In the past year, as I've latched firmly onto Medicare, some asymptomatic numerical data has kept me more in touch with my personal physician than at any time since he served as one of my more distinguished Internal Medicine residents. He called the medicines correctly, and I've assisted him by taking them almost without fail, so numerical data obtained since the Covid-19 pandemic changed the medical care landscape has never been better. My prior quarterly assessment took place over the telephone, his taking my word for hypertensive data obtained mostly by my home kit. A second agent entered my daily pill container, the systolic BP's came down to desired levels, and I had no side effects of medication. Regional infection risks have abated enough for him to see me in the exam room.
As I waited my turn in his socially distanced waiting area, I seemed the sturdiest of the men there, no women waiting to be seen. People exited but I did not notice that none received a followup appointment, only a note from the secretary of a referral to the regional medical center.
My turn arrived, no complaints on my part. As he proceeded with the encounter, he noted that he and his partners opted to close their practice, accounting for the referral of the previous patients in lieu of followup scheduling. The reasons my doctor gave sounded very familiar, as I had done the same ten years earlier. A lease renewal with ruinous rent increase served as the terminal event. But a look around the waiting area told more. Charts, including mine, still came in bulky manila folders. He entered notes on a computer but could not afford to invest in fully electronic record keeping. Reporting data, billing, insurance, tracking hospitalizations which his group until recently had continued to follow in the hospital, and innumerable petty distractions from the more satisfying elements of being the doctor had claimed another four experienced clinicians, two late career, two mid-career . As much as I appreciated his expert guidance over many years, the time to transition had arrived.
He had inherited me from another outstanding resident who I helped train largely for geographic reasons. My office stood in the building next to his. I needed negligible medical care most of the time, some lipid management, a false alarm on a cardiac concern, allergic rhinitis before nasal steroids went OTC, and some annoying prostate symptoms with even more annoying orthostasis on the usual alpha blocker. He never seemed disappointed at tweaking the medically innocuous, unlike me who thrived on the complexity of lab work at the extremes. My blood pressure eventually needed attention and my appendix, of blessed memory, brought me to the OR after I retired, but medical care never reached complexity. An annual review with lab work became quarterly as medicine needed adjustment. I expected this to plod along indefinitely but the lure of a stable salary as part time hospitalist and part time internist for a thriving orthopedic practice replaced the burdens of independent practice management.
I had just retrieved my three month supply of medication from the pharmacy so there was no urgency to secure a replacement personal physician. As I exited the office the secretary handed me their closure letter, suggesting that followup care be arranged through the regional medical center, which had become something of a local monopoly, though a number of independent practices remained, often with concierge enrollment charges. I looked up the web site, which I expected to be the medical center's physician referral service. It was not. Rather it was an unselected list of staff physicians in Internal Medicine which numbered about 1000 individuals. Subspecialists, ICU physicians, hospitalists, education directors all aggregated with primary care physicians but excluded their whole family practice department which would add another few hundred people. The site had locations where the hospital operated satellite centers. I accessed those but none had a list of physicians assigned to those sites, let alone indication of FP or IM. Next option, called the physician referral phone number provided in my doctor's letter. I noted the site and asked her to give me a list of physicians at that site. She couldn't. This was not very helpful.
Next step, looking up a physician on their payroll who I know well, a contemporary, who I know works at one of the sites. Success. That site has seven physicians. I preferred on of the younger ones, somebody I don't know personally, and read the training bios. Interestingly, all five were women. I called the number which got answered on the 13th ring, though the person I finally reached could not have been more helpful. We reviewed the time frames for appointment, she asked when I would run out of medicine, and then we settled on a woman who seemed a contemporary of my own children who are also physicians. Mission accomplished, though I would have expected a dominant medical center to make the task of latching onto one of their employee physicians a little less troublesome than it seemed.
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