When Claudia Siegel contracted stomach trouble earlier this year, she turned to her primary care doctor for a prescription for something to help ease the diarrhea. The Philadelphia resident was surprised when she received an online message informing her that since she hadn’t visited her doctor in over three years, she was no longer a patient.
And since he’s not taking new patients, she’ll have to find a new primary care doctor.
“I think that’s unconscionable, noting that many patients may have stayed away from the doctor’s office over the past few years because of the COVID pandemic,” Siegel said. “There is no notification to patients that they are about to lose a doctor.”
While it is disappointing to learn that you have been denied the practice of a physician because several years have passed since your last visit, this approach is not uncommon. No one can predict exactly how widespread this experience will be. But experts also do this.
Arguments about dropping patients do not often make some sense. Since many primary care physicians have a waiting list of potential patients, weeding out patients they rarely see opens up patient positions and improves access for those who need it. other.
“Most primary care activities are extremely busy,” says Dr. Russell Phillips, director of the Harvard Medical School Primary Care Center and a general resident at Beth Israel Deaconess Medical Center. Busy, in part due to pent-up demand due to COVID.
“While continuity of care is important, if the patient hasn’t come in and we don’t know if they’re going in, it’s hard to make room for them,” he said.
Patients often move elsewhere or find another doctor when their insurance coverage changes without notice, experts say. In addition, physicians may seek to categorize people they have not seen for a long time as new patients because their medical, family, and social history may require time-consuming updates after a period of time. long period of rest. A patient’s condition is one of the factors that determine how much a doctor is paid.
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However, the transition may be trying for the patient.
“I can totally understand the patient’s point of view,” said Courtney Jones, senior director of case management at Patient Advocacy. “You believe you have a medical team you trusted before to help you make decisions, and now you have to find another trusted team.”
Siegel said she rarely visits the doctor, following the advice of her doctor father that people should not go unless they are sick. Although she hasn’t been to the doctor’s office in person recently, Siegel said she has corresponded with practice staff, including updating them on her COVID vaccination status.
After receiving the layoff order online through the Jefferson Health system patient portal, Siegel called the family medicine facility’s patient line directly. They told her three years was the protocol and they had to follow it.
“I asked, ‘What about the patient? ‘ said Siegel. “They don’t have an answer for that.”
It was a month before Siegel, who is covered under the traditional Medicare fee-for-service plan, could see a doctor taking new patients. By that time, her stomach virus symptoms had resolved.
Jefferson Health does not have a policy for patients to lose their doctors if they are not seen regularly, 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 in the electronic medical record as new (instead of established) patients, according to 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 to offer new provider options under certain circumstances. “
The American Medical Association’s ethical guidelines recommend that physicians notify patients in advance when they withdraw from a case so they have time to find another doctor.
But the organization, which represents physicians, has no guidelines for maintaining a patient pool, AMA spokesman Robert Mills said.
The American Academy of Family Physicians, which represents and advocates for family physicians, declined to comment for this story.
Phillips, of Harvard University, said: “A primary care physician group usually includes people who have been seen in the past two years. Doctors can have 2,000 or more patients, studies show. Maintaining a workable number of patients is important, both for effective patient care and for physicians.
“Practice has found that a major contributing factor to physician burnout is having more patients than you can handle,” says Phillips.
Demand for physician services is expected to continue to outpace supply in the coming decades, as people age and require more care and the number of doctors retiring is on the rise. According to a forecast by the Association of American Medical Colleges, by 2034, there will be a shortage of 48,000 primary care physicians.
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Maintaining a regular relationship with a primary care provider can help people manage chronic conditions and identify new problems promptly. Dr David Blumenthal, a former primary care physician and president of the Commonwealth Fund, a research and policy organization.
Healthcare organizations are increasingly focused on requiring doctors to meet certain quality indicators, such as managing a patient’s high blood pressure or providing comprehensive care about the disease. diabetes. In this environment, “it can be problematic for doctors to take responsibility for the health of patients who don’t see them,” Blumenthal said.
Money also counts on it. A steady visit is good for the profit of the practice. Owen Dahl, a consultant with the Health Group Management Association, an organization for healthcare managers, says practices can also decide to avoid new Medicare patients or those with existing medical conditions. certain types of insurance.
In general, the physician is not required to continue to see the patient. Physicians may expel patients because they do not follow clinical recommendations or frequently cancel or miss appointments. Violent or abusive behavior is also a reason to drop the patient.
Under certain circumstances, a physician may be liable for “patient abandonment,” a form of medical malpractice. State rules vary, but there are elements in common. Those rules often apply when a doctor harms a patient by dropping them suddenly into a critical period of treatment. It is generally not applicable if a patient has not seen a doctor for several years.
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While the quiet release of a rarely seen patient may not have immediate medical consequences, patients should still be informed, experts say.
“Customer service is really 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 hanged. If you are a patient, the physician should be proactive. “
Kaiser Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
