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Doctor Shopping Shouldn't Happen Inside a Medical Practice


Some don't understand why practices don't let patients switch their physicians, but to me, there's no real benefit to patients and detriment to doctors.

When I finished my fellowship and joined a practice, I was seen, rightfully so, as the new kid on the block. The senior doc had been solo for over 10 years, and was “the man.” Everybody knew of him, all the other physicians referred to him. He got lots of patients through word of mouth.

After all that, his schedule was pretty full - which is why he hired me. So the plan was for me to get all the new patients. Except patients didn’t want to see me, they wanted “the man.” Since they needed to be seen, they settled for me. Most of them were perfectly happy to continue seeing me, but there were others who saw me just to get their foot in the door, then asked to switch to my partner. He didn’t want that any more than I did, so it became our policy that patients couldn’t switch within the practice. With the exception of the emergency visit, or a physician illness, once a patient saw one of us, they could not switch.

Fast forward nine years to when I hired my new associate after having gone solo for a year. Same thing: patients wanted to see me (hmmm, I guess that makes me “the man”), but since the wait to see me was three months, as opposed to two weeks, they would ask if they could see Dr. X and then follow up with me. The answer is no. For many reasons.

First of all, while it is flattering that they want to see me and not her, that request is arbitrary. Secondly, most patients who want to switch after they’ve seen one of us, want to do so because they don’t want to hear what we’ve had to say. The thing is, I trained Dr. X through three years of residency and two years of fellowship. She practices medicine the same way I do. We discuss cases from time to time, and ask each other for opinions, and invariably, we end up hearing the same answers that are already playing in our heads. Third, I already have a very full schedule with my own follow up patients - I can’t add more. Fourth, even though they are not considered new patients, if they switch docs, it’s as if they are new. OK, sure, the history is already in the chart, but seeing someone for the first time always takes more time. Heck, follow-up patients that don’t come back for eight months take longer than ones that come every three months.

Now, I have a patient that would like to switch to Dr. X. It is clear that she doesn’t like me. She doesn’t trust what I say, she doesn’t adhere to my recommendations. She cries at her visits, she argues with me. And she doesn’t understand why I get frustrated. I told her that unfortunately it’s because I actually care. Nonetheless, she still wants to come to this practice, but wants to see Dr. X. Let me point out, she was seeing another endocrinologist before and left him to see me because, as she put it, “he’s an a**hole.” I’m sure she has equally pleasant words for me. Suffice it to say, I personally don’t care if she sees anybody but me, however, I don’t want to set a precedent, and Dr. X doesn’t want her.

My husband doesn’t understand why we don’t let patients switch back and forth, but I think it is a bad idea. I see no good coming of it. Patients will derive no real benefit, and the two of will be pulling our hair out.

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