Is There a Doctor in the House?

Is there a doctor in the house?  If you’re a new patient, probably not.  Just try to find a doctor, let alone a specialist, who will see you within 2 months.  God forbid you have an issue needing attention.  Go to the ER, and your insurance company will taunt you with paperwork.  Go to work, get others sick, and you’ll get yelled at too.

Is there a doctor in the house?

This is today–guess what happens when the 44 million uninsured are going to need to see doctors too!  There is a huge problem that is hovering below the radar while government and media makes the show of dumping the 1900 page legislation on desks:  THERE ARE NOT ENOUGH DOCTORS.  Not just general practitioners but ob-gyns too.

I recently moved 100 miles from my last home base.  Just far enough to require finding all new doctors.  Women are historically bigger consumers of health care.  On my regular team are a primary care practitioner, an OBGYN, a dermatologist, and a rotating orthopedist (One for knees and another for ankles).  When you’re a late-30s athletic woman of childbearing age with decades old skin problems, eventually, you have a staff.

Several months back, I decided to find a primary care practitioner (or PCP) before I needed one.  But then I did need one.  It took hours of phone calls to find a practice near my home in suburban Philadelphia that took new patients, and could see me within two months.  My husband’s doctor wouldn’t even see me.  I eventually found a doctor.

I found a dermatologist in much the same way after hours on the phone.  I almost considered keeping my doctor in NYC.  How often do you need a dermatologist?   It turned out to be once a month–too often for a 200-mile round trip and a 10-minute appointment to get the latest tube of goo to try and clear my skin.

Both my PCP and my dermatologist told me the same thing:  You need to find a local ob-gyn.

I put it off and put it off.  I love my NYC doctor.  He spends time with patients. He doesn’t dole out any BS.  In his Upper East Side waiting room at a tony address, you’d see Orthodox Jews next to WASPy ladies and women on welfare.  It always felt democratic. Few women like going to the ob-gyn–but I loved going to see Dr. Saul Stromer.  Even before I was married, I was impressed by the fact that he delivers more babies than any other doctor at Lenox Hill Hospital.  That was not just cool.  That was dedication.

But like a stubborn kid who finally listens, I decided to find a local OBGYN.  I should have counted the phone calls I made and practices I contacted.  In the end it took 2 1/2 hours to get an appointment less than two months and 10 miles away.

The doctor will see you now.

I started with referrals from my PCP.  The earliest appointment was MARCH 2010. I called many independent practices to no avail.  I pulled out the big Ivy guns.  I called the University of Pennsylvania.  The receptionist just wants your name, birth-date, and insurance company so my own Ivy League progeny got me nowhere.  But I still figured that Penn Ob/Gyn Care would have an opening.  They have a medical staff of 116 people for chrissakes!  Granted, that does include Gynecologic Oncologists, a specialist in pelvic reconstruction and 15 midwives, but still!  Their first available slot?  December 29, 2009, almost 2 months away.

It’s not the doctors’ fault.  They only have so many hours in the day.  They want to provide quality care.  This is another real healthcare impasse.  Yes, if I had zero insurance, I’d have other priorities.  But I’m sure others share my dilemma.

All specialists are not the same.  Aside from the cosmetic surgeons whose bread and butter comes from cash-for-cans boob jobs, most docs are overworked, and don’t enjoy their families or hobbies enough.  What’s the incentive to become a PCP when you can make more money and have a better schedule as a specialist?

Is delivering babies incentive enough for ob-gyns to balance the fact that they can have as many sleepless nights delivering those babies as the new moms they help create? Let’s consider their astronomical malpractice insurance.  In Florida, with the highest malpractice insurance for ob-gyns, premiums run more than $195,000, according to a 2005 study in Obstetrics and Gynecology.  That’s money owed before a single patient is seen.

According to the American Medical Association, as of 2004, nearly half of America’s counties lacked an ob-gyn: Of 3,143 counties in the nation, 1,541 do not have a practicing ob-gyn to deliver needed care.  Most of the new-ish doctors I know, under the age of 35, are radiologists.  Why?  Because they want work-life balance, and I applaud them.

In a survey from recruiting firm Merritt Hawkins, primary care docs make an average of $173,000/year.  Radiologists, on the other hand, rake in $391,000.  Which would you do?  And don’t forget, they have $200,000 in student loans.

The AMA reports there were 303,749 primary-care doctors in the U.S. at the end of 2007.  That number reflects an 11% increase.  But other specialties are up 13%.  The American Academy of Family Physicians predicts a shortfall of 40,000 family doctors by 2020.

But just like we need folks who want to be sanitation collectors, and third-shift workers, we need doctors.  Garbage men earn a premium for their dirty work—well deserved.  We provide incentives for teachers to work in inner-city schools; their rewards often come in the form of subsidized graduate degrees or cash bonuses.  We also provide tuition incentives in R.O.T.C. programs to bolster our armed forces with smart, educated young men and women.  These programs are not experiments–they work or they would have been nixed long ago. The Armed Forces figured it out with their “Health Professional Services Program,” or “HPSP.”  This program, offered by the Army, Air Force, and Navy is like ROTC for med school.  However, you will owe a lot of time in exchange for free tuition and it helps if you’re into the military thing.

Congress is working very hard, balancing many conflicting interests.  Let’s not pummel those in Washington yet.  Much of the legislation being considered does provide money to incentivize residents to work in community health centers over hospitals.  Other provisions allow for scholarships or student loan forgiveness if the doctor pursues primary care fields. But all the things in the healthcare bill aren’t supposed to take effect until 2013.

If I’m a college student, I want a sure thing.  Do the math.  That means current college sophomores (who are likely declaring majors like pre-med) would have their BAs before it takes effect (and then be stuck with med school loans).  Current freshmen are in the best position to take advantage of what’s coming down the pike.  According to the National Center for Education Statistics, there are more than 4 million college freshmen.  They could probably be bought with nice computers, Wii’s and some pizza.  Target them!

Everyone has a right to follow passion—whatever it is (even the Boob Docs).  But we’re often influenced along the way—by the potential to save lives, by a teacher, by the drive to build something, or sometimes to just bring home a paycheck.  Let’s encourage more life savers.  We’ll all be better off.

And to those who do become doctors, I can’t promise I won’t get huffy if you can’t squeeze me in.  But I know you’re doing your best.