Your doctor may have dropped you if you haven’t been seen in a few years


When Claudia Siegel got a stomach bug this year, she contacted her primary care doctor to get something to relieve her diarrhea. The Philadelphia resident was surprised when he received an online message informing him that because he had not visited his doctor in more than three years, he was no longer a patient.

And since he wasn’t accepting new patients, he would have to find a new primary care physician.

“I think it’s unconscious,” Siegel said, noting that many patients may have been turned away from the doctor’s office in recent years because of the pandemic. “There was no news to patients who are about to lose their doctor.”

As the open enrollment period – when people can sign up for health insurance – begins, people should check if they are still patients of their doctors, experts say.

It is unfortunate to learn that you have been abandoned by the doctor’s practice because many years have passed since your last visit, but the approach is not uncommon. Exactly how widespread the experience is, no one can say. But specialists do this too.

The argument for dropping the occasional patient makes some sense. Since many primary care physicians have a waiting list of prospective patients, eliminating those they rarely see opens up patient slots and improves access for others.

“Most primary care practices are incredibly busy, in part because of the increased demand for covid,” said Russell Phillips, the director of Harvard Medical School’s Center for Primary Care and a general internist at the Beth Israel Deaconess Medical Center.

“Although the continuity of care is important, if the patient has not been and we do not know if they will come in, it is difficult to leave space for them,” he said.

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A difficult transition to a new doctor

Patients often move away or find a different doctor when their insurance changes, without notifying the practice, experts say. In addition, doctors can try to classify people who have not seen in a long time as new patients, since their medical, family and social history may need a time update after a long break. Patient status is an element that determines how much doctors are paid.

However, the transition can be trying for patients.

“I can completely understand the patient’s perspective,” said Courtney Jones, a senior director of case management at the Patient Advocate Foundation. “You believe that you have a medical team that you trusted before to help you make decisions, and now you have to find another team that you trust.”

Siegel said she rarely went to the doctor, adhering to her doctor father’s advice that people shouldn’t go unless they’re sick. She hadn’t been to her doctor’s office in person recently, but Siegel said she had been corresponding with practice staff, including updating her on her coronavirus vaccination status.

After receiving the discharge online through the patient portal for the Jefferson health system, Siegel called the family medicine practice’s patient line directly. They told him that three years was the protocol and that they had to follow it.

“I asked, ‘What about the patient?'” Siegel said. “They had no answer for that.”

It was a month before Siegel, who has coverage under Medicare’s traditional fee-for-service program, could see a doctor who was accepting new patients. By that time, his stomach virus symptoms had resolved.

Jefferson Health does not have a policy that patients lose their doctor if they are not seen regularly, according to a statement from spokesman Damien Woods.

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He said, however, “Patients who have not been seen by their provider for three years or more are classified in electronic medical records as new patients (rather than established patients), per Center for Services guidance of Medicare and Medicaid (CMS). Whenever possible, Jefferson works with these patients to keep them with their primary care provider and offers options for new providers in certain circumstances.”

The American Medical Association’s ethics guidelines recommend that doctors notify patients in advance when they withdraw from their cases so that patients have time to find other doctors.

But the organization, which represents doctors, has no guidelines for maintaining a patient panel, said AMA spokesman Robert Mills.

The American Academy of Family Physicians, which represents and advocates for family physicians, declined to comment for this story.

Demand for services expected to increase

A panel of patients from primary care physicians typically includes those who have been seen in the past two years, said Phillips, of Harvard. Doctors can have 2,000 or more patients, studies show. Maintaining a workable number of patients is crucial, both for effective patient care and for physicians.

The demand for medical services is expected to continue to outstrip the supply in the coming decades, as people age and require more care at the same time, the number of retiring doctors is increasing. According to projections by the Association of American Medical Colleges, by 2034, there will be a shortage of up to 48,000 primary care physicians.

Maintaining a regular relationship with a primary care provider can help people manage chronic conditions and promptly identify new problems. Regular screening also helps make sure people get important routine services like immunizations and blood pressure checks, said David Blumenthal, a former primary care physician who is the president of the Commonwealth Fund, a research and policy organization. .

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Health organizations are increasingly focusing on requiring doctors to meet certain quality metrics, such as managing patients’ high blood pressure or providing comprehensive care for diabetes. In this environment, “it could be problematic for doctors to be responsible for the health of patients they don’t see,” Blumenthal said.

Money figures into it too. Regular visits are good for the bottom line of a practice.

In general, doctors are not required to continue seeing particular patients. A doctor may turn away patients because they do not follow clinical advice or cancel or miss routine appointments. Belligerent or abusive behavior is also grounds for leaving a patient.

In some cases, doctors can be legally responsible for “patient abandonment”, a form of medical malpractice. State regulations vary, but there are common elements. These rules are usually applied when a doctor harms a patient by suddenly leaving in a critical phase of treatment. It generally does not apply if a patient has not seen the doctor for several years.

Although quietly leaving a rarely seen patient might not have an immediate medical consequence, patients should be informed, experts said.

“It’s really good customer service to explain 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 left hanging. If you are the patient, the doctor should be proactive.”

This article was produced by Kaiser Health News, a program of the Kaiser Family Foundation, a non-profit endowed organization that provides information on health issues to the nation.


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