How many posters have had doctors change "business models" and will now only act as their infectious disease specialist, no longer their PCP?

[ellentonboy]

Just wanted to ask BZ members if they have had a similar experience in the last few years.  My long time physician, who is both an internist and an infectious disease specialist, suddenly decided he was joining a corporation and was having a change in his "business model".    I had little warning, but these were some of the changes, and it made me furious. I had been with him for about 15 years, so to say I was livid would be an understatement.  This guy diagnosed me, filled out all my necessary paperwork, referred me to some of the best specialists, and helped me recover when I had 12 T cells and a viral load of over 2 million.  As you can see, I have been pretty close to "checking out".  Here were the changes:

1.  He would only act as my Infectious Disease Specialist.  He explained this was not a problem for me, as my insurance did not require referrals, so I could come to him without delay.

2.  He would NO LONGER be my Primary Care Physician.  So if I was sick, had the flu, any other issues other than those related to HIV, I needed to see my Primary Care Physician.  Funny, I don't have one, as I always went to him.  So that meant, I needed to find a second doctor, start from scratch, and explain to him my past (rather checkered) and how I got to where I am today.  I don't mind sharing some of my sexual escapades, travels, hookups, screw ups, and possible encounters with law enforcement with you fine gentleman.   We are  all friends here, right?  No judgment here from BZ members.  However, I did not want to explain some things to a total stranger in a lab coat, who I don't know and may frankly, find me to be a bit of a "handful"

3.  My current doctor would no longer write "controlled substances"?  Excuse me?  Well you have only been doing it for the past 15 years and frankly I want my 2 mg of Lorezapam and 3 mg of Alprazolam (accefionatly known as Xanax) daily.  I am sure I don't have to tell some BZ members that it is incredibly difficult and painful to come off these medications. I have not abused them, and even though I take the maximum allowed by law in this state (according to my doctor), I am not stopping.  Plain and simple.  So what does this mean?  I had to find a THIRD doctor, one to write me scripts for these two medications and frankly, I don't want to beg some new doctor to write something I have been taking for almost two decades.  

So I lost it, I mean I wrote him a polite, NO THANK YOU I WILL GO ELSEWHERE letter, and he can be the infectious disease specialist for some other guy.  So I received a polite phone call from this 20ish sounding guy from his office who, speaking to me in a condescending tone, told me why it was a financial decision and for me not to take it personally.  That he would find me doctors that would basically give me what I wanted (scripts!) and open minded about my past medical history and rather "animated" behavior.  I thanked him, told him I would find someone to do all three, on my own.  I did just that...

Here is my question to BZ members.  The 20 something who called me said "This is the current state of medical care in Florida, and many doctors are moving in this direction". WTF?  Really?   So has ANYONE out there, received this kind of slap in the face from their long time provider??? I would really like to know.   I am fortunate to find a doctor who will do all three, but then again he is 68 and usually sits across the room from me and writes 5 refills on all my meds.  My numbers are excellent and I am being provided the controlled substances I need, till he retires of course and then I will begin this journey again.

Anyone out there experience something like this?  Can anyone explain further why this may have happened?  I am sure there are people who work in the medical field that are on this site (I know for the BB porn areas).  But seriously, can anyone shed any light on this subject? 
 

Thanks for listening...

[BootmanLA]

I have not personally experienced this with my ID specialist (who is, like yours was, my PCP). That said, it is indeed a fact that the practice of medicine is changing rapidly.

When I first needed a doctor after graduate school, I was fortunate that I had a relative-by-marriage (married to my cousin) who had recently become a doctor. He went into partnership with an older doctor, and a large chunk of my relatives on that side of the family came to be his patients in his practice. Other doctors joined, the original doctor retired, and there was a nice thriving little group of doctors. Then a large local hospital bought their practice (and many others), and they all became employees rather than business owners. There were, as in your case, financial decisions that went into that, some of which probably have to do with liability and malpractice. I'm sure there were also some savings by consolidating things like building maintenance, payroll services, claims processing, and the like under a central umbrella.

One way those large groups control costs is by covering physicians for what they are specialists in, and no more. So, for instance, the malpractice liability rates may be lower for an ID specialist if he's not also diagnosing, treating, and writing prescriptions for a variety of other conditions.

