When Claudia Siegel came down with a stomach bug earlier this year, she contacted her primary care doctor for a prescription to relieve her diarrhea.
The Philadelphia resident was shocked when he received a message online informing him that since he hadn’t seen 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 another primary care doctor.
“I think it’s unimaginable,” Siegel said, adding that many patients have not seen a doctor in recent years because of the Covid pandemic. “Patients had no notification that they were going to lose their doctor.”
Dropping from the patient list is disappointing, but not uncommon.
The logic of leaving the patient “orphaned as a doctor” makes some sense. As many GPs have a waiting list of potential patients, dropping those they rarely see opens up space and improves access for others.
“Most primary care practices are incredibly busy, in part because of the stress of Covid,” said Dr. Russell Phillips, director of the Center for Primary Care at Harvard Medical School and a general internist at Harvard Medical Center. .
“While continuity of care is important, if patients don’t come and we don’t know if they will, it’s hard to make room for them,” he said.
Experts say patients often move or find another doctor when they change insurance without notifying the practice.
Additionally, doctors may want to classify people they haven’t seen in a while as new patients, because they may need to update their medical, family, and social history, which takes time after this break in visits. A patient’s condition is one factor that determines how much money doctors are paid.
Still, the transition can be difficult for patients.
“I completely understand the patient’s perspective,” said Courtney Jones, senior director of case management at the Patient Advocate Foundation. “You think 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 went to the doctor, following her doctor father’s advice that people shouldn’t go unless they’re sick. Although he hasn’t been in person at his doctor’s office recently, he explained that he has been communicating with office staff, including informing them about the status of their COVID vaccinations.
After receiving notification through the Jefferson Health portal that he was no longer a patient, Siegel called. They told him that three years was the protocol and they had to follow it.
“I asked, ‘What about the patient?'” Siegel said. “They had no response.”
Siegel, who has Medicare, is a month away from being able to see a doctor who is accepting new patients. At that time, the symptoms of the stomach virus had already disappeared.
Jefferson Health has no policy for these types of situations, according to a statement from spokesperson 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 the electronic medical record, based on guidelines from the Centers for Medicare and Medicaid Services (CMS). 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 (AMA) ethics guidelines recommend that doctors notify patients in advance, so they have time to find another doctor.
A primary care doctor’s patient list usually 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 clinicians, maintaining an effective number of patients is critical.
“Practices are realizing that one of the biggest contributors to physician burnout is having more patients than they can serve,” Phillips said.
Demand for medical care is expected to outstrip supply for decades to come, as people age and more care is needed as more doctors retire.
According to estimates by the Association of American Medical Colleges, there will be a shortage of 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 quickly.
Regular screening helps ensure people get needed routine services, such as immunizations and blood pressure checks, said Dr. David Blumenthal, a former primary care physician and president of The Commonwealth Fund, a research and policy organization.
Healthcare organizations are increasingly focusing on requiring physicians to meet specific quality metrics, such as monitoring patients’ high blood pressure or comprehensive diabetes care. In this setting, “doctors being responsible for the health of patients they don’t see can be problematic,” Blumenthal said.
Money also plays a role. Constant inspection is good for the final results of a practice. Practices may decide not to take on 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 treating patients. A doctor may “dismiss” patients because they do not follow clinical recommendations or consistently cancel or miss appointments. War criminal behavior is also grounds for patient removal.
In some cases, doctors can be held legally liable for “patient negligence,” a form of medical malpractice.
State rules vary, but there are common elements. These rules generally apply when a doctor harms a patient by suddenly placing them at a critical stage of treatment. Generally, this will not apply if a patient has not seen a doctor for several years.
However, experts said that in any case patients should be informed.
“It’s really good customer service to explain the situation,” said Rick Gundling, senior vice president of the Healthcare Financial Management Association. As for Siegel, he said: “This woman should not be kept in limbo. If you are the patient, the doctor has to be proactive.”
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