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Comment by bookofjoe | Hacker News Reader

I just scheduled my first appointment with a new primary care doctor. It's on January 7, 2025. NOT a typo.

Some problems solve themselves. If you're already deceased by the time the service date comes up, the provider doesn't have to do anything.

That's fucked up.

Modern problems require modern solutions

The "free market" is so good at problem solving! I hope the entrepreneur who thought of this made a tremendous profit!

Imagine thinking the US health care system is anywhere near a "free market"

My dad used to say he had three piles of papers on his desk: "urgent", "very urgent" and "no longer urgent".

While it's mostly not quite as bad here in Norway, it's getting there.

Lots of GP's here are quitting because they've been overloaded by paperwork. Government wants more documentation on everything. Can't just trust "some random doctor" who's known the patient for decades to sign a few days of sick leave, nope, we need paper trail!

My SO's GP almost started crying during one of her checkups since he was so overworked. He'd have a normal day seeing people during normal working hours, then there would be at least 5-6 hours of paperwork to do. He quit half a year later.

The newly trained doctors have caught on and don't apply for open GP positions. The result is that we have a massive deficit of GPs which keeps getting worse day by day.

Death by paperwork is the symptoms of late-stage bureaucracy. In the early days of something, it's all fly-by-pants and everything is so good compared to the previous alternative that nobody cares, but as it gets more and more "finalized" the paperwork mounts more and more to "prevent" issues, because the issues the overload of paperwork causes aren't accounted for.

Ten patients die because there was no doctor to see them? Nothing important.

One patient sued because a doctor made a mistake that didn't even kill them? Hugely important, ten more pages of paperwork will have to be added; the paperwork won't prevent it happening again, but now it'll clearly be the doctor that is liable, not the practice/hospital/insurance company.

You must be psychic. I'll be 75 on June 8 of this year, and it occurred to me that scheduling old people for appointments a year and a half way is a frictionless way of keeping a full schedule that will only get lighter as geezers like me drop dead before we can be seen. Oh well...

Not psychic at all, unfortunately! I just upvote you a lot and keep and eye out for your (nearly always thought provoking) posts. IIRC, you said in the past you're a retired M.D., is that right?

If you live around the bay area, I'd love to buy you lunch sometime. You are indisputably a super interesting person, @bookofjoe! Email in profile, promise I'm pretty cool as far as humans go :p

If you're not in the bay stea, would still likely to connect with you if you're open to it. Cheers good sir.

Thanks for your kind words. Yes, I'm a retired neurosurgical anesthesiologist (38 years: 1977-2015).

I lived in LA from 1966-1983, when I moved to Charlottesville, Virginia, where I've remained.

I'm easy to connect with: bookofjoe@gmail.com

When I'm not acting out on HN, I do so in these arenas:

https://www.bookofjoe.com/ (since August 2004) https://www.youtube.com/user/bookofjoe (since March 2006) https://twitter.com/bookofjoe (since November 2006)

Reminds me of this little-known Seuss book: https://www.youtube.com/watch?v=WHyrVyCqKwo

If it's not a scheduled appointment, but a "next available time" one, ask to be put on a cancellation notification if you're near the doctor's office; they get a cancellation, call you, you're there in 10 minutes kind of thing.

You must also be psychic! The day after I got my "see you in the future" 2025 appointment, I woke up and saw there was a text from the doctor's office offering an earlier appointment: it said to go to the scheduling portal and follow the instructions.

I thought, "huh." That was around 6 am. I mulled it over: did I even want an earlier appointment? I'm not a big fan of doctors (full disclosure: I am one). So I went about my day and finally around 1 p.m. decided it wouldn't hurt to have a look; after all, I could ignore or decline the offered new slot.

No worries: when I logged on around 1 p.m., the portal said the new slot was no longer available.

I wasn't sad.

General practitioners (who you need for primary care doctors) are unfortunately in extreme undersupply in the US.

This is a combination of things:

1) Being a specialist is much more lucrative

2) The AMA has been resisting calls to increase the pipeline of doctors

3) The absolutely shitty treatment of medical interns.

4) Many of them left due to Covid (the primary care physician is on the front line dealing with the Covidiots)

Is a doctor really necessary for GP type stuff though? I've found physicians assistants to be just as effective and more readily available.

Yes and no. The buck needs to stop with somebody and that responsibility is on the GP. So, you need at least ONE visit to the main GP before you can access their assistants.

I agree that most of what GPs do is be a "router" than sends your packet to various specialists. But somebody actually has to do it.

NPs can practice independently in ~1/2 of states, they aren't relegated to being 'assistants':

https://www.aanp.org/advocacy/state/state-practice-environme...

Of course they will escalate some care to other providers.

That's ... insane. We can get an appointment same-day sometimes, and never more than a week out.

Maybe it's a very popular doctor?

Is this doctor special or in high demand or something? this sounds like a machine err.

Kaiser's web portal showed no PCP doctors available, but when I called I was able to get assigned.

No, just an ordinary family doctor. Coincidentally, my neighbor across the street, a 70-year-old woman, had her longtime family doctor retire. She was given a list of names recommended by her doctor. She called the first one to make an appointment and — believe it or not — received one for January 2025 (not the same doctor as me). I told her we should go as a couple to both appointments for moral support.

Woah. Where in the United States is this? Have you tried looking around at different providers or is there a extreme shortage?

Might as well drive or fly to another area for healthcare.

Charlottesville, Virginia

Wow, I'm in the Nova/DC area. Thats really somewhat surprising to hear. Does Charlottesville have a medical network like One Medical that exist there?

Whenever that happens I just to the ER and greatly exaggerate my symptoms.

anecdata - E/Rs in my locale are 6 to 8 hour waits with total time spent with triage/nurse/physician totalling maybe 15 minutes (20 if they decide you need an x-ray). Since the queue seems to vary very little it just seems weird.

Due to this wait, I've been conditioned to treat it as a last resort. Perhaps that is the desired effect.

You wanna be careful with that...

Was that due to a lack of supply or too much demand?

Which city/system?

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