Another is by managing billing. ID specialists can bill for ID-related services at a higher rate than a GP, most likely, and by having him see only ID patient issues, all his work can be billed at a higher rate than if some of it had to be billed at GP rates. It may be that this larger corporation can consolidate all the ID work under, say, two ID specialists instead of three, and hire a cheaper GP to do the PCP work in another clinic or facility.

In any event, it's indeed likely to be a strictly business decision and one that wasn't entered into lightly. I'm not suggesting your feelings on the subject are wrong in any way; I'm just saying that the office worker who tried to offer assistance transferring part of your caseload to other doctors was genuinely trying to make the transition as workable as possible for the patients in the office.

Side note on my cousin-in-law's practice: I was without insurance for several years before the ACA as a self-employed person, so I didn't go to the doctor unless I was actually sick, and that usually happened after hours anyway so I'd just go to the Urgent Care and self-pay if needed. Once I was insured, I found that not having seen the doctor in over a year, my file was "closed" and his office managers weren't letting him take on new patients (which I would be, after that gap). My partner was seeing another doctor in that practice (he was insured at work), but that doctor decided to quit the practice and go into a "boutique" firm that offered what they called "concierge" medicine - they didn't take insurance, and you paid them a substantial fee every year, and in turn you got a certain number of MD visits a year, including wellness consultations, etc.  Great if you have a lot of money to splurge on care with no insurance subsidizing it, but not for us; my partner had to switch to a different doctor in my cousin-in-law's practice. This kind of thing is only going to become more common as more and more care is consolidated.

[hntnhole]

I'll be waiting to read the replies; I find your experiences with Big Pharma infuriating as well, and yours are far more complex than mine.  While we're waiting though .......

6 hours ago, ellentonboy said:

suddenly decided he was joining a corporation and was having a change in his "business model"

This is a crystalline example of what the practice of medicine has turned into, and continues apace.  People are simply not like General Motors, Ford, Chrysler - in that when the alternator goes south, simply take it out, plug in another, bill the hell outta whoever will pay, and presto - over and done with.  Business models are universal in most industries, but the way I see it, Health Care is different.  Alternators don't have minds, souls, cares and fears.  People can and often do.  When your former pcp said he's changing "business models", that was an insult of the first magnitude.  

 

6 hours ago, ellentonboy said:

told me why it was a financial decision and for me not to take it personally.

And then some kid calls with that?  Like you hadn't managed to figure out which way the shit was flowing?  I'm sure you managed better than I would have to keep a civil tongue in your head.  And then proceeds to sluff off the blame for this behavior on what everyone else is doing?  Shallow as a saucer.  Did you ask the kid how much the Corporation would pay in kickbacks?  

I haven't been forced into that situation as of yet, but it won't surprise me when it happens.  Best of luck !!

[Guest]

I understand you would like one stop shopping and yes the state of healthcare around the world is just a fucking absolute mess. But let me just pose something for you to think about. Not trying to change your mind.

I am an athlete. A few years ago I had something going on and it took a specialist who works only with athletes to figure out what it was. The primary couldn't figure it out. The traditional specialist couldn't figure it out. The guy who works only with athletes figured it out. Since then, anytime I have been referred to somebody I usually ignore the referral and search out somebody who specifically works with athletes. 

My primary doc, while really good and treats people with hiv, has no clue about some of the advances in care, like the Cabenuva shots. But my ID doc did. On the other hand, my ID doc is so laser focused on infectious disease I have this raised level of confidence that she's not dabbing in other specialties. For me that's a good thing.

Sometimes having a specialist, who stays in their lane and their lane only is not such a terrible thing. 

Edited October 18, 2022 by CumdumpDad

[seaguy]

Big corporate healthcare companies are buying up medical practices and then giving them the Wallstreet makeover where decisions are based on profit not what is best for the patient.

 

The same think is happening with hospitals.  Catholic run hospital chains are merging and taking over struggling and not struggling community hospitals and then enforcing Catholic religious restrictions.  So no more abortions, birth control, etc.  Basically forcing  every patient to follow Catholicism if they want to be treated at that hospital.  So much for freedom of religion and Trumps' supreme court will make it worse if they can.

