Boston Healthcare System Total Garbage?

Submitted by UltimateZo t3_yfa16s in boston

My partner and I just moved to Boston from CA and have been loving it. Boston is a fantastic city and gorgeous in the fall. Overall we are certainly happy to be here. We are in our late 20s, physically active, and eat healthy, so we don’t usually have major health issues. From the small issues we’ve had, the healthcare system in Boston has by far been the WORST part of this city.

I had a violent migraine (or maybe it was a minor stroke) episode earlier this week and because I had too much pride (and am an idiot) I did not go to the ER. I took pain medication and rode out the rollercoaster that followed. This was absolutely not the right decision and have been advised since to not do this again.

Since that event I figured I should see a PCP and then a specialist. I had already called hospitals to get on the appointment list for a Neurologist, but even though my insurance does not require a referral, pre-authorization, or primary care doctor it doesn't mean squat. A referral is necessary to see a specialist in Boston regardless of your insurance. So I go on a journey calling around to see what the timeline is to get a PCP and I an met with a laughable 6 weeks, 3 months, 6 months, etc. I decided to go on the app for my healthcare (UnitedHealthcare) and was able to find a PCP located north of Boston for a virtual visit. We met Thursday and she was absolutely awesome. We got straight down to business, no BS doctors pride to deal with when talking about my issues, and she agreed that this was serious. She wrote me a referral to a Neurologist and Endocrinologist (bloodwork related).

Okay cool, things are going in the right direction. So I start calling around to get a timeframe for Neurology appointments at some of the bigger hospitals nearby since we are located in Back Bay.

  1. Massachusetts General: 2 weeks to evaluate the referral (why?) and scheduling in December. Can't schedule until my referral has been evaluated and sent to the correct Neurology department.

  2. Brigham and Women’s: Scheduling into January.

  3. Beth Israel Deaconess: Scheduling into March.

Yes I only called 3 hospitals because I have to wait a crazy amount of time just to speak with someone, and I plan to call more tomorrow.

  • My response again to these scheduling timeframes: "What the f?"

So not only is there a completely unreasonable and absurd wait time to just get a PCP in Boston, it also affects the specialists!? The healthcare here just seems like an absolute sham to push people to urgent care or ER visits. Beth Israel have every single day and time slot (90 days worth) booked for all their Neurologists until March? Yeah okay seems legitimate.

The Massachusetts Department of Health lists 15 acute care hospitals in Boston Metro area and the population of Boston is roughly 650,000 people. Correction Boston Metro area is 5million people.

The San Francisco Bay Area has 16 hospitals and 7.5 Million people; I can attest I was never ONCE quoted 3 to 6 months for a nurse, doctor, specialist, or a surgery. It doesn't take PhD level math to see that things just don't add up here.

I must be missing something here. Was there a Boston Massachusetts Healthcare 1-year skip the line pass for $300 a year or $30 a month for 12 months?

  • How does anyone get anything done in this city with regards to healthcare?
  • Are these hospitals just reserved for the elite?

THIS IS NOT MEANT TO BE A BAY AREA VS BOSTON POST. THIS IS MY EXPERIENCE WITH HEALTHCARE AND I AM LOOKING FOR ADVICE.

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willzyx01 t1_iu2huoo wrote

Nobody goes to California for hospitals.

Literally the entire planet comes to Boston for hospitals. Especially speciality care.

Majority of doctors here (PCPs and Specialists) are also instructors and travel around the country a lot (yes, even PCPs).

Boston has a lot of urgent care clinics that are affiliated with local hospitals. Go there instead.

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UltimateZo OP t1_iu2nsvm wrote

Edit: Since the whole shitting on California hospitals post is getting a lot of traction, I’ll leave this link here for educational purposes. Might want to look up facts before saying nonsense.

https://health.usnews.com/health-care/best-hospitals/articles/best-hospitals-honor-roll-and-overview

People definitely do go to California for medical, but this post wasn't meant to be a Boston vs CA post. I know people are sensitive about this and it was not my intention at all. This has been MY EXPERIENCE with healthcare, and Boston has not been great to me so far.

I have gone to Mass General Brigham urgent care for flu symptoms and it was fine. , You're telling me they have the capacity to deal with serious neurological issues? X-ray, CT, MRI?

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Apprehensive_Text_68 t1_iu5gxtw wrote

Boston is weird about California… I moved to Boston from the central coast and completely agree with you, I rarely had to wait more than a month even for a specialist but here it’s at least 6 months out.

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UltimateZo OP t1_iu5h5bb wrote

Yes clearly a mistake to even bring up CA in the initial post! I agree the wait times here are longer than what I have previously experienced.

