Is there a doctor (GP) in the house? Evidently not...does it matter?

Sitrep: I'm older (51, they tell me) and grumpier than I used to be.  No glaring health issues that I am aware of other than the sort of physique afforded those who don't have to kill their own dinner.  I am not ill or injured at moment.  My doctor retired shortly after Covid kicked off and for the last five-ish years, I have had no primary care provider.  My old doctor was replaced by someone I encountered once while getting a tetanus shot.  He made a distinctly negative impression, and I have not been back.

I do have health insurance through my employer.  It's a PPO, I think.  The insurance carrier is Cigna.  Their website is, in the current fashion, cryptic enough to be baffling, branded up one side and buzzworded down the other, with lots of pictures of people enjoying active lifestyles and smiling at tablets.  Very shiny, not necessarily very helpful.

Theoretically, one can use the insurance outfit's website to find providers, but results are...mixed.  It seems about as effective and efficient as GRM's search function, though less current.  I tried looking for a doctor and picked a few likely candidates that the insurance carrier listed as accepting new patients.  Unfortunately, their own clinic/office websites indicated that they are not.  So far, I am not confident that I will find an actual doctor.

What I have found, listed as a PCP and accepting new patients, is a PA-C.  I have an appointment scheduled with him for late this week.  The question is whether to hold out for a real doctor or just run with the PA-C.  I have no idea what they are capable of or whether I need to worry.  There is some lingering fear that, through relative youth and inexperience, he may miss something that a better trained, more experienced traditional doctor might catch.  In automotive terms, I'm afraid of getting the Express Lube treatment rather than a thorough inspection and diagnosis.  Like I said, I don't have any major conditions that I know warrant attention, but who knows what evils are hiding in this carcass?  I don't, and I am concerned that a physician's assistant may not, either.

There's also the concern that I'm going to get the short end of the stick because of how integrated health care providers and insurance carriers are now.  There seems to be a growing emphasis on keeping costs down for the carrier by shorting the quantity and quality of care afforded to each patient, and it seems unlikely that is going to work to my advantage.

I have a few days yet to cancel the appointment.  That will probably mean another wait of sixty days, maybe more, to get back in.  Should have asked this question sooner, but here we are.

Comments, suggestions, and anecdotes are all welcome.

At the age of 50, your at the perfect time for a much needed transition.  

So far you have wanted "experts" like health providers or financial matter providers, or legal matter providers to be older and therefore wiser than you.  The transition you need now is to find providers who are younger than you.  

The key point is you need these providers to outlive you.  Find one now that is 15-20 years your junior. 

My long time primary care doctor died last year at the age of 90.  (The last time I saw him he told me he was retiring at the end of that month; two months later I saw his obituary in the newspaper.  The amazing thing is he still looked and acted like a man 20 years younger.)  So, this year I had to find someone new for my annual physical.  When I called to make an appointment I was given the choice of seeing a physician's assistant in a timely manner, or waiting another couple months to meet with an MD.  I decided to make the appointment with the PA and it worked out okay - I liked his personality and manner, he did all the same things during the exam and had the same tests run (blood sugar, cholesterol, etc.)  So, seeing a PA isn't necessarily a bad thing, but of course results can vary.  I'd say go ahead with the appointment, and if you're not satisfied then next time around realize you'll probably have to allow more time to get an appointment with an MD.

I'm not an MD, but a veterinary GP. I've got a clue about health care. 
 

All of my preventative care has been done by a Nurse Practitioner for over a decade. She's the best practitioner I've ever known, and I've told her so more than once. Her physical examinations are very thorough, her history taking (a very important skill) is excellent. 
Whether it's an MD or a PA, your general care provider is going to refer you to a specialist if there's a problem.
 

I went to a appointment with my son recently with the "older MD." I was so unimpressed. He didn't even put a stethoscope on my son's chest. Very cursory exam, and didn't really seem engaged. Very disappointing.
 

Sounds like a case of needing to find someone old enough to have real life experience to draw upon, but young enough to be familiar with current guidelines and best practices. 

I'm your age (for a couple more weeks) and use a family practitioner that my wife and kids also use as a PCP, but if I had to find a new one I would consider a PA or NP. He knows when to hand it off to an expert, but at the same time takes a practical approach when it comes to non-critical issues (when I had tennis elbow I had the choice of PT or he could give me a print out of exercises to do at home).

It's a relationship, so make the appointment, see how you feel with their approach, how they address any concerns or questions you have, and if they seem rushed or are willing to take as much time as necessary during your visit. 

