Your primary care physician: why you should stay in touch



KHN

When Claudia Siegel had a stomach bug earlier this year, she went to her primary care doctor for a prescription for something to relieve her diarrhea. The Philadelphia resident was shocked when he received an online message after he hadn’t visited his doctor in more than three years to let him know he was no longer a patient.

And since he wasn’t accepting new patients, he would have to find a new primary care doctor.

“I think it’s a no-brainer,” Siegel said, noting that many patients have been turned away from the doctor’s office in recent years because of the covid pandemic. “Patients were not notified that they were about to lose their doctor.”

While it’s embarrassing to find out you’ve been turned away from your doctor’s practice because it’s been years since your last visit, the approach isn’t uncommon. Exactly how widespread the experience is, no one can say. But specialists do that too.

The argument for occasionally leaving the patient makes sense. Since many primary care physicians have a waiting list of prospective patients, removing those they see infrequently opens up patient slots and improves access for others.

“Most primary care practices are very busy, in part because of the demand from covid,” said Dr. Russell Phillips, director of the Center for Primary Care at Harvard Medical School and a general internist at Beth Israel Deaconess Medical Center.

“Although it is important to continue the care, if the patient has not been admitted and we do not know if he will be admitted or not, it is difficult to leave them a place,” he said.

Patients often move away or find another doctor when insurance changes without notifying the practice, experts say. In addition, doctors may seek to classify people they have not seen for a long time as new patients, as their medical, family and social history requires a time-consuming update after a long break. A patient’s condition is an element that determines how much doctors are paid.

However, the transition can be difficult for patients.

“I can completely understand the patient’s perspective,” said Courtney Jones, senior director of case management for the Patient Advocate Foundation. “You think you have a group of doctors that you once trusted to help you make decisions, and now you have to find another group that you can trust.”

Siegel said she rarely went to the doctor, following the advice of her doctor father that people shouldn’t go unless they were sick. Although she hasn’t been to her doctor’s office recently, Siegel said she’s been in contact with staff at the practice, including keeping them up-to-date on the status of the covid vaccine.

After receiving an online release through the patient portal for the Jefferson Health system, Siegel called the family medicine practice’s patient line directly. They told him it was a three-year protocol and they had to follow it.

“I asked, ‘What’s wrong with the patient?'” Siegel said. “They didn’t have an answer for that.”

It took a month for Siegel, who has coverage under Medicare’s traditional fee-for-service program, to see a doctor who was accepting new patients. By then, her stomach virus symptoms had resolved.

Jefferson Health does not have a policy that patients lose their doctor if they are not seen regularly, according to a statement from spokesman Damien Woods.

However, he said, “Patients who have not been seen by their provider for three years or more are classified as new patients in electronic medical records (non-established patients) according to Centers for Medicare and Medicaid Services (CMS) guidance. Whenever possible, Jefferson with these patients works to retain primary care providers and offers options to new providers in certain circumstances.”

American Medical Association ethics guidelines recommend that physicians notify patients in advance when they are withdrawing from a case so that they have time to find another physician.

But the organization that represents doctors has no guidelines for maintaining a patient panel, said AMA spokesman Robert Mills.

The American Academy of Family Physicians, which represents and advocates for family physicians, declined to comment for this story.

A primary care physician’s panel of patients typically includes those seen in the past two years, said Harvard’s Phillips. Doctors may have 2,000 or more patients, research shows. Maintaining a useful patient population is critical for both efficient patient care and physicians.

“Practices realize that a major driver of physician burnout is having more patients than you can handle,” Phillips said.

Demand for medical services is expected to continue to outstrip supply in the coming decades as people age and require more care, while at the same time the number of doctors retiring is on the rise. According to projections by the Association of American Medical Colleges, there will be a shortage of 48,000 primary care physicians by 2034.

Maintaining regular contact with a primary care provider can help people manage chronic conditions and quickly identify new problems. Regular checkups also ensure people get important routine services, such as immunizations and blood pressure checks, said Dr. David Blumenthal, a former primary care physician who is president of the Commonwealth Fund, a research and policy organization.

Healthcare organizations are increasingly focusing on requiring physicians to meet certain quality measures, such as managing patients’ hypertension or providing comprehensive diabetes care. In that environment, “it could be problematic for doctors to care about the health of patients they don’t see,” Blumenthal said.

Money is also included. Steady visits are good for a practice’s bottom line. Practices may also decide to avoid new Medicare patients or those with certain types of insurance because the payments are too low, said Owen Dahl, a consultant with the Medical Group Management Association, an organization for health care managers.

In general, doctors are not obliged to continue seeing a patient. A doctor may turn away patients because they do not follow clinical recommendations or because they cancel or miss regular appointments. Belligerent or abusive behavior is also grounds for discharge.

In some cases, doctors can be held legally liable for “patient abandonment,” a medical malpractice. State rules vary, but there are common elements. These rules generally apply when a doctor harms a patient by suddenly abandoning a critical phase of treatment. Generally, it would not apply if a patient has not seen a doctor for several years.

Even if an infrequently seen patient quietly collapses without immediate medical consequences, patients should report it, experts said.

“Customer service is very good at explaining the situation,” said Rick Gundling, senior vice president of the Healthcare Financial Management Association, an organization for financial professionals. As for Siegel, he said, “This woman should not be left hanging. If you are a patient, the doctor must be proactive.’