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Yak_Rodeo t1_iu2noi6 wrote

just to be clear youre asking why 3 of the most premier hospitals in the country are booking several months out?

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SnooGiraffes1071 t1_iu4xdrv wrote

One of which is booking for December, so somewhere between 34 and 65 days out...

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Full_Alarm1 t1_iu3kpxv wrote

This is an aggressive response considering what OP is describing is a common experience, regardless of hospital choice, to wait extremely long times for pcp’s or specialists. It is a reoccurring topic in this sub. I moved to the area ten years ago from NY and continue to be amazed at the inability to timely schedule medical appointments.

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UltimateZo OP t1_iu2odek wrote

I have never experienced a timeframe so absurd and based on the metro population these hospitals have to serve I don't understand how it can be 3-6months. Then again this doesn't account for people flooding to these hospitals because they are "premier", which is what you seem to be insinuating. Better to just be straight forward.

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Yak_Rodeo t1_iu2par7 wrote

im not insinuating anything, i stated a fact. mass general is one of the best hospitals in the world and you expect to get a neurology appointment there in short order? its like asking why you cant get a friday reservation at carbone when applebees in des moines always has openings

also you realize the boston metro area is around 5 million people right? why compare san frans metro area to bostons city population?

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nkdeck07 t1_iu4k8hn wrote

Their "evidence" against it was also showing that California also has 2 of the top 10 hospitals in the country, neither of which is in San Francisco and which are huge distances from one another. (I mean you could sorta claim it with Standford but still). Boston has 2 in that list within walking distance from one another.

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UltimateZo OP t1_iu91n5c wrote

Your PCP must have you on some good medication to think that CA or the San Francisco Bay Area (emphasis on Bay Area) are just San Francisco! California also has 3 of the top 10 hospitals: Cedars-Sinai, UCLA, and Stanford. Truly you are ignorant.

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UltimateZo OP t1_iu2qbot wrote

Perfect some factual info! I've updated the post to include the 5million figure as I was just quoting Boston proper which is incorrect. Thanks!

Mass general was only one of the 3 hospitals I called. Are Brigham and Women's and Beth Israel also Carbone? How about Tufts, Boston Medical, Cambridge? If they are all Carbone then where the hell do you go?

My intent was to get advice on HOW to navigate the healthcare system and get medical help that isn't just going to Urgent care or ER.

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[deleted] t1_iu5efcl wrote

Why didn’t you go to a neurologist who was affiliated with your primary care physician who you said was outside the city? I assume it’s like Salem hospital or something, so why didn’t you go there for a neurologist rather than Mass General? going to Mass General for migraine is like going to the French Laundry for a hotdog, sure they can make it but you’re gonna have to wait

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UltimateZo OP t1_iu64llo wrote

People really enjoy their food analogies huh…

The PCP I met with was through a virtual appointment and she is located in Amherst, MA. She is completely remote because that was the way for me to meet with a PCP next day. So no, not Salem hospital.

Enjoy your hotdog at French Laundry!

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benck202 t1_iu2n4ma wrote

If it’s an emergency, you need to go through the emergency system to see specialists at the hospital right away. You said yourself you should have gone to the ER. The type of scheduling you’re doing is for non-urgent appointments and it sucks that there’s a wait but that’s the way it goes. You also chose the three most prestigious general hospitals in the city which are also three of the most prestigious hospitals in the world- as another poster mentioned, people come to Boston to seek health care from all of the world. Your comparison with SF is also apples and oranges- you should be comparing to metro area which is more like 5 million, and many of the Boston hospitals are Extremely specialized. Having Boston eye and ear and Spaulding rehabilitation nearby may be great in the future, but doesn’t help with your immediate issue. Because I’m being critical, I do also want to make sure to mention that hope you’re ok.

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UltimateZo OP t1_iu2ovo7 wrote

The first person to actually give a crap about my current condition. A huge thank you and I really appreciate your response. I do understand that these hospitals are world renowned and prestigious for the care they provide. I plan on calling some other places tomorrow like Tufts, Boston Medical, and Cambridge Health.

I am currently stable and okay. I am a little worried about going to weightlift since the episode happened about 30 minutes after I got back to our apartment. Seems weird to go to urgent care or ER, but my worry is still there about what if something this severe happens again before an appointment date.

Maybe I should just go to urgent care or ER? Do they have the capability to do CT and MRI scans?

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benck202 t1_iu2ps1z wrote

I can’t answer that for you, but I would say: 1. If you think your condition puts you in any sort of immediate danger you should always go to the ER- better safe than sorry 2. At least in my experience, the several times I’ve been admitted through the ER I’ve seen specialists right away if the emergency doc thinks there’s an issue. Obviously don’t know what