Doctor Shortage Delays Medical Care

Physician demand in all specialties is greater than the supply.  As the population grows the number of doctors is decreasing.  The 2036 projected shortage in the United States is 86,000 according to the 2023 study by AAMC (Association of American Medical Colleges).

The Covid pandemic worsened the crisis as more doctors left physician life primarily due to money.  During this time Medicare continued to decrease doctors' reimbursement for medical services rendered to elderly and disabled patients.  Basic costs like office rental or purchase, malpractice insurance, employee salaries were the main sources of money outflow.  All of these were increasing as were costs for an aging population most of whom had at least five chronic medical conditions.

As a potential physician shortage may be approaching, it has become more difficult to get timely appointments.  If you have insurance, they must be in network to avoid extra cost beyond your insurance coverage.  This usually means longer wait time primarily due to smaller listing of doctors.  Many physicians also have limited visiting hours unlike days of old when they made themselves more available to patients than two days a week.

In addition, doctors are more specialized and selective in their choices.  One choice is cash only payment instead of insurance, Medicare, or Medicaid.  Another choice is the specialty or subspecialty chosen.  The more specialized are usually more expensive and highest paid. Some have gender and age preferences. Burnout due to overworking has led to limits in the number of new patients for some doctors, or just quitting.

Patients should try to find doctors they feel are best for them and their family.  Even if it means consulting several in the same specialty until you get the right one.  Doctor shopping is becoming more popular as the healthcare landscape keeps rapidly changing.  The Internet makes it easier to do, but the telephone makes it more personable.  Talking to someone can give you more informatiom and add to your research.  Word of mouth is still a good way to find doctors.  Seek out the best doctors and you will find trustworthy personalized precision health care for you.  Best health!

Patient & Doctor Value Visit

Visits to your doctor or any healthcare provider can be frustrating and time consuming for all involved.  These are some things you can do to make it an easier and more productive.

One of the first things you want to do is make a written or typed medical history to take with you, especially if this is your first visit to a new doctor. Make a copy for you and your doctor. You both will be able to refer to it as needed. This will save valuable time, and give you and your doctor more time to talk instead of flipping through your medical record. It can be difficult trying to "remember" what test or procedure you had 10 years ago or even last year.

It is a good to make appointments when you are well and stable.  Keep a list of things you want to talk to your doctor about. Update the list before each visit. This way you will be able to keep track of what has been discussed, and what needs to be discussed. Try to talk about the most important things first especially those that need immediate attention. Each time you go for your visit, you can refer to your list and take up where you left off. Be sure to express your immediate concerns first. We all know how short a doctor visit can be.

Request copies of your medical records from all your doctors. "The medical record is the cornerstone of keeping track of everything pertaining to your health." This gives you a complete assessment of all your medical problems. You will be able to check the accuracy of your records, and bring any errors or absent information to your doctor's attention. Let your doctor know about anything you do not understand, or if there is something you are unable to read due to poor handwriting. It is surprising to see how many doctors are often unable to read their own writing.

Schedule your appointment for first available times in the morning or afternoon.*  This will likely ensure that you will be seen on time with a shorter wait time and longer visit.  It will help you and your doctor focus on your total health care versus acute, intermittent health concerns that can easily take up your whole time. Unless an emergency arises, the wait should be less than 15 minutes.  If there is an emergency you should be notified and given the option of waiting or rescheduling, or going elsewhere for treatment. 

The easiest thing you can do is be on time.  Best health!

*How to Make Your Doctor Appointment http://bit.ly/akMrpX

by J.L, Richardson, M.D., family medicine expert and author of Patient Handbook to Medical Care: Your Personal Health Guide, honorable mention of Writer's Digest International Self-Published Book Award** and Indie Excellence Award finalist.

(**Written by a reliable source, this book is the perfect quick reference for all of those squeamish people who hate going to the doctor. I am one of those people. I hate wondering why a certain test was performed, exactly what a common diagnosis may mean, what the proper specialist for my malady might be called, and negotiating the maze of health insurance forms and other paperwork that seems to accompany my ailment; thereby adding insult to injury. To avoid the mystery, misery, and tedium of the wellness process, I often remain sick in order to forego or delay much needed medical appointments. The author writes for people like me; she writes in a calming, professional tone and explains, in as simple and non-threatening a manner as possible, what I can expect along every step of the healing process. By learning to keep a medical diary, knowing what to expect of my medical staff as well as how to decode their complicated language, and then by understanding the basics of the complex American healthcare system, I can take charge of my own healthcare. This little book provides me with all the tools necessary to do just that. ~Writer's Digest)

Doctor Availability Less Available?

As a potential primary care physician shortage may be approaching, it has become more difficult to get timely appointments.  If you have insurance, they must be in network to avoid extra cost beyond your insurance coverage.  Many physicians also have limited visiting hours unlike days of old when they made themselves more available to patients.  

