Finding Primary Care Providers Can Be Hard – Part 2 of 2

In part 1 of this series, we discussed why there is a shortage of family doctors or primary care providers and physicians. In part 2, we talk about some solutions.

Physician, nurse practitioner, or physician assistant/associate

Many of us are used to seeing a family doctor or a group practice of doctors but since the 1960s, we have had what are called “mid-level” practitioners: nurse practitioners (NPs) and physician associates (PAs) — previously referred to as physician assistants. “Midlevels” entered the healthcare space to provide primary care in regions with a low supply of physicians. They are now considered primary care professionals or primary care providers (PCPs)

PAs complete two years of study (500 hours) and 2000 hours of clinical practice before passing a required examination to start practice. PA graduates who would like additional training in some areas like critical care or urology, can follow residency and fellowship programs, but residency is not required. They see and treat patients under a doctor’s supervision, but the doctors don’t have to physically be in the same room or building. Still, they must be reachable either by phone or electronic communication. In addition, a doctor must typically review the PA’s charts (records) in a timely fashion.  That timeline may also vary from state to state. PAs must pass a licensing exam to practice and must maintain accreditation with continuing studies as determined by each state’s medical board. 

PAs can prescribe routine medications and some controlled medications in certain states. They can do surgeries with local anesthetics and assist a doctor in the operating room with more advanced procedures.

NPs are registered nurses typically with bachelor’s in nursing (BScN) and a master’s or PhD for Nurse Practitioners. They usually complete a master’s program in 1.5 to 2 years (3000) hours and must pass a qualifying exam to practice. Nurses who complete a PhD program as a Nurse Practitioner may identify themselves as a Doctor of Nursing Practice (DNP) in the clinical setting. (Confusingly, DNP may also stand for a Doctor of Naturopathic Medicine so please check your care provider’s credentials!)

NPs and PAs can do many of the same things, but some differences exist. PAs must work under a doctor’s supervision. In some states, NPs may run their own clinics and work independently.

Given the increasing complexity of medicine, often, they will work in tandem with a treatment team that  includes physicians. PAs and NPs may provide care in the clinic, hospital, urban, rural, or suburban settings.   

Now for the search for primary care providers

If you find yourself looking for a healthcare provider, here are some tips that may make things easier:

• Check with your insurance company for a list of primary care professionals (PCPs) in your area covered under your policy. 
• Ask friends and family who they see and can recommend.
• If your PCP is leaving the practice and you can’t follow them, ask if they have any recommendations for a replacement.
• Check with the licensing associations and medical boards for PCPs in your area. This will verify that they are a physician, PA, or NP in good standing in the state where they provide care. 
• Look for recommendations by local advocacy groups if you have a specific health condition, such as psoriasis or diabetes.
• Look for online reviews that can give you an idea of what a specific PCP is like. Are appointments on time? Is the office staff friendly and helpful? These are issues that you can take into account. Keep in mind that if you read negative reviews, primary care providers are often not in a position to defend themselves against negative reviews because of patient confidentiality laws referred to as HIPAA in the U.S. or PIPEDA in Canada.
• Consult the government page, “Find Doctors and Medical Facilities” at https://www.usa.gov/doctors.

There are also some practical issues to review:

• Is the PCP board- or association-certified? Board-certified primary care providers have completed a residency in the specialty, passed a licensing exam specific to their specialty and keep up-to-date with continuing medical education directed at the advancements in their specialty.
• Are the office hours convenient for you? How long do you have to wait for an appointment? Are there set times for walk-ins if you have something that needs to be seen, but it’s not an emergency? Are there telehealth appointments? Are email access or text messaging services available? Are they available 24/7? Do they charge for email or text messages? 
• Is the location easy to access?
• How do you reach the PCP if you have a question? How long does it take the PCP to reply to your concerns? Are their instructions understandable?  
• Does the PCP focus more on treatment or prevention?
• If the PCP is for a friend or loved one who doesn’t speak English, does that professional speak their language? Do they have interpreters available?
• If it is important to you, does the PCP share similar interests?  

Some offices or clinics allow potential patients to interview and meet the staff. If you find one that allows for a consultation, verify whether there is a charge or it is free.  (Don’t forget to bring your insurance information with you to the appointment to review with the staff!) 

Finding a healthcare professional can take some legwork and a lot of time, but having someone familiar with you and your health needs is worth it in the long run.