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Old 11-15-2011, 08:02 PM
 
Location: Chapel Hill, N.C.
36,437 posts, read 41,684,911 times
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We have been here in Chapel Hill about 3 years and started going to the various UNC clinics and doctors but about the time you get used to a doc, they end their fellowship and leave and the bureaucratic redtape and politics are starting to grow very tiring.

Today I tried out a private practice specialist and ended up having a great conversation about this problem. He was very candid about some of the politics involved at UNC Hospital and why he withdrew his privileges to go to a private hospital. He gave me almost 45 minutes for a first time visit and even made an appointment with another doctor for me (surgeon for a consult). I was really impressed.

We have several great hospitals in this area but I'm wondering if you folks prefer to deal with professionals at the major hospitals or seek private practice professionals.
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Old 11-15-2011, 08:07 PM
 
Location: The Triad (NC)
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All I want to see is a published list of their charges...
then I'll decide where to spend my money.
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Old 11-15-2011, 08:11 PM
 
Location: Chapel Hill, N.C.
36,437 posts, read 41,684,911 times
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Quote:
Originally Posted by MrRational View Post
All I want to see is a published list of their charges...
then I'll decide where to spend my money.

Really? Cost is your main criteria? have you had to deal with a teaching hospital with a serious illness yet? We have always had excellent insurance and now Medicare so cost is not really the main consideration.
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Old 11-15-2011, 08:19 PM
 
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For me it would depend on what I was getting treatment for. The university hospitals are going to be your best bet for some conditions, especially in pediatrics. For a run of the mill condition or regular check ups I'd probably go to a private practice.
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Old 11-15-2011, 08:32 PM
 
684 posts, read 1,043,349 times
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The only real downside I see with the Universities (other than parking and wait time!) is that I was billed for both 'hospital' and 'clinic' fees - I believe because all of the labs are carried out by the hospitals? I could be wrong - but I do know that for both Duke and UNC, I was billed twice for each visit, from two different entities, and was told, 'that's just the way it is'. Great doctors, though....but happier in general with private practices.
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Old 11-15-2011, 09:40 PM
 
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Very interesting issue with pros and cons to both sides and I think a lot boils down to personal preference. Of course, these are generalized statements - you can always find both great and not-so-great docs in each setting.

(Note: I am in the health care field. Hopefully I'm not too biased but I've gotten a good look at both sides of the table)

University setting:

Pros:
- A lot of specialization (especially in large institutions like UNC and Duke) so you can pretty much find anyone to treat almost everything. You really want to be in or have access to a UNC or Duke if you have a serious illness or an uncommon disease.
- Research - Lots of clinical trials or cutting edge research that may allow you to get access to treatments you might not get for another handful of years (or several handfuls)
- Reputation - This matters to some people (i.e. to have the "best" doctor for this or that). It is very difficult to achieve a world-class reputation unless you publish a lot of papers/articles/books and do a lot of research. Then get asked to speak at a lot of conferences. Most private practice doctors can't do this because they don't have a lab. Or hire a clinical researcher to organize it for them. But note that the level of reputation one has does not necessarily correlate with the quality of clinical care you get; sometimes a doctor is super smart AND super caring, sometimes not. But in general, most of the people employed or who trained at UNC or Duke are pretty darn smart people.
- Physician coverage - if your doctor is away on vacation/at a conference/unavailable fr what ever reason, there is always another doctor to cover for them at all hours. While all physicians (university and private practice) have this, there is usually broader coverage at the university.

Pro or con depending on your viewpoint:
- Teaching hospital. Some love it, some hate it with the constant flow of trainees (medical students, residents, fellows). There may be a lot of repetition and you see more people in a single visit than just the doctor but your case passes through multiple eyes/brains and you never know who will pick up on something that might be important to your case. Plus, younger docs might be more open-minded to different ideas or treatments. Docs also may be good at explaining things since they are forever teaching it to someone else. But turnover can be high.
- One centralized hospital system - in an ideal setting, all the care being within one system OUGHT to make it easier for docs to communicate, to get appointments, and to minimize patient costs but admittedly, this doesn't often happen. Also, you tend to get referred within the hospital system for almost everything. But neither UNC nor Duke is the best at everything, you know? They each (as do Rex and WakeMed) have their own strengths...wouldn't it be nicer to have some choice in where to be referred to?

But, it is faster to view any radiology studies done at the hospital from any computer in the hospital system as opposed to having to go to a different hospital to request a CD of the study.

Cons:
- Very long visits and often long waits for appointments
- Bad parking/high parking prices at the University (sometimes free at satellites)
- Staff that sometimes seems like they don't care since they are employed by the University or hospital and not a particular doctor.
- The politics. Actually, they are everywhere but are often less visible in a private practice setting. This can, however, affect who you get referred to or what hospital you

Private practice setting:

Pros:
- Service is usually better and faster, partly because you are often free to walk away if you are dissatisfied (whereas a referral practice at a University practice often has a captive audience), hurting the practice.
- Free parking!
- Nicer, more updated offices (usually)
- More stability in staff and doctors
- May have more flexible hours like early morning or evening hours, or Saturday hours (the Universities cannot or will not pay overtime for these hours)

Pro/con:
- Amount of time spent per patient. This is really variable. Primary care doctors (internal medicine, family practice, pediatrics) may be able to give you more time initially and it may or may not continue. Other doctors might spend even less time with you because the more patients they are able to see, the more money they make (or rather, try to break even....most doctors need to see 25+ patients in a day to break even). It may just feel like you see them more if you haven't spent 3 hours waiting for them to begin with!