Remember you are in control of your Healthcare, if you don't like the level of care you are getting don't settle for the providers laziness or ignorance. They are being paid well to provide a service at a high level of competence, demand excellence. Don't be a dick but get what you pay for.

What he just typed.  I am 69 and have yet to find a GP DR who I have been comfortable with long term.  The good ones retire early to enjoy life, others have not been able to find the cause of problems, and some just have a bad attitude.  So do not expect to find one easily, it takes time.  You are pretty healthy so that is in your favor.  PAs are OK, if they get over their head there are usually DRs in the office to consult with.  So look at ratings, on line and thru your insurer, ask on a local facebook group and talk to people you know.  Not sure how an initial consult with a new GP is handled with your insurance, worth looking into.  

But bottom line you are the boss, not the DR.  Push back is OK, doing research online is a good idea too.

This forum has old people all over the country/world. I'm certain somebody could refer you to a respectable solution.
My personal opinion is that for the low frequency of seeing a primary care, I will pay out of network prices to get the good one.

Shoot. We pay cash for the wife's primary care.

Some plans won't pay if primary care is from a PA vs an MD. Perhaps this is an HMO thing? IDK.

I dated a doctor for a while.  She advised me for anything beyond a checkup to make sure I am seeing a doctor, not a NP or PA.  

I did not heed this advice due to scheduling reasons - several times since I have seen PAs that have been dismissive or unable to resolve issues and I ended up having to schedule a separate appointment with a doctor instead.  Now I'll call the office and request an appointment with a doctor, although this makes scheduling harder.

In reply to DarkMonohue :

I went through this recently. I've always been in good health and have never been much of a see a doctor person. I'm a couple years younger than you, and a couple years ago I got serious about checking up on and maintaining my health. It was much easier than I thought. Log in to Cigna, and create an account once logged it. You should be able to manage everything from there. They will have your insurance info, and will set you up with providers in your network. It will also track all of your appointments, and is the most efficient way to message your doctors. Like others mentioned, they will set you up with a primary care physician, and anything beyond that will go to specialists if needed. 

Related to this thread and a spinoff of my minor rants rant.  I'm on day three of acute and unpleasant stomach pain.  Called my GP this morning to be informed that she'd dropped me as a patient because the last time I saw her was in 2021.   Sorry I'm healthy?

So I'm waiting in the ER waiting room now.  This sucks.

Thanks for all the input so far. Boost_Crazy, I will revisit the Cigna website. What I have seen for far was not terribly encouraging. I went looking for a PCP and the first of their "best match" candidates was a pediatrician. It's definitely not an all-you-gotta-do-is situation.

In reply to TravisTheHuman :

An NP should know enough to refer to you someone who can diagnose more complicated issues. 

9/10, that's not necessary. 

The problem is that in some healthcare markets, the supply (of PCP/MD) is so low relative to the demand, that an NP can be the difference between "I'm going to refer you to a MD" vs "You need to go to the hospital immediately." 

Personally, I want a relationship with my primary medical advisor. I want them to remember me, remember my story, remember that weird stomach bug I had last year, that odd blood panel that we redid, that overnight in the hospital a few years back. I want them to remember that when I'm concerned about something, I'm not looking for drugs, I'm legit concerned. If you don't have a relationship with your practitioner, they might not "know you" well enough to determine what's serious and what's not. I've had plenty of MD's do this as well. 

One of the biggest changes I've seen in healthcare is how impersonal it's become and how in some cases it seems like you're seeing a different provider every time you get a checkup. I don't mind a 2nd Opinion, but I'd rather get it myself than have forced on me everytime I see the Doc. 

DarkMonohue said:

Thanks for all the input so far. Boost_Crazy, I will revisit the Cigna website. What I have seen for far was not terribly encouraging. I went looking for a PCP and the first of their "best match" candidates was a pediatrician. It's definitely not an all-you-gotta-do-is situation.

You'd think that since a pediatrician only sees people < 18, the healthcare IT systems would know that and prevent/warn the staff against scheduling adult patients with them, but no.  I've had at least 2 or 3 different occasions over the last decade where my phone calls saying "my regular doctor is busy, is there anyone else in the office I can see tomorrow?" have resulted in accidentally scheduling me with a pediatrician.  So far they have always caught it before I actually showed up, but it still baffles me how this is possible.

Doctor availability varies widely depending on where you live -- in general, the more populated the area the greater the availability.

