Your doctor retired. Now what do you do?
Mar. 11—Julia Porter, an 86-year-old resident of an assisted living facility in Mystic, had seen Dr. James Scarles for decades, sticking with him as he moved from an independent private practice to one associated with Hartford HealthCare.
Then he left.
Porter was referred to a nurse practitioner in the same practice, and recently said, "I'm happy enough with her, if I can get in to see her."
But, she said, it's not easy. When her son-in-law died, her blood pressure went up a little, she said, and when she tried to reach her nurse practitioner, she couldn't get through. A promised callback never materialized.
"I changed my pills myself," Porter said. "After the funeral, my pressure went down."
Nowadays, when it comes to patients and their primary care providers, there are "too many in-between people," she said.
Evelyn Kennedy, 95, a Groton retiree who ran Sewtique, a fabrics shop, for almost 50 years, saw the same doctor for nearly as long. Recently, he retired.
"A remarkable man, we parted as friends," Kennedy said of Dr. Maheesh Kabadi.
She said she's in the process of finding a new doctor, having located a prospect who needs her to fill out a form to get things going. She's waiting on the form.
"To be perfectly honest, I don't have a doctor," Kennedy said. "So be it. If I fall or get a cut, I'll go to the hospital and I'll say, 'Hey guys, I need help. What should I do?'"
Porter, Kennedy and more than a dozen others responded to The Day's late-February post seeking people willing to share their experiences in regard to finding a family doctor, general practitioner or primary care provider. Most of those who responded were near or beyond retirement age and nearly all described similar trials.
Respondents had found themselves in the market for a new doctor because their longtime physician had retired or otherwise left the profession, examples of a well-established trend that's been occurring across the country. According to a 2021 report released by the Association of American Medical Colleges, the U.S. faced a shortage of between 17,800 and 48,000 primary care physicians within 12 years.
Neither the state Department of Public Health nor Hartford HealthCare responded to requests for data or comment.
Common among respondents to The Day's query were complaints about delays in being referred to a new provider and in securing a first appointment with a provider; the lack of doctors in general practice; 15-minute medical appointments; and the electronic medical records systems that they say have depersonalized doctor-patient communications.
When a doctor he saw in Ledyard died years ago, Ed Victoria, of Groton, started seeing a Northeast Medical Group doctor on Clara Drive in Mystic, a relationship that lasted three years. When that doctor moved on about a year ago, Victoria said the practice told him he was more or less on his own.
Victoria found a doctor with the Hartford HealthCare Medical Group on Shaw's Cove in New London, only to learn weeks ago that the doctor would be leaving.
"Being 65 years of age, I was in a panic," he said. "I wanted to be sure I could get my medication."
Fortunately, Victoria was able to line up another doctor he's scheduled to see at the end of May.
Mark Kurpaska, 69, of Old Lyme, said his primary care physician of more than 20 years, Dr. Suresh D'Mello, retired at the end of 2019. The Northeast Medical Group office where he saw D'Mello assigned him to a family nurse practitioner in the practice. He's given up trying to find a doctor.
"The downside is I'm not treated as part of a family practice," Kurpaska said. "I don't get physicals, I get wellness visits because they're a Medicare freebie, not a full physical exam. If you ask for advice about something, you get charged for an additional office visit because it's above and beyond the wellness visit."
"I'm in relatively good health, I don't need a lot of attention," he said. "As I get older, though, it would be nice to have a primary physician."
Sally Viara, 78, of Westerly, said the biggest problem she's encountered is getting a doctor's appointment when she's sick.
"If you've got a fever or a sore throat, they tell you to go to the emergency room," she said.
Viara, who managed a four-doctor practice in Manchester in the 1980s, said it was then standard procedure to leave a few slots open for emergencies when scheduling appointments. That's no longer the case, she said, suggesting it's because Hartford HealthCare and Yale New Haven Health, the corporate entities that now dominate health care in the region, "have pulled all these practices under their umbrella" and the pressure on doctors and nurses to see as many patients as possible.
Kris Magnussen, a registered nurse with Ledge Light Health District, which serves as the local health department for nine towns in southern New London County, has experienced changes in the general-practitioner scene as a patient. When Dr. D'Mello left the Old Lyme practice where she'd been a patient for 40 years and once worked, she was assigned to an APRN (advanced practice registered nurse) who subsequently moved on as well.
"I had great difficulty finding a provider that would take me, and finding one that would not make me wait for six months for a get-to-know-you visit," she said. "Being 69 years old, it's scary not to have a provider."
Eventually, Magnussen switched networks and found a provider willing to see her in April. But she wonders how she'll get prescriptions filled in the meantime.
"A big issue is attracting physicians to Connecticut and to internal medicine," she said. "So many of them my age are retired. Another thing is the electronic charting, which is especially hard with an older population. It's so impersonal ― and 15-minute appointments are not enough."
Care too impersonal
In the not-so-distant past, Magnussen said, patients' medical records and charts were kept on paper and each physician worked with a nurse who handled patients' phone calls, often performing triage in the process. Patients used to have a relationship with their doctor. Doctors and nurses used to spend a lot of time on the "psychosocial" aspect of things.
"There's not the time now for them to get to know you," Magnussen said.
Rosemary Stephenson, practice manager with the Neurological Group, a private specialty practice in New London, responded to The Day's query hoping to shed light on the challenges private practices face.
"It's straight forward," she said. "We're under contracts with insurance companies that in some cases were written years ago. They refuse to renegotiate, so we're being paid the same way we were five or six years ago while expenses have all quadrupled ― malpractice (insurance), rent, utilities, salaries and benefits."
The financial pressures on independent private practices is undoubtedly among the reasons so many have joined big organizations, Stephenson said.
Another factor, she said, is the mounting administrative demands on practices, including such tasks as ordering tests, seeking prior approvals from insurance companies, dealing with pharmacies and accommodating requests for audits.
"There are so many middlemen between patients and doctors," Stephenson said. "It's costing patients more but doctors are not getting more ― it's all these middlemen."
What's the solution?
For all the agreement on the issues surrounding the shortage of general practitioners, solutions are hard to come by. How, for example, do you increase the ranks of general practitioners?
"The difference in recruitment and retention among specialists compared to general practitioners is something the country has been looking at for years and years," said Dr. Oliver Mayorga, chief medical officer at Lawrence + Memorial Hospital in New London. "Going back to when I was graduating from medical school, the preference (among students) is for specialties."
A big part of the reason, Mayorga said, is the high cost of a medical education, which can leave graduates hundreds of thousands of dollars in debt. Many may feel they have little choice but to pursue a career in a high-paying specialty rather than, say, a family practice.
New York University has tackled the problem by offering tuition-free medical education, and just last month Yale announced receipt of a $25 million gift in support of financial aid for students at its medical school.
"We're seeing more transition to specialties that offer a better work-life balance, that don't require work after hours, on-call weekends and on holidays," Mayorga said. "Some physicians, nurses and medical staff are deciding to retire early. During the pandemic, we looked at health care workers as heroes but that moment has passed. It's a lot of work, a lot of stress."
Mayorga said improving the public's access to primary care outside the hospital is a major concern.
"You should never have to show up to the ER with an ankle sprain because you didn't have access to a doctor," he said.