Cons:
- Every doctor is required to do a certain amount of continuing medical education (CME) every year (actually every 3 years in NC) but it can be hard to fit into the schedule and they may only do their CME in one lump every couple years. So it can be easy to get into a groove and just do what they were taught x number of years ago. It may not be the latest and greatest whereas docs in the University settings tend to be more up to date.
- It can be hard to figure out who is good until you've gone through the experience with them. And if you are dissatisfied with the service or your care, you don't have much recourse (aside from not going back or going to the state medical board if there was gross negligence)
- More fees. Typically a private practice will charge you fees such as to refill prescriptions outside normal working hours, fill out forms or paperwork, copying your medical records, missed appointments, etc. To be fair, this is uncompensated work (by insurance) and forms are not always easy to fill out (try filling out 20+ different 10 page forms or letters every few days, always needed ASAP!).

Conclusion:
In general, I think that UNC and Duke satellite offices try to function like a private practice with the benefits of the larger hospital system with varying degrees of success. Rex and WakeMed are already just private practices affiliated with the hospital so you might get the efficiency of private practice but each practice interacts with the hospital differently so your experience might be different as opposed to the uniformity of the university hospital experience.

Overall I think a lot of it depends on how you want your care to be handled. If you want a specialist or the "world class" doc treating each condition with the depth of experience and knowledge that goes with it (for example, a cardiologist for your heart disease, endocrinologist for diabetes, orthopedic surgeon/PMR doc for your back pain) but probably a more fragmented experience of care, requiring YOU to be in charge of your care and coordinating it then go with a UNC or Duke. Otherwise you are likely more satisfied with a private practice experience but it can very difficult to find the right fit.

I could go probably on but I won't. Kudos to anyone who made it through the whole post!
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Old 11-16-2011, 04:59 AM
 
277 posts, read 576,077 times
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Quote:
Originally Posted by guest12 View Post
The only real downside I see with the Universities (other than parking and wait time!) is that I was billed for both 'hospital' and 'clinic' fees - I believe because all of the labs are carried out by the hospitals? I could be wrong - but I do know that for both Duke and UNC, I was billed twice for each visit, from two different entities, and was told, 'that's just the way it is'. Great doctors, though....but happier in general with private practices.
That billing can be different for the different types of clinics. The type you are talking about is called a "hospital based clinic" aka: an HBC. I work for a PDC "private diagnostic clinic" and our patients do not pay any hospital fees to come to our office. There are also CPDCs, DPCs, etc. It really depends upon how the practices are set up. PDCs strive to work more like a private doctor's office who happens to have privileges at Duke. Hope this helps!
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Old 11-16-2011, 06:19 AM
 
Location: The Triad (NC)
26,881 posts, read 57,977,821 times
Reputation: 29332
Quote:
Originally Posted by no kudzu View Post
Really? Cost is your main criteria?
Did I say that? But I'll tell you this much...
KNOWING what the charges are, in advance of need and in a transparent manner, sure is important to me.

Maybe you have someone else paying your bills? I don't.

Quote:
We have always had excellent insurance
and now Medicare so cost is not really the main consideration.
Lucky for you.
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Old 11-16-2011, 06:46 AM
 
9,198 posts, read 21,177,371 times
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Personally, I prefer not to use UNC system doctors. Everyone else in my family does use them. I hate the bureaucracy of it all. Every step of basic healthcare there - from making an appointment, parking, checking in, getting billed, etc. - seems like a hassle to me. And frankly the care seems very unpersonalized - to UNC, patients seem like nothing more than their "patient record locator number" (required every time you call them).

For one of my family members, we find it difficult to find one physician in the UNC system who will really take ownerhship of the case and accept overall responsibility for coordinating diagnosis and treatment. We get bounced around, and it seems like it's up to us to figure out what we need to do, who we need to see, and then follow up with others to make sure information gets shared.
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Old 11-16-2011, 07:22 AM
 
239 posts, read 962,943 times
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For one of my family members, we find it difficult to find one physician in the UNC system who will really take ownerhship of the case and accept overall responsibility for coordinating diagnosis and treatment. We get bounced around, and it seems like it's up to us to figure out what we need to do, who we need to see, and then follow up with others to make sure information gets shared.[/quote]

It's multidisciplinary care and collaboration. If the pt has cancer there can not be one person making all the decisions-surgery, radiation, medical oncology, and more can all be involved in the care of the pt. Plus UNC does have nurse navigators to help pts understand what the next step is and who to call etc. All pt information is available to all providers in the pt's medical records-so all notes, labs, radiology reports etc are there.
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