In our current model of healthcare, primary care physicians tend to be our initial point of contact with the healthcare system. 

Typically, a history and physical examination is completed and a treatment plan is developed that includes plans for preventive care and treatment of chronic medical conditions. The physician may order diagnostic testing, prescribe medications, and make referrals to more specialized doctors. Over time, trusting relationships develop as follow-up care is delivered.

Today, and for many reasons, the U.S. is experiencing a significant shortage of these professionals, leading to difficulties accessing care. As a result, individuals seek services from urgent care and retail clinics, as well as costly emergency rooms. Because this care is episodic, follow-up is difficult, long-term relationship building is impossible, preventive care is not addressed, and nuanced changes in chronic medical conditions may go unnoticed and untreated, leading to grave illness and hospitalization.

This month, we discuss strategies for accessing primary care in this challenging environment.

Enhance the Relationship You Have

The first question we ask of a client who expresses a need for a new primary care physician is, “Why are you looking?” Often, it’s because of a relationship or communication issue with the provider or the practice. Given how difficult it has become to find a new provider (clients are often unaware of this), we suggest first making an effort to improve the existing relationship. 

Begin by contacting the practice manager, the person responsible for making management decisions in a medical practice and ensuring patient satisfaction. State that you are struggling with an issue and request a meeting to share your perspective and work through a new approach to working together. Your physician may have no idea you are not satisfied; give them a chance to meet your expectations.

If your differences are irreconcilable, ask if there is another provider in the practice who may be a better fit. If you stay within the same practice, as an existing patient, you may not have to wait so long for a new appointment.

Understand Your Insurance Requirements

If you must look elsewhere, make sure you will have coverage with the providers you choose. If you are in a Health Maintenance Organization (HMO), your providers must be in-network. If you are in a Preferred Provider Organization (PPO), you will have some coverage for providers out-of-network, but you will have greater out-of-pocket expenses.

Develop a List of Potential Providers

Start with your insurance customer service representative. Ask if they know of primary care physicians/practices with an “open panel,” meaning they are taking on new patients. 

Additionally, use your insurance portal to search for primary care physicians. Often, there is a notation of practices taking new patients.

Now, with a list of potential providers in hand, visit healthcare system web sites. On most, you will find a link titled “Find a Doctor.” Enter primary care as the specialty and you will see that the list of physicians will include physicians with the specialty of Primary Care, Internal Medicine, and Family Medicine — all of whom may be appropriate for you. Depending on your age, Geriatric Medicine may also be an option.

By clicking on a provider, you can gather a lot of information about their specialties and sub-specialties, affiliations with hospitals, gender, language, educational background, expertise, and more. Always double-check that the insurance coverage they accept is your specific health insurance plan and not just the company that offers it.

Define Your Criteria

Develop a list of criteria for a new provider and weigh how important each is to you. These may include hospital system affiliations, gender, age, education, years of experience, distance from home, and more. Everyone has a different list; there is no right or wrong.

However, keep in mind that with providers in short supply, you may need to make compromises. For example…

• Timing. A client needed a new physician immediately because she moved across the country and had no one to prescribe her needed medications. So she made an appointment with a physician not in her most desired system and eventually transitioned when she ascended to the top of a long waiting list.

• Relationship. Another client went outside her desired system and ended up staying there because the relationship was so positive. She had to bridge some communication gaps because the system’s medical records did not automatically sync, but the extra steps involved were worth it to her.

• Physician availability. Be willing to see a nurse practitioner or physician assistant for your initial visits, with a plan to transition to a physician in the future.

• Distance. I moved to Rhode Island eight years ago and still drive two hours into Massachusetts to see my primary care physician. It’s only once a year and thanks to email, telehealth, and the provider’s patient portal, the trade-off has worked — for now.

Research the Practice

Visit the practice’s website (if they have one) to identify how it is structured. Things to investigate include:

• Who are the providers in the group?

• Do they have specific areas of interest/sub-specialty such as diabetes, sleep, geriatric care, etc.?

• Are nurse practitioners, physician assistants, registered nurses, case managers, and social workers part of the group? 

• What hospital system are they affiliated with? 

Develop a List of Questions to Ask

Here are a few you may not have thought of:

• May I schedule a meet and greet appointment with a new provider to see if we are a match for each other?

• How do I share my medical records?

• How does your practice manage off-hour patient needs and how do providers cover for each other?

• Do your providers work as a team, and if so, who makes up the team?

• Do you use telehealth appointments?

• Do you have a patient portal that includes the ability to communicate with my provider via email?

Begin to make calls with these and any other questions you have developed.

Additional Tips

• If your current physician is leaving a practice or retiring, ask if they can select a new provider for you and facilitate a transfer of your care through their personal relationship.

• Ask your family members, friends, and acquaintances if they are in physician practices they like and if they might have influence to encourage their provider to take you on and/or if you may use their name when you call.

• If you have a relationship with a specialist, ask if they have suggestions and influence.

• If you are willing and able to spend additional money, consider seeking care from a concierge practice. Ironically, they are also difficult to find in this time of acute shortage.

Summary

Primary care is critical to preventing illness, managing chronic medical conditions, and promoting your overall health. With our health care system experiencing a monumental shortage of primary care providers — a situation that will not be rectified anytime soon — you must be diligent in your search for good providers and in managing those relationships.