How dermatology became the 'it' job in medicine

Anecdotal, but I'm in the North East US and I called, and I'm not joking, nine primary care offices. Eight of them said they couldn't take anymore patients, and one said I could get an appointment six months later.

I hadn't needed to go to a primary care doctor in my adult life, but it was mind blowing that this was the case. Many friends of mine have had the same experience.

Had the same thing in the Midwest about 8 months ago. Had to call a half dozen offices before one would take me and appointments had to be scheduled long in advance. I had not been to the doctor as an adult either and was quickly surprised by how frustrating healthcare is.

I had this experience when shopping for a highly rated doctor. Luckily I was able to get in on a great doctor after a few weeks of casually calling around, and now can get appointments no problem.

When I was younger on crap insurance, I was able to quickly find one by having no standards other than "be a medical physician". And the doctor I went to was definitely lower rung.

Same, had to call around a lot to find primary care, and was being given multi-month waitlist estimates for seeing an ENT specialist. I've had more luck recently as I was able to get into see an ENT in less than 30 days. It's also crazy how much everyone tries to upsell you. It' hard to tell what tests or procedures I really need.

I laugh to myself whenever I read some disclaimer that says “ask your doctor” because… how? I’m supposed to call the office, wait six to nine months, and then ask about a mild health concern I had that’s long past?

In mid-2023 I decided it would be good to have a primary care doctor since I was 74 years old at the time and hadn't been to a doctor in decades.

Full disclosure: I am a retired board-certified anesthesiologist.

I asked around town (Charlottesville, Virginia) and got two names from doctors I trust.

The first was not taking new patients; the second was, so I made an appointment: first available appointment was January 2025 (i.e., in 18 months). I happily took it.

I figured maybe this was a way of triaging old people like myself: if we're forced to wait long enough before being seen, maybe we'll die in the meantime so slots will open up.

At least in my area, huge medical groups or insurance companies have bought nearly all primary care practices. They’ve cut costs and raised prices and it’s virtually impossible to see an MD for an acute medical condition. All procedures need to be scheduled out months now.

It reminds me of what some Canadian friends described their healthcare system being like 20 years ago. If we’re paying more and getting the same service, I’m not sure there’s much reason not to socialize healthcare now (health care, not insurance).

While getting less service, as a marketplace insurance purchaser my premiums are doubling next year. It’s still “cheap”, but that would be a significant shock for most families.

Primary care has the opposite problem right now. Practices are closing faster than new ones are opening, and doctors are leaving the profession faster than new doctors are joining. There is an actual shortage of primary care docs.

This is new since Covid era. You used to be able to get an appointment for a physical just a few weeks out, and it was easy to find a new doctor if you needed to.

This has been developing for a very long time. The two major medical school systems, MDs and DOs have kept supply of medical school graduates below the demand. This has kept the market rate for fees up but has created market inefficiencies. There is an under supply of general practice doctors. And it will be hard to reverse as the internships and residencies are usually in hospitals and large medical centers and there is little room to expand the incoming DR supply.

Given the rise of Physican Assistants and Nurse Practitioners and their expanding scope of (even independent) practice across various states, specifically to address this growing shortage of primary care physicians (PCPs), it almost becomes a self-fulfilling prophecy that fewer potential physicians choose family medicine as that's the first specialty that seems most likely to be addressed by PAs and NPs.

As a medical professional, do you think yearly checkups are useful or necessary for healthy individuals in their 20s and 30s? It seems like you've done well for yourself without the need of one due so long.

This is for "new patients" though, once you're in it's generally fine. It's a back-pressure mechanism for them to not sign up too many new people.

Yep, with our current system we have evolved it into a monstrous and inefficient hybrid that contains most of the downsides of a socialized system with most of the downsides of a free market system. It's utterly insane what we're doing, and there seems to be very little interest in fundamental change.

I'm not a medical professional, but I have a close friend who is. Most of the time, no you don't need yearly checkups. But if you develop something like diabetes, a thyroid condition, or some types of cancer, it might save your life.

If you're going to do it, I would recommend having a bunch of labs done so you can at least know how you're doing. For example might as well test A1C, Vitamin D, Iron, Thyroid, Testosterone and many other hormones and vitamin levels to get a good picture of your nutrition. If you're low/high in many of these things a simple supplementation can radically improve your life, but not if you don't know about it. A friend of mine recently found his Testosterone levels were really low, and after starting TRT he feels way, way better. It improved depression levels and many other things, with a bonus that now when he goes to the gym it's actually possible to get some results.

Worth pointing out is that you can have (most) of these labs done without a doctor. There are websites you can buy kits, and you can sometimes just go in-person to Labcorp offices and they'll run stuff for you.

Anyway, just something to consider.

It regionally-dependent though. On average, if we need to see a doctor, we can get an appointment in a day or two. For a routine physical, it might be two weeks, three at most.

We decided to look for a new primary care doctor in Washington. I was amazed when I read my wife's email to the effect that our physicals were booked for 11/25. Then I understood that this was next year, not next week.

My wife is a medical professional and it is in your best interest to get yearly checkups if only for a regular lab report history.