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View Poll Results: Where do talented new doctors tend to establish themselves?
Near affluent, metropolitan areas where they can more rapidly recoup their investment 21 77.78%
Equally distributed and available most places 6 22.22%
Voters: 27. You may not vote on this poll

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Old 05-27-2014, 12:41 PM
 
Location: Glenbogle
730 posts, read 1,027,552 times
Reputation: 1046

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Quote:
Originally Posted by theoldnorthstate View Post
the specialist can be wherever as long as you have a good GP who can get you to whatever specialist you need.
Ah but that's the big problem: Finding a GOOD g.p. They are becoming scarcer than hens teeth and probably will continue to be so, as the younger doctors go for the higher paying specialties and the older GPs retire.

If you have a health plan that requires a referral, then the choice of a GP is definittely critical. This is why I will never again have a health plan that requires referrals or preauthorizations. I prefer to choose my own specialists instead of trusting the judgment of a GP; the worst recommendations I've ever gotten were those that originated from a GP. And if the GP belongs to a group/network, they may be required to refer patients ONLY to specialists who are also in that group/network. I have been told this by several doctors who operate within a group/network. One told me "I have to refer you to Dr X; we are not supposed to refer patients out-of-group." That's scary.

I would trust the recommendation of a specialist for another specialist rather than a recommendation from a GP. For instance when I needed a gastroenterologist, I called several of my existing specialists (oncologist, surgeon, dermatologist and urologist) and said "I need a good gastroenterologist, who would you personally recommend?" Three of the four doctors recommended the same GI guy (none of my specialists operate within a group) so that's who I went to.

I've found that it's easier to get an appt with a specialist if another specialist has recommended him/her. I've often wondered if it's because specialists have more respect for other specialists than for GPs, lol
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Old 05-27-2014, 12:59 PM
 
Location: Portland, Oregon
10,008 posts, read 16,671,715 times
Reputation: 6417
One issue for physicians practicing in small towns/rural areas is whether or not there is a critical mass of other physicians. Rare is the person who find being on duty 24/7 acceptable long term. I have heard of a physician who declined a practice when he analyzed the frequency of call outs.
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Old 05-27-2014, 12:59 PM
 
14,260 posts, read 23,995,588 times
Reputation: 20076
Quote:
Originally Posted by StressedOutNYer View Post
Ah but that's the big problem: Finding a GOOD g.p. They are becoming scarcer than hens teeth and probably will continue to be so, as the younger doctors go for the higher paying specialties and the older GPs retire.
I have been with the same internist for 13 years. If he would leave, I would switch off to one of the Nurse Practitioners or Physician Assistants in the practice. They have a lot more time to spend with you and are easier to get appointments with.
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Old 05-27-2014, 01:09 PM
 
Location: State of Being
35,885 posts, read 67,172,097 times
Reputation: 22373
Just wanted to clear a few things up that folks have stated on this thread.

Most docs do not "take call" as they did in the past. Hospitalists fulfill that duty now. Most docs work 9-5 hours. Docs don't do "rounds" as they did in the past, either.

Surgeons and specialists have to deal with Emergency Dept. "call" of course, but that is typically on a rotating basis so an orthopaedic surgeon may not be "on call" but 1 weekend a month or less.

Also, it is inaccurate that the trend is for docs to join large corporate practices. Instead, the trend over the last 15 years is that docs join hospital sponsored practices, and so sign contracts with hospitals, instead of forming private practices.
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Old 05-27-2014, 04:54 PM
 
Location: Ponte Vedra Beach FL
14,628 posts, read 17,932,507 times
Reputation: 6716
Quote:
Originally Posted by StressedOutNYer View Post
Ah but that's the big problem: Finding a GOOD g.p. They are becoming scarcer than hens teeth and probably will continue to be so, as the younger doctors go for the higher paying specialties and the older GPs retire.

If you have a health plan that requires a referral, then the choice of a GP is definittely critical. This is why I will never again have a health plan that requires referrals or preauthorizations. I prefer to choose my own specialists instead of trusting the judgment of a GP; the worst recommendations I've ever gotten were those that originated from a GP. And if the GP belongs to a group/network, they may be required to refer patients ONLY to specialists who are also in that group/network. I have been told this by several doctors who operate within a group/network. One told me "I have to refer you to Dr X; we are not supposed to refer patients out-of-group." That's scary.

I would trust the recommendation of a specialist for another specialist rather than a recommendation from a GP. For instance when I needed a gastroenterologist, I called several of my existing specialists (oncologist, surgeon, dermatologist and urologist) and said "I need a good gastroenterologist, who would you personally recommend?" Three of the four doctors recommended the same GI guy (none of my specialists operate within a group) so that's who I went to.

