September 9, 2013
Changing Doctors, Now May Not Be the Best Time
Normally I would not be afraid to suggest changing doctors if you are not receiving correct care for your diabetes. But, as we draw closer to the implementation of the Affordable Care Act (ACA), this may not be the best time for changing doctors. I say this with caution because some doctors are cleaning house by dismissing patients they no longer wish to have as patients. Why? Because if you are a patient that is not following their orders, have complex medical problems, or are what they deem as obese, they do not want you to be a drag on their practice. You could be the patient that prevents them from receiving the incentives they feel entitled to under the new guidelines from the Centers for Medicare and Medicaid Services (CMS).
For the rest of you that are satisfied with your doctor or have a great doctor-patient relationship, work on keeping it that way or strengthening it, even if the relationship might not be that great. Once January 1, 2014 arrives, there will be an influx of new patients to take the place of dismissed patients and they will pick and chose from among them. If you live in a rural area of the US, the doctors may become even fewer and farther between.
Also, living in a rural area, it may be more difficult to find an endocrinologist if you are needing insulin to replace oral medications. Don't count on having certified diabetes educators (CDEs) available or registered dietitians (RDs) in the rural areas. Until we get a few years of corrections in the ACA, and incentives are again revised to encourage doctors to move out to the rural areas, finding doctors may become a very real problem.
In all of this, I can only hope that telemedicine is not hamstrung to prevent medical assistance for the people in rural areas. I just know that several state legislatures failed to enact laws because of lobbying efforts of the state medical boards and several medical professional groups.
There is hope as some doctors and endocrinologists are changing and working to change. They are seeing the handwriting on the wall. They are beginning to see a small decline in the “pill cure” generation and a giant increase in internet savvy patients. These primary care providers will not be able to dictate and prevent their patients from finding evidence that the doctors are out of touch and not doing the patients' right. This has been a pleasant revelation.
Also, with the publishing of doctor information by the CMS on the Physician Compare website for people to have access for researching which doctors are taking how much money from representatives of big pharma and other incentives, doctors will no longer be able to hide their biases.