[ellentonboy]

15 hours ago, CumdumpDad said:

I understand you would like one stop shopping and yes the state of healthcare around the world is just a fucking absolute mess. But let me just pose something for you to think about. Not trying to change your mind.

I am an athlete. A few years ago I had something going on and it took a specialist who works only with athletes to figure out what it was. The primary couldn't figure it out. The traditional specialist couldn't figure it out. The guy who works only with athletes figured it out. Since then, anytime I have been referred to somebody I usually ignore the referral and search out somebody who specifically works with athletes. 

My primary doc, while really good and treats people with hiv, has no clue about some of the advances in care, like the Cabenuva shots. But my ID doc did. On the other hand, my ID doc is so laser focused on infectious disease I have this raised level of confidence that she's not dabbing in other specialties. For me that's a good thing.

Sometimes having a specialist, who stays in their lane and their lane only is not such a terrible thing. 

I hear what you are saying.  My doctor advertised as both an Internist and infectious disease specialist.  HIV treatment was always his priority, and he was great at it.  He kept me alive when I didn't exactly behave as a model patient.  I understand what you are saying about having a specialist that is laser focused, he was.  However he also offered to treat the common cold, refer me to specialists for an injury I experienced while playing competitive tennis.  What aggravated me with him is that he has known me for YEARS, I have been social with him, as well as his many partners, outside of the office.  What shocked me was the way the whole situation occurred.  Very little, or no warning.  When I first became aware I was livid, I wrote a  very nice, but direct letter, thanking him for all the years he took care of me.  I knew this man since I was 27 years old, he was like a big brother to me.  I just felt he sold out, he took the easy way.  Now another poster had mentioned the subject of billing, and how he can get more money for billing as an Infectious Disease Specialist.  I understand that, as he told me privately he had to pay severn employees weekly and it was a strain.   However, he was always an Infectious Disease Specialist, almost everyone who went to him was a gay male who had HIV.  But he still wrote scripts for the flu, and he still wrote controlled substances.  Why now?  Yes posters have told me their opinions and what has happened to them in their  medical journey, but I took it personally and frankly, as a slap in the face.  But that's me.  If you have been my doctor for nearly twenty years, and you know every intimate detail of my life, I expect more than some form letter.  I found his departure cold, and somewhat unprofessional.  If you can call me at home, and ask me questions about who I have had sex with, and why I have certain strain of HIV, then you should be able to call and say "you need to find several new doctors, I can only provide one service now".  He didn't that, just the damn form letter.  

I'm venting here, I appreciate your input.  I think some of what you posted my previous doctor did.  He was focused on HIV, he new every new medication that was coming out or was newly available, and yet treated me for things a GP could do.   It's not that I am an entitled gay man (much), who deserves "one stop shopping" (I had it before, why take it away) but I am now stuck with a 68 year old doctor who basically copied everything my previous doctor was doing,  Same regimen, same controlled scripts, nothing new.  I am undetectable, but what happens when that is no longer the case?  My previous doctor would have had a plan B, he's done that in the past, and I shudder at what I face once my T cells decline and my viral load returns.   I don't have faith in the new ID guy, even though he writes whatever I ask.  But what happens when he retires?  I am not so sure.....

Thanks for your response, much appreciated.

[ellentonboy]

17 hours ago, hntnhole said:

I'll be waiting to read the replies; I find your experiences with Big Pharma infuriating as well, and yours are far more complex than mine.  While we're waiting though .......

This is a crystalline example of what the practice of medicine has turned into, and continues apace.  People are simply not like General Motors, Ford, Chrysler - in that when the alternator goes south, simply take it out, plug in another, bill the hell outta whoever will pay, and presto - over and done with.  Business models are universal in most industries, but the way I see it, Health Care is different.  Alternators don't have minds, souls, cares and fears.  People can and often do.  When your former pcp said he's changing "business models", that was an insult of the first magnitude.  

 

And then some kid calls with that?  Like you hadn't managed to figure out which way the shit was flowing?  I'm sure you managed better than I would have to keep a civil tongue in your head.  And then proceeds to sluff off the blame for this behavior on what everyone else is doing?  Shallow as a saucer.  Did you ask the kid how much the Corporation would pay in kickbacks?  