Be aware of reasons doctors may be selective about their patient choices.  This may include:

• too many patients per doctor
• cash only
• limited to certain insurance or Medicare, Medicaid only
• gender preference
• age limits like over fifty
• too many chronic conditions

You must seek out doctors you feel are best for you.  Even if it means seeing several in the same specialty before you get the right one.  Doctor shopping is becoming more popular as the healthcare landscape keeps changing.  The Internet makes it easier to do, but the telephone can make it more personable.  Talking to someone can give you more information to add to your research.  Word of mouth is still a good way to find doctors.  Seek out the best doctors and you will find great available healthcare personalized for you. Best health!

Internet Information and Your Health

Health information once obtained from bought or borrowed hard copy books, magazines, and papers is now available on your computer in seconds. Many studies have shown that the Internet is rapidly becoming the main source of health information for patients and health care providers around the world.  This has made it a tool of preventive medicine individually and globally.  Many are able to "pre-diagnose" themselves and maintain wellness by the time they seek medical care.  This makes for a shorter differential diagnosis dilemma for your doctor; thereby, shortening the time for correct diagnosis and treatment.

Health literacy on line also includes abundant applications for your smart phone and computer, interactive social media, and websites from health providers and institutions.  One of the most interactive and informative is Twitter.  Lists such as these for doctors,  http://bit.ly/2XWKw29 and medical/health http://bit.ly/2GWkbvH  contain lots of information that links directly to sources. Most of these include websites as well as individual snippets of information called "tweets".  Searches for specific health information can also be done using the internal search box.

While the Internet may help diagnose, it far from replaces your doctor's advice. Use it as a health literacy tool to educate yourself.   Check out "What the Internet Does for You and Your Health" http://bit.ly/a3RAjw for more health literacy lessons. Best health!

Tips for Effective Communication

1. Listen a lot.
2. Be specific.
3. Ask for a reasonable change that will relieve the gripe.
4. Make sure your patient/healthcare provider understands what you want and you understand what she or he wants.
5. Deal with only ONE issue at a time.
6. ALWAYS consider compromise.
7. Never assume you know what the other is thinking. Check it out. Don't assume or predict reactions, rejections, or acceptance.
8. Accept what the other feels. Don't tell your patient/healthcare provider what he or she should or should not be feeling.
9. Don't name call or label.
10. Sarcasm is dirty fighting - call each other on it.
11. Stay in the present. Grievances should be dealt with at the earliest possible moment. Don't save them up to use as weapons.

Great health relies on effective communication by everyone - YOU the patient, your family, and your health care team. Best health!

Is the Doctor Really "In"?

Dear Patient,

It has indeed been a privilege and wonder to take care of you and your family.  Due to unforeseen circumstances, we must vacation indefinitely so we can find the best solutions for cost effective health care.  Our budgets are lean as well and get leaner as more patients drop out to do self care or go to emergency rooms, public health clinics, or stand in "lotto" lines to get get health care from traveling clinics.

We must campaign for your healthcare and our salary.  Routine sequential cuts for reimbursement by Medicare and Medicaid are taking its toll.  Insurance companies demand more time with less pay as well.  Now that the healthcare bill requiring each and every one of you to have insurance has been repealed.  Self pay is an option, but you must have food and shelter first.  Less money in, more money out.

Due to lack of campaign funds and time for raising necessary monies to do so, we are using and pooling our resources.  We wish to provide you with continuity of care, but we must also find ways to keep a roof over our heads and food on the table.  Many of my fellowess and fellow physicians are supplementing our income as well through other occupations.

Thank you for allowing me to care for you and the family.  We are true believers that great health is true wealth; however, you must have money to keep it.

Best health,
Dr. Feelgood

P. S. Check out Patient Handbook to Medical Care: Your Personal Health Guide via links in the right column.  Get a heads up and start checking yourself and your family.

Letter to the President: Code Blue! Get Crash Cart STAT!

Dear Mr. President,

Please be aware that the doctors of this great nation are finding it near impossible to care for our patients, your people.  Our patients are literally dying as the debt crisis looms in limbo for way too long.  We are trying to avoid our patients demise, but with almost 1/2 of our population, especially seniors and kids, on Medicare and Medicaid this is already a major problem.  Further cuts would be detrimental to us and our patients, your constituents. 

Quality of care and proper treatment is near impossible especially with the physician shortage.  Medicare and Medicaid should be increases to help us provide, instead of being cut again and again. Payment delays are unacceptable. This statement from the American Academy of Family Practice (Payment Delays Resulting From Debt Ceiling Impasse Are Possible, AAFP Warns http://ow.ly/1dZzY0 ) details the problems as does the letter sent to you and  in June by AAFP Board Chair Lori Heim, M.D., who said, "If any budget proposal is to restrain the growth in health care spending, it must also support programs that build the family physician and primary care workforce, pay for quality and outcomes of medical care, and ensure that everyone has access to that care."  http://bit.ly/pFjeE7  This is a code blue! Can you imagine not getting paid for your hard work? Or getting sued because you lacked?

