Portugal and then called them for my results as soon as I got back. They said everything was normal. I asked for my specific TSH lab value and then she proceeded to tell me that she didn't see it on the lab results!!!! I was so aggravated at this point! After listening to me complain, she said she would have the doctor call me. The doctor finally called me back and of course there was nothing she could say except, "come back in so we can take more blood". Ugghhh!!!! Just as we were getting off the phone, she said "Oh wait I found the TSH result".

Unfortunately today I had to go back to get my tetanus booster and have them sign my medical forms for my internship. While I'm in the waiting room, which was full of people, the receptionist yells out to ask me if I'm traveling and then he informs me and everyone else in the waiting room that the tetanus shot is going to hurt really bad and my arm will be throbbing for awhile after. The PA (different from the first two) gave me the shot....sort of. It was completely painless, almost too painless. I look down at my arm after getting the shot and saw clear liquid dripping down my arm. I'm pretty sure she didn't actually inject anything at all. As I write this, a few hours after "getting the shot" my arm is not throbbing or in any pain at all.

I wish the story was over at this point, but it continues. On my way out I gave the "doctor" my health forms and she was almost done when she realized they didn't do one of the titers I needed. Holy Shit! I said, "yeah I was expecting that". I had no other choice but to have her take more blood and wait a few more days. This time I saw the lab requisition myself, so unless she crosses it out or throws my blood out.....I should be done after this. My internship preceptor is not going to be happy about my paperwork being late!

During my visit today, the PA wanted to talk about my fatigue issues. I told her I wasn't interested in dealing with it at this clinic and would find another doctor. Many people don't have the option to wait and go to another doctor! I cant imagine what I would do if I had a serious condition and needed more care. I would be screwed!

Is it the worst of the worst that work at these Urgent Care Clinics? Do they get their degrees online? From ITT Tech or the University of Phoenix?

Here is the NPR Story........

Primary Care From The ER

Kamela Christara appears at the triage window in the emergency room at Cooley Dickinson Hospital in western Massachusetts.

The 47-year-old single mother has advanced Lyme disease, and she can't find a primary care doctor to oversee her care. She's called half a dozen practices in three towns, and none are accepting new patients. So when problems come up, even routine ones, she comes to the emergency room. Each time, she goes through her medical history with the intake nurse.

Christara is worried she'll keep getting sicker if no one doctor is tracking her health. Even her regular prescriptions come from the emergency department.

At least Christara doesn't have to pay out of pocket for this ER visit. She has the state's Medicaid insurance, which was expanded under a landmark health reform law passed in 2006. It requires all residents to have health insurance — either through a state-subsidized plan, an employer or privately bought insurance. As a result, an estimated 440,000 more people have health coverage. And they all need a primary care doctor to get into the system.

Too Many New Patients, Not Enough Doctors

"I think it's great that people have insurance," says Dr. Jacqueline Spain. "I'm wondering where they're getting their care." Spain is the medical director of the Holyoke Health Center, a busy clinic in a low-income community.

Since the reform law passed, the Holyoke Health Center has been inundated with calls from newly insured people seeking a doctor. More than 1,600 people are on its waiting list; Spain says it takes about four months to get a first appointment.

"It's entirely reasonable for somebody who's now got insurance and maybe has a whole list of things that's worried them and troubled them," Spain says. "They expect that they should be able to go out in the market and get all of that care. There just aren't enough of us to give it to them."

"We get 5 or 10 calls a week — sometimes a day — from patients who need a new doctor," says Kate Atkinson, a family doctor in nearby Amherst. "And, literally, people crying and begging to come into the practice. It's very stressful to keep saying no to people." Atkinson has become a national activist for improvements in the primary care system.

"Eighteen primary care doctors of this area have left the practice of primary care in the past two years," she says. "Someone needs to ask why."

Why Primary Care Doctors Are Leaving

One problem, she says, is money. Insurance companies, Medicaid and Medicare pay less for primary care than for specialist visits. And no one pays for the time it takes to fill out paperwork, take surveys for the insurance company or write sick notes to employers.

"A urologist, in one procedure, makes more than I make in two days of seeing patients," Atkinson says.

Massachusetts Dr. Dan Levy, who left primary care for medical administration, says that's only getting worse with universal health care, since newly insured patients tend to come with a pile of saved-up complaints.

"You have someone on your hands with five separate medical problems, 15 minutes to see them. If you spend the extra half hour, you don't get paid for it, so the pressure is to refer them to a subspecialist," Levy explains. "It takes a lot of the pleasure and fun out of doing medicine."

Western Massachusetts is a rural area — the doctor shortage is more acute here than in cities like Boston. But it's a problem everywhere. In a national study released this fall by the Physicians' Foundation, 80 percent of primary care doctors called the job unrewarding; half of them plan to scale back or stop practicing within three years. At the same time, most medical students are choosing specialty tracks, like surgery.

The trend could raise the cost of health care; people without primary care doctors tend to rely more on emergency rooms and let small problems get bigger.

Massachusetts recently passed legislation to make primary care more attractive — through loan forgiveness, home buying help and better reimbursements. State Sen. Jon Scibak says the viability of health reform is at stake.

"The worst thing that can happen right now in the Legislature is inaction," Scibak says.

It won't be easy to pay for change, especially in this budget climate. Still, John McDonough says that's no reason to give up on universal health care. He was one of the architects of health reform in Massachusetts and is now an adviser to Sen. Ted Kennedy.

"What has happened is that Massachusetts health reform has put a spotlight on the workforce shortages that don't get meaningfully talked about in just about any other state," McDonough says.

In other words, Massachusetts is merely the first to take on a problem the rest of the country will soon confront — especially if more people are given health insurance.


DeltaBluez Tess said...

How HORRIYING!!! Did they leave any part of your arm not full of needle holes?

I am so glad I have great Doctors over here!! We can't wait until you are back

Kenneth said...

Well, if you weren't anemic before, you should show a profile of acute blood loss. Maybe an exaggeration, but I fear universal health care might cause more Docs to close their practices limiting to those patients with supplemental (good) insurance. Kenneth