Haven’t seen your doctor in a few years? You may need to find a new one

When Claudia Siegel got a stomach bug earlier this year, she reached out to her primary care doctor for a prescription to relieve her diarrhea. The Philadelphia resident was surprised when he received an online message informing him that since he hadn’t visited his doctor in more than three years, he was no longer a patient.

And since he’s not accepting new patients, he needs to find a new primary care physician.

“I think it’s absurd,” Siegel said, adding that the Covid pandemic may have kept many patients away from doctor’s offices over the past few years. “Patients had no notification that they were on the verge of losing their doctor.”

While it’s disappointing to learn that you’ve dropped out of a physician’s practice because it’s been years since your last visit, the procedure isn’t uncommon. Just how extensive an experience, no one can say. But experts do it too.

Sometimes the rationale for excluding a patient makes some sense. Because many primary care doctors have waiting lists of potential patients, removing those they rarely see opens up patient slots and improves access for others.

Director of Primary Care Center at Harvard Medical School and a general internist at Beth Israel Deaconess Medical Center. “Most primary care practices are incredibly busy, in part because of the pressing demands due to Covid,” says Russell Phillips.

“While continuity of care is important, if the patient isn’t there and we don’t know if they’re going to come, it’s hard to leave room for them,” he said.

Experts say patients often walk away or find another doctor when their insurance habits change without notification. Also, clinicians may want to classify people they haven’t seen in a long time as new patients because their medical, family, and social history may need a time-consuming update after a long break. Patient status is one factor that determines how much doctors get paid.

Still, conversion can be attempted for patients.

“I completely understand the patient’s perspective,” said Courtney Jones, senior director of case management at the Patient Advocate Foundation. “You believe you have a medical team that you trusted before to help you make decisions, and now you have to find another trusted team.”

Siegel said she rarely goes to the doctor, following her physician father’s advice that people shouldn’t go unless they’re sick. Although he hasn’t visited his doctor’s office in person recently, Siegel said he has corresponded with practice staff, including keeping them up to date on their Covid vaccination status.

After being dismissed online through Jefferson Health System’s patient portal, Siegel called the family medicine practice’s patient line directly. They told him that three years was the protocol and they had to follow it.

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

Under Medicare’s traditional fee-for-service program, Siegel was a month before he could see a doctor who was accepting new patients. By then, her stomach virus symptoms had resolved.

According to a statement from spokesman Damien Woods, Jefferson Health has no policy that requires patients to lose their doctor if they do not see them regularly.

However, he said, “according to Centers for Medicare and Medicaid Services (CMS) guidelines, “patients who have not been seen by their provider for three years or more are classified as new patients (rather than established patients) in the electronic medical record. Whenever possible, Jefferson works with these patients to keep them with their primary care provider and offers options for new providers in certain situations.”

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

But the organization, which represents physicians, has no guidelines on maintaining a panel of patients, 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 panel of patients’ primary care physicians typically includes those seen in the past two years, says Harvard’s Phillips. Doctors may have 2,000 or more patients, research shows. For both effective patient care and doctors, maintaining an effective patient population is critical.

“Practices realize that a major contributor to physician burnout is having more patients than you can deal with,” Phillips said.

Demand for physician services is expected to outstrip supply in the coming decades, as people age and require more care while the number of retiring physicians increases. According to estimates by the Association of American Medical Colleges, there will be a shortage of up to 48,000 primary care physicians by 2034.

Maintaining a regular relationship with a primary care provider can help people manage chronic conditions and identify new problems early. Regular check-ins help 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.

Health care organizations increasingly emphasize that doctors meet certain quality metrics, such as managing patients’ high blood pressure or providing comprehensive diabetes care. In this environment, “holding physicians accountable for the health of people who don’t see them can be problematic,” Blumenthal said.

This includes money. Regular inspections are good for the practice’s bottom line. Practices may decide to avoid new Medicare patients or those with certain types of insurance because the payments are too low, said Wayne Dahl, a consultant with the Medical Group Management Association, an organization for healthcare managers.

In general, doctors are not obligated to continue seeing patients. A doctor may dismiss patients because they are not following clinical recommendations or routinely cancel or miss appointments. Rebellious or abusive behavior is also grounds for discharge.

In some cases, physicians can be held legally liable for “patient abandonment,” a type of medical malpractice. State rules vary, but there are common elements. These rules generally apply when a doctor harms a patient by abruptly abandoning them at a critical stage of treatment. This would generally not apply if a patient has not seen a physician for several years.

While quietly dropping an infrequent patient may not have immediate medical consequences, experts say patients should be informed.

“Explaining the situation is really good customer service,” says 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 hanged. If you are the patient, the physician has to be proactive.”

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