The worriation of this debt disease is infecting our people in many obvious ways.  I see those on limited incomes with no less than five chronic conditions struggle to keep food on the table and a roof over their heads as their health expenses become obliviously unaffordable.  We all know what happens then.  Chronic medical care that could have been avoided incurs, and we all pay, especially the patient and doctor.

As we strive for a Healthy People 2020, it is looking bleak.  Though Congress has the purse strings, the buck stops with you.  Eliminate this unnecessary worriation that has gone too far and too long causing more anxiety, suicide, and worsening of overall health for many. 

As family physicians on the forefront of patient care, the burden rests with us to do our best. The most you and Congress can do is resolve the present debt crisis.  If this was was your doctor treating you and your family, such delay would be unacceptable most likely leading to adverse outcomes.  Everyone must do their job as if someone's life depended on it. Much too often it does, especially for patients and doctors.

Thank you, Mr. Obama. 

Best regards,
Dr. Richardson

Free Health Advice - Would You Dare?

In these days of rising costs on everything, health care may be seen as "optional" unless free or discounted. Many healthcare providers are often asked (especially at parties!) for free advice on and off the Internet. 


Would you use free health advice from a doctor, nurse, or other medical provider? http://twtpoll.com/r/s16vcz

Doctors & Specialists

For many people, the most familiar doctor is their personal or primary care physician (PCP). This is the doctor that coordinates all of your medical care routinely and continuously. Usually this doctor is a medical doctor (MD) who is a family practitioner, an internal medicine doctor (internist, for short), or a doctor of osteopathic medicine (DO). There may be times when your doctor or you feel an “expert” opinion is needed in a certain area. Then your doctor will refer you to a specialist. These doctors help the primary care physician with proper diagnosis and treatment.

After completion of undergraduate and medical school in the United States (which usually takes from six to eight years), the physician enters an internship (first professional year) followed by a residency program (two years or more) at an accredited university program in the specialty chosen. The choice of specialty determines how long the doctor is in residency training. Family practitioners and general osteopathic doctors must complete three years of medical training in all areas of medicine. D.O.’s receive additional training in osteopathic manipulative medicine (OMT), which adds a holistic approach. Surgeons have three years of general surgery, including some general medicine. General internists train for three years. If a doctor chooses to specialize further, in a sub-specialty, there may be an additional two years or more of training.

Once training is complete, the doctor may take a test to become certified in the chosen specialty. This is an indication that the doctor has excelled in a particular field and is ready to provide the best, most up-to-date medical care. The doctor must possess a license to practice medicine for the state(s) in which she or he practices. This comes from the state licensing board, which also monitors physician conduct and competence. Doctors who do not follow the law are sanctioned by this board. The mission of the board of medicine is to protect the patient.

Patients are able to contact the state boards to determine if doctors are licensed and if any disciplinary action has been taken against the physician for wrongdoing of any kind. In addition to providing information about physicians, the state boards handle patient complaints about doctors. This can lead to hearings where doctors are “tried” as in court and may lead to discipline and loss of license. The public information collected by state boards can be found on some state health agency websites.

Choosing your PCP and specialists is crucial to your health care. Word of mouth is the best and most common way good doctors are found. The internet is also a great resource.

Best health!

Doctor Search on the Internet - Healthy Thing to Do?

Have you looked your doctors up on the Internet? When you do, you may find incomplete inconsistencies. Many web sites had no listing for several doctors I was looking up. So I looked at some others.

I went to the state medical board pages. I found that some doctors listed on the other web pages were not listed on the state board pages. Another doctor is listed with an active and an inactive license (several are listed like this). This doctor’s medical education and training have been done overseas. Some doctors have no residency training listed. This doctor has been in practice for 45 years, and is licensed in two countries and two other states. The doctor’s address is listed as a PO Box.

The type of information listed was different amongst the states. For instance, one state listed one line of information – license number, status of license, present location, disciplinary action (yes or no, not what), date of issue and expiration. Another state gives this plus the doctor’s education and training information, details of disciplinary legal action, other states/ countries where licensed, and board certification status. There were inactive licenses that were listed as active in another state’s information.

These incomplete inconsistencies are rather consistent. Do you know about your doctor’s background? Is your doctor properly trained and licensed? Which information is correct?

The American Medical Association (AMA) has a page with links to the state boards for licensing. Check your doctor at http://www.ama-assn.org/ama/pub/category/2645.html. Compare it to the information at “doctor finder” sites. Incomplete inconsistency.

J.L. Richardson, MD is a family medicine doctor and author of "Patient Handbook to Medical Care: Your Personal Health Guide".
http://www.mypatienthandbook.com