Comment by ryandrake | Hacker News Reader

Comment by ryandrake | Hacker News Reader

I moved a year ago and still have not found a new primary care doctor. The search is almost comical:

Take a search space of all doctors within 50 mile radius. Now start applying filters: Must be "in network" with my insurance (-A%), must be of specialty "primary care physician" (-B%), must be accepting new patients (-C%), actually picks up the phone when called or returns your call (-D%). A%xB%xC%xD% leaves me with about 3 candidate doctors.

New patient appointments are out 3 months for Doctor X, 5 months for Doctor Y and 9 months for Doctor Z.

Doctor X

So I set up an appointment for Doctor X. 3 months later, the front desk receptionist calls and informs me that Doctor X is unavailable on the day of my appointment, so I need to make a new appointment--a wait of another 2 months. So I make that appointment. 2 months later, front desk receptionist calls and says Doctor X is retiring and no longer taking patients.

Doctor Y

Next I set up an appointment for Doctor Y. 4 months later, I get a call from Doctor Y who informs me he is also no longer taking new patients.

Doctor Z

Finally, I now have an appointment with Doctor Z for some time in 2024. Fingers crossed...

It seems a better strategy would have been to just set up appointments with all of them in parallel and just go with the first one to actually want to take my money.

When people try to argue against socialized medicine they like to point out how the American system doesn't have wait times, and systems like Canada and U.K. make you wait many months for a doctor. Obviously they haven't tried finding a USA doctor recently.

If you had an actual problem that needed a specialist, and you had a PPO plan (most people do), you'd pick a regional provider chain and find their urgent care, walk in, and get an initial consultation done the same day. Stipulating you need a specialist, they'd make a referral, which you could either use directly or use to book with another specialist. Last time, I was 6 weeks out for my referred specialist from my PCP, and 3 days out from the one I called.

It is annoying to book an annual physical, and to establish a long term PCP relationship. It takes forever to book my PCP; months. But I've learned simply never to go to my PCP directly for stuff.

I have a PPO, but each specialist I contact still wants a referral from my PCP. I suspect that it is the insurance companies that create this and every other distortion of our ridiculous HC situation in the US

It's normal to want a referral, but have you tried getting a referral from an urgent care clinic? They just want a primary care / family medicine doctor to confirm your case merits specialist attention.

My wife waits months for specialists. She's currently been trying to find someone to do a biopsy on something that's probably not but could be cancerous. She has an appointment for December. That's the soonest she could find someone. We're an hour north of Boston and we've searched all directions. Medical has become impossible.

Depending on the complexity and acuity of the problem, I'm surprised that urgent care providers are willing to make these referrals. It puts them on the hook for reviewing consultation notes and followup results on potentially dozens of visits, time for which I assume they have no capacity to bill, since they are not your PCP and have no longstanding relationship (just an acute care provider). Not to mention a lack of context (no followup visits to see how PT is going), lack of infrastructure for keeping track of consultation results (for us they just show up in a big manilla envelope and need some kind of system for reviewing, scanning, storing).

My system thankfully has great access to PCPs, so I virtually never make a nonemergency referral; coordinating this care is the role of the PCP and entirely outside of my scope of expertise and training. Urgent care seems like a poor replacement for having fair access to a PCP, but maybe that's just like, my opinion, man.

> When people try to argue against socialized medicine they like to point out how the American system doesn't have wait times

Wait till you find out why America has a shrinking number of primary care physicians.

Why is that?

One of the biggest factors is the US government pays the salaries for doctors in their residency programs. They indirectly set, and therefore limit, the number of seats available in US programs by the amount of funding they provide.

There are many other failures as well. For example, most programs requiring a bachelor degree to start. This artificially raises the cost. There are a few programs now that intake high-school graduates and add a year or so to cover the basic courses that they need, such as anatomy and physiology, but effectively cut off about 3 years of higher education.

I am curious what the post above was alluding to.

I live in Canada and it is also difficult to get a family physician. Not that I would even entertain trading our socialized system of course, but it is still a problem here.

The wait times and socialised system are close to orthogonal. In the UK, 15 years ago, I could get a new doctor and an appointment the same week after I moved. Apparently the wait time is way higher now, with the UK aiming for a more privatised approach.

In Australia, in a semi-socialised system I can usually get an appointment the same week, and often the same day it needed. On the other hand I needed to wait 4 months for a specialist.

So yeah, the relation between those things is not that simple.

Reply on news.ycombinator.com