I haven't been forced into that situation as of yet, but it won't surprise me when it happens.  Best of luck !!

Thanks for that.  Btw, I took my former doctor's name and number out of my contact list.     I don't want his final thoughts of me to be what comes out of my mouth after a Grey Goose martini (or three) because it would hardly be flattering.  That 20 something snot that basically lectured me is lucky I could not reach through the phone and grab him by the neck. I actually had thoughts of stopping in the office and asking to speak to the doctor, but after some soul searching I realized it won't change anything and I might end up in jail for a day.  So I will stick with the elderly gentleman, do some research and find someone closer to fifty who is not planning on retiring in the next year or so.  I am very concerned, all joking aside.  I realize stomping my feet and acting like a child worked till I was about 30, but not any longer.   Thank God for BZ, I can complain here and though not everyone finds my situation unique, at least I have a place to vent without fear of arrest!

[BootmanLA]

8 hours ago, ellentonboy said:

What shocked me was the way the whole situation occurred.  Very little, or no warning.  When I first became aware I was livid, I wrote a  very nice, but direct letter, thanking him for all the years he took care of me.  I knew this man since I was 27 years old, he was like a big brother to me.  I just felt he sold out, he took the easy way.  Now another poster had mentioned the subject of billing, and how he can get more money for billing as an Infectious Disease Specialist.  I understand that, as he told me privately he had to pay severn employees weekly and it was a strain.   However, he was always an Infectious Disease Specialist, almost everyone who went to him was a gay male who had HIV.  But he still wrote scripts for the flu, and he still wrote controlled substances.  Why now?

Part of it may simply be legal issues. If the corporation acquiring his practice has shareholders, even if it's not publicly traded, there may have been restrictions on what could be said before the transaction occurred, so as not to interfere with the transaction, tip off competitors, etc. If it IS a publicly traded entity of some sort, the restrictions can be even harsher to avoid issues with the Securities and Exchange Commission.

He told you his payroll was a strain - that goes a long way towards explaining why he chose this option. But in addition: health insurers are constantly putting the squeeze on providers, trying to get more work for less money, and thanks to COVID, lots of other expenses (like rent) are rising. Property insurance rates in Florida are undoubtedly continuing to escalate as they have for decades. All in all, it may just have reached the point where costs required action.

As for the mix of work: here's the thing. Making up numbers to illustrate a point (and simplifying, ignoring things like contracted rates, mandated discounts, etc.), let's say he has 20  "slots" to see patients in a given day. An appointment for an ID issue merits a $300 reimbursement on average from insurers while a PCP appointment merits a $150 reimbursement. Let's say 15 out of 20 appointments during the day are for ID issues and can be billed as such; 5 of them are for other issues like those for which you would also see him.

If the acquiring corporation has a total of 5 ID specialists after purchasing this practice, and each one was billing 25% of his hours to non-ID issues, they could dump one of the five, consolidate his caseload among the other four, and hire a GP for far less money than the ID doctor they're replacing while still generating the same overall billings. Or they could just not offer the PCP services at all, shifting those people elsewhere, and still letting one ID guy go because with the streamlined workload, they don't need five.

As for the notification: yeah, form letters suck. But the problem is, he's likely got scores or hundreds of patients that all have to be notified. Assuming even 5 minutes per patient to explain things - and that's not very long, considering what he's got to explain - coupled with ID verification, leaving messages, calling people that weren't reached the first round, etc. etc. - you're talking weeks of time spent just to personally notify every patient.

And honestly: I realize you've been with this guy a long time, but so have, most likely, a lot of other patients. They all deserve equal consideration, and sometimes, there just isn't the time in the day needed to allow for personal notification of a major change like this. It sucks - yes - but that's modern American medicine. This is what happens when you have competing health care finance entities (ie insurers) coupled with private providers, patients, and ostensibly unrelated parties (like employers) all with their hands in the pie. 

[NEDenver]

Went through it 15 years ago.  Probably the hardest part was cycling through a half dozen pcp’s to find one that’s not homophobic.  Haven’t had the homophobic doctor problem since moving to the VA, at least.