When I moved to the Philadelphia area in fall 2021, I was worried about making friends, about being a new home owner, about finding a good pizza place (crucial). One thing that didn't stress me was finding a new primary care physician: When I told my beloved doctor in Virginia where I was moving, she excitedly told me that her best friend from medical school had a practice just one town over. Perfect, I thought.
Then I tried to make an appointment and got the prognosis: Her practice wasn't accepting any patients.
What followed was more than a year of trying and failing to find a new PCP, even as I was experiencing some medical problems. It seemed that every office I tried was full up. Finally, in desperation, I called the original practice in late November 2022 and asked again. "We'll be accepting new patients in January," the receptionist told me. "Call back then." I called back at about 9:05 a.m. the first day the office was open in 2023. I got in. And now I have a doctor I like a great deal, one who can squeeze me in if I'm sick and who listens to me. It's even better than having a go-to pizza place.
My struggle made so much more sense after I edited Jeffrey Millstein's excellent First Opinion "Value-based payments are making it harder to see your primary care doctor on short notice." Millstein — who is an internist, clinical assistant professor at the Perelman School of Medicine of the University of Pennsylvania, and regional medical director for Penn Primary Care — writes that in an environment that prizes value-based care, "priority status goes to encounters that satisfy payer requirements and population-based metrics — annual wellness visits, post-hospital care, comprehensive care visits, and chronic care management — leaving limited access for problems like acute pain, suspected infection, and new mental health concerns."
To avoid this, he says, primary care physicians simply can't carry the huge number of patients (often 2,000 or 3,000) that has become normal. "This, in turn, calls for a clinician workforce capacity that we do not have," Millstein writes.
The moral of the story for me: I can never move again, lest I lose this doctor.
Also in First Opinion this week: Surgical oncologist Nathalie McDowell Johnson writes, "Despite advancements in oncology, a woman's race too often dictates her likelihood to survive breast cancer" — and shares one reason for that: a popular genomic test "is less accurate for Black women." Plus: online privacy for people with substance use disorder, the unintended consequences of the end of Roe, a new approach to treating trauma during conflict, and a new idea for expanding access to 988, the mental health crisis hotline.
My recommendation for the week: "Believable: The Coco Berthmann Story" starts with a cancer scam and then goes off the rails from there. Hosted by Sara Ganim, who won a Pulitzer for her contribution to reporting on the Penn State football child sexual abuse scandal, "Believable" brings the sharp, careful journalism that is so often missing from true crime podcasts.
Got an idea for or about First Opinion? Email me.
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