I have excellent, relatively inexpensive, employer-sponsored health insurance for which I am immensely grateful. Let’s start there.
But even so, I’m having a hard time getting decent primary health care. In fact, it’s been nearly two years since I saw a doctor who knows me. And I think I’m beginning to pick up on a trend.
In 2004, I became a patient of a wonderful GP I’ll call Myra. (Think of this as HIPAA privacy in reverse.) Myra was in her 50s, a tiny, delightful good witch of an allopathic practitioner. She wore long, layered skirts on her fireplug of a body and her hair was all a wild, silvery mess about her head. Myra had gone to medical school late, after her divorce, when her three children were in high school. By the time I met her, she’d been practicing for only about 8 years. She approached my care like one might a garden: She poked around curiously, spent a lot of time gazing at the sun, and leaned against a wall as she talked. I can count on one hand the number of times I left her office with a prescription; Myra’s style was to recommend hot, salt baths or homemade garlic remedies or lots more sex.
On one of the worst days of my life—when I had to accompany my son with autism from the group home where he’d been living to a locked psych ward—Myra went with us to do the pre-admission exam. She moved around my miserable, brain-broken boy and laid her hands on him, as if she were performing unction. After he’d left with his keepers, she stayed with me while I sobbed.
I wouldn’t say Myra and I were friends, but I knew her sons’ names and what each did for a living. I knew about her daughter’s chronic illness and bad boyfriend. I had delivered into Myra’s hands inscribed copies of my books. So it came as a jolt when I received a letter from her clinic 18 months ago, informing me that Myra was leaving the practice effective the following week. And there was no chance of getting one last appointment, the letter warned. Her schedule was already completely full.
Myra never sent a letter of her own explaining; she simply vanished. And I worried that perhaps she’d had a health crisis of her own, but there was no way to find out. The clinic manager just smiled brightly at my questions and recommended I switch to the young woman they’d recently hired, which I did for a while.
The new doctor was nice—highly competent, I’m sure—but Myra’s polar opposite. When I went in for a physical she asked me a series of questions, rapid-fire, her head bent over a form. Before I left, she handed me a sheaf of prescriptions, every one to answer some idle response I’d made (heartburn every once in a while; a little hayfever; yes, trouble sleeping). On my way out the door, I threw them all in the trash.
Then I had a brilliant idea: my gynecologist. I didn’t know her as well but of all the doctors I’d met, she was the only one I liked as much as Myra. And some women use a gynecologist for their primary. Problem solved.
So I made an appointment for my physical and showed up the required 15 minutes before the scheduled time. I filled out the paperwork, was weighed, showed to a room and checked by a nurse. Then I waited for an hour and a half, with nothing but Conceive magazine to read. By the time the doctor rushed into the room, red-faced with hurry, I had 20 minutes to get to a critical client meeting. We talked for 5 minutes and agreed to call this an office visit. I would reschedule the physical because my insurance would pay for only one per year.
The second time I got a call the morning of my appointment, saying my doctor had been called away to deliver a baby—which she doesn’t typically do—because they were understaffed. Appointment three, I again sat in a room waiting. This time, after 45 minutes, I heard a conversation in the hall. I poked my head out. It was my doctor, consulting at length with another who was asking questions so basic I could have answered them: At what point in pregnancy do you do the first ultrasound? What if the mother doesn’t want it? Which other tests should be done?
I ducked back into my room, assuming it was my turn once they were done. But no. My doc turned and headed into a patient room down the hall. After waiting another half hour, I put on my clothes and left.
The following month, when I was felt the beginnings of a sinus infection just days before I was to board an international flight, I made an appointment through one of the monster clinics near my office. The woman I saw was funny and helpful and slow to treat. She gave me nasal spray to use only in case of emergency, and her phone number for a Swiss doctor to call if I were to get really sick over there.
“Crazy question,” I said as I gathered my things to leave. “Are you, by chance, taking new patients? I’m looking for a primary care provider…”
But before I could finish, she was shaking her head. She didn’t take ANY patients, the woman explained. She was a floating, long-term temp physician who worked in clinics when there was a shortage, or someone was out on maternity leave. She’d had her own practice for 20 years, the doctor continued while leaning against a wall. But she grew to hate it. All the red tape and paperwork, falling reimbursement rates. So many patients with different—or no—insurance you simply couldn’t cram them all in.