This has been true for a long time.  Amusing story -- back in the 90s, when I started going to track days at Thunderhill (located in Willows, CA, which is a fairly small town in a rural/agricultural area), there was a guy with a fairly new Boxster who was pretty much always there no matter what event I went to.  Turned out he was a recently-graduated doctor, and in medical school they'd offered him a program where he would get discounts on tuition if he agreed to go work in a rural area that was poorly served by doctors.  He looked at the list of available cities, discovered that Willows was on the list, and jumped at it. :)

In reply to pheller :

Good luck, from my experience not gonna happen.  Practices are open for so many hours you never know who will be seeing you when you most need a Dr.  They won't remember you but that is what computer systems are for.  And the pay for support staff is so competitive the good ones can find better pay by bouncing around.  

The good news is doing research on drugs or diagnosed illnesses is easier than it has ever been.  So you as the consumer can be educated and need to do this.  If you spend hours reading about what tire, oil, polish to use on your car how much time is learning about the drugs you are taking and procedures they want to do to you worth?

pheller said:

In reply to TravisTheHuman :

An NP should know enough to refer to you someone who can diagnose more complicated issues. 

Agreed.  However, in my experience, it wasn't happening.

RE: PCP, I would like to have a "General Contractor" of doctors so to speak.  As you mentioned, I would like to have a relationship with them.  Not necessarily best friends or anything, but something more personal than an oil change.  For the past 20 months or so I have been to a variety of doctors (for a single issue/mix of related issues), none of whom speak to each other and focus on treating me.  Their approach is much more "lets see if this falls into my area of expertise" and if nothing jumps out at them, then "its not my problem"

I'm an OT (similar to a PT) who has worked in the past few years in acute care in a hospital, as well as an outpatient clinic treating upper extremity injuries. In those settings, it depends on the person, but I sometimes actually prefer the PAs and NPs over the MDs. I've seen seasoned MDs give the "express lube" treatment plenty of times, to use your analogy. It's person over the letters after their name in my opinion. Especially in this case.

And outpatient, good luck getting an MD to see you. They are almost all NPs and PAs anymore in my experience.

Times are a changing. I'm in the almost exact same boat as the OP. Not too worried at the moment, but they switched me to a NP for my next appointment.

The near future:

In reply to jamscal :

That is exactly my concern. Lack of control and lack of understanding seem to be fairly universal themes in health care. Makes sense. Not that much different from the fear that normals have of dealing with an unscrupulous or incompetent mechanic, I guess.

I did just phone the office and confirm that they have me scheduled for an exam. The phrase "establish care" was used just often enough to warrant making sure that the appointment would include an actual wellness exam rather than just a meet-and-greet. The receptionist says it will, so it hasn't gone completely off the rails yet.

Mrs Monohue is of the opinion that I should just proceed with the PA and see how it goes. Setting aside my inherent and learned cynicism, I don't have a strong argument against that approach. So I guess we'll give it a try.

Floating Doc (Forum Supporter) said:

All of my preventative care has been done by a Nurse Practitioner for over a decade. She's the best practitioner I've ever known, and I've told her so more than once. Her physical examinations are very thorough, her history taking (a very important skill) is excellent. 
Whether it's an MD or a PA, your general care provider is going to refer you to a specialist if there's a problem.
 

I went to a appointment with my son recently with the "older MD." I was so unimpressed. He didn't even put a stethoscope on my son's chest. Very cursory exam, and didn't really seem engaged. Very disappointing.

Same experience-had been getting physicals/basic care from a female PA for 10+ years. Switched to a male MD and was pretty dissapointed. In a hospital or critical care settings the nurses are always better to work with than the doctors as well. 

Hot take: An entire generation of doctors entered the practice because they wanted to become wealthy. Nurses became nurses because they wanted to take care of people.

Hotter take: Women are better listeners, and you want somebody who listens.

CrustyRedXpress said:

Same experience-had been getting physicals/basic care from a female PA for 10+ years. Switched to a male MD and was pretty dissapointed. In a hospital or critical care settings the nurses are always better to work with than the doctors as well. 

The way I see it, if all you're doing is routine stuff, physicals, vaccinations, blood test screening, treatment for common illnesses, etc and you're basically healthy to begin with (no ongoing chronic conditions) then a PA/NP will likely be fine.  The place where the additional depth of training that an MD brings to the table is important is for diagnosing less common, more critical stuff and for handling the interactions between multiple things.

Of course, the risk in going to the PA/NP for the routine stuff and saving the MD for once a discrepancy is noticed is that this discrepancy may not be noticed until later than you would prefer.