I've found that it's easier to get an appt with a specialist if another specialist has recommended him/her. I've often wondered if it's because specialists have more respect for other specialists than for GPs, lol
I don't agree with you - assuming you're in a decent health network and/or have good insurance coverage. I'm not familiar with all the specialists where I live. There are tons - not only in my geographical area - but where I get most of my care - Mayo JAX. Under my Medicare/Medigap coverage - I don't need pre-authorizations or similar. But I often need some guidance in terms of who's best for X/Y/Z. And that's where my primary care doc - who's an experienced internist - comes into play.

I mean - just to give you some idea - my colonoscopy GI guy is part of a non-Mayo about 50+ physician GI group here. Huge practice. If I needed a GI person for something other than routine colonoscopy - perhaps something more serious - I don't think I'd just want to throw darts on a board or get advice from non-doctors. I'd count on my primary care doc to guide me. Robyn
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Old 05-27-2014, 09:23 PM
 
Location: Whereever we have our RV parked
8,787 posts, read 7,707,284 times
Reputation: 15080
I can tell you from experience that doctors don't stay in small towns very long any more. As soon as they can, they move to the city. Rural areas are becoming mostly poor people on Medicare or Medicaid. I'm sure that there are many small towns that would dry up and blow away if it wasn't for govt. payments to keep the place open.
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Old 05-28-2014, 05:52 AM
 
5,822 posts, read 13,318,850 times
Reputation: 9290
They certainly aren't in upstate NY. Difficult to get a primary doctor, who doesn't move within a year or two. Once you do get one, you can't get in to see them. I had pain in my leg and couldn't even get in to see the PA. Gave up on the primaries and go to a clinic when needed.
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Old 05-28-2014, 10:44 AM
 
9,194 posts, read 9,275,870 times
Reputation: 28807
Quote:
Originally Posted by StressedOutNYer View Post
Ah but that's the big problem: Finding a GOOD g.p. They are becoming scarcer than hens teeth and probably will continue to be so, as the younger doctors go for the higher paying specialties and the older GPs retire.
Quote:
Originally Posted by StressedOutNYer View Post
If you have a health plan that requires a referral, then the choice of a GP is definittely critical. This is why I will never again have a health plan that requires referrals or preauthorizations. I prefer to choose my own specialists instead of trusting the judgment of a GP; the worst recommendations I've ever gotten were those that originated from a GP. And if the GP belongs to a group/network, they may be required to refer patients ONLY to specialists who are also in that group/network. I have been told this by several doctors who operate within a group/network. One told me "I have to refer you to Dr X; we are not supposed to refer patients out-of-group." That's scary.

I would trust the recommendation of a specialist for another specialist rather than a recommendation from a GP. For instance when I needed a gastroenterologist, I called several of my existing specialists (oncologist, surgeon, dermatologist and urologist) and said "I need a good gastroenterologist, who would you personally recommend?" Three of the four doctors recommended the same GI guy (none of my specialists operate within a group) so that's who I went to.

I've found that it's easier to get an appt with a specialist if another specialist has recommended him/her. I've often wondered if it's because specialists have more respect for other specialists than for GPs, lol
The place where doctors establish a practice is a function of:

1. Income
2. Cost of Living
3. Pleasant and appropriate surroundings to raise a family.
4. Access to first rate hospitals, facilities, and medical technology.
5. Good ratio of doctors to patients (not too high or too low)

There are some highly individual factors too. My BIL wanted a place that was primarily rural because he felt rural patients did a better job taking care of themselves and appreciated having access to a physician more than people in a city did. On the other hand, my FIL dearly wanted to set up his practice somewhere near where he had grown up as a child because of some mystical connection the place had to him.

Good physicians exist in abundance because of the quality of medical training in this country. Superb physicians are found here and there and my family and I have learned the hard way they can be few and far between. I've had the occasion to take the depositions of a number of physicians in my area. I've also read plenty of resumes' of doctors as well. Some things stand out for me. Has the doctor ever written an article published in a medical journal? Is the doctor involved in any research or studies? Does the doctor hold an adjunct faculty position with any medical school? I don't think anyone wants to take the time to look up a physician in "Who's Who Among American Physicians". I can tell you this resource does exist and it contains a lot of valuable information. Its also possible to look up a doctor online and learn some things about him/her that way. Too many people focus on bedside manner. My BIL has a terrible bedside manner, but when it comes to performing surgery truly is top notch.

I'll throw one more wrinkle into this. There are people, like myself, who have made a deliberate decision to keep a particular primary care physician who they do not believe is top notch. There are some very specific reasons, I keep this doctor even though it might surprise some.
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Old 05-28-2014, 11:52 AM
 
Location: in the miseries
3,302 posts, read 3,580,382 times
Reputation: 3810
They need to pay their loans back unless they win the lottery
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Old 05-28-2014, 03:55 PM
 
741 posts, read 641,725 times
Reputation: 576
They go where they can make the most money ... for the most part. You'll find a lot of them in Chicago, as one example.
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