So one day, she up and quit. Walked out with two weeks notice and started living her own life. She temps for six months a year and travels the other six; stopgap doctoring is so lucrative, she said, this is possible. And you don’t have to worry about the business end of things. “It’s happening all over,” she said. “Doctors just get tired of all the stress and bullshit and”—she shrugged—”we leave.”
I happen to work in advertising on a medical device account. And the thing we hear, over and over, is that marketing to doctors involves understanding them. They do not want to hear about how a product will make their patients’ lives better. (Though this, of course, is where all our minds and creative impulses go first.) Yes, physicians care about their patients…but it’s a secondary or perhaps even tertiary concern.
These are people who have spent 10-12 years and hundreds of thousands of dollars training for their career. It was a calculated risk. They invested the time and the money because they expected the long-term reward to be worth it, and in every other era it has been. But with the increase in malpractice insurance premiums, federal regulations, required paper forms, complex reimbursement systems, falling Medicare rates and uninsured patients, the payoff for all but the top specialists simply isn’t what they expected it to be.
So what makes physicians buy certain products is messaging around how it will increase their practice efficiency, allowing them to see more patients per day, or boost their outcomes (patient stats) so they’ll be more sought-after and can charge higher fees. If a device maker will throw in a system to simplify the reimbursement process, even better. Then a doctor can get rid of the person he/she pays $20 per hour to enter all that stuff.
I know all this sounds cold. But I’m not making judgments. In fact, I understand. Being a doctor sounds really hard—people coming to you all day, in pain, begging you to help or understand or just let them talk. As many as 12 or 15 a day, lighting on your examining table and expecting your full attention. Who wouldn’t get tired of that?
Of course, I don’t believe Myra felt this way. But that’s the thing: Patients never do. Our research also shows that while physicians are, understandably, looking at the bottom line, the people they serve insist that their own caretakers’ motives are pure. In other words, we expect our doctors to be saintly, selfless creatures. What a burden that must be.
Add to this the army of Baby Boomers, some 76 million, now in that high-maintenance age range of 49-66. They’re occupying doctors’ offices now the way they once did the offices of Republicans. They’re poorer than they expected to be—the younger set in particular. Many are using Medicare and Medicaid (which they richly deserve, having paid into both programs all their working lives). And they’re being bombarded with messages that they can feel younger with sex-enhancing drugs and hormone patches and treatments for low testosterone. It’s no wonder they’re willing to wait the two hours it takes to be seen.
At the same time, there are now more women doctors than ever before (they’re due to outnumber male doctos by 2017), and study after study shows that women tend to work fewer hours because even if coupled, they also take primary responsibility for their children, social life and home.
What it all comes down to is this: Doctors are disappearing. Especially the ones who provide that all-important holistic primary care.
None of this really mattered to me, because I’ve had the good fortune to be healthy for most of my life. I had all those fine-boned, redheaded, high-strung problems: allergies, insomnia, Vitamin D deficiency (because I have to avoid the sun), plus various hormonal spikes and woes. But nothing that needed any real attention. Until now.
After 20 years of daily keyboarding—doing ridiculously dumb things like hunching double over my laptop as I worked in bed—I developed a repetitive stress injury so severe it’s begun to degrade the cartilage on the right side of my body. To put it bluntly, I have arthritis. In my mid-40s. Almost entirely self-caused.
I discovered this during a visit to a very kind doctor I’d never met, who spent probably 15 minutes more than her allotted time doing finger and wrist tests and reviewing x-rays of my spine. She gave me a cervical collar and a wrist brace, a referral to a physical therapist and a note to come back and see her in a month.
“Does this mean you’ll be my primary doctor?” I asked, trying to keep the desperation from my voice.
And I watched as conflict crossed her face. No doubt she already had too many patients and the smart thing would have been to decline. But I saw her look at my crazily tilted neck and soften.
“Sure, I can do that,” she said and rushed out the door to someone who was waiting down the hall.