Access to health care
I have to admit that for the past ten years or so, before and during the ACA debates, and since, I've been pretty smug about access to health care. We live in a small town near a larger town in New Hampshire. That larger town is still pretty small by big city standards, but it has a hospital that is part of a large and well-regarded health care system. And I was happy with my first primary care physician (whose practice was bought up by this system) and with her replacement. I was a happy camper. Then that second doctor left. Okay, so another doctor will take her place, right? Not so fast, health care fans.
I called the other day to make an appointment with my former provider's replacement. She's a Nurse Practitioner in her late twenties. My needs are relatively minor so that was sort of okay, for the moment. My wife, on the other hand, has a complex medical history, and an NP or even an advanced nurse practitioner won't cut it. Is there a doctor in the practice who could see her? Nope. No doctors. Repeat. No primary care physicians are available to take on patients who've been with this facility for almost 20 years. None. And the reaction from the clinic? Tough.
So she's going to another hospital in the system where they have pcps taking on new patients. But even there, the first recommendations were for nurse practitioners.
Now I'm wondering what to do. Nurses and physician assistants in their 20s don't have the medical or patient experience or perspective to address issues that doctors, already far more extensively trained, deal with every day. Sure, they have to learn, and that's fine. And I would be fine if were were talking about diabetes management or any number of other chronic, but routine, matters. But who's mentoring them, when there appear to be fewer and fewer doctors on staff at a clinic and hospital serving a "catchment area" of more than 100,000 people. Plus, since they are not doctors and cannot prescribe, or may need to consult in order to get approval to prescribe, as a patient I potentially end up seeing a powerless gatekeeper (and paying for that) before getting referred to a doctor who can actually do something. BTW, this is not to say there are no specialist doctors. I know there are good people in various specialties, but even there I've been told that excellence is spotty.
And in the don't get me wrong category, I don't have a problem with nurses or physician assistants, or other "other than doctor" practitioners. One of my kids was a paramedic for some years. Every one of them plays a key role in the medical system. But the fact that a doctor is not readily available is shocking to me after 20 years of that being a routine state of affairs. I guess it's my turn to feel the effects of life in non-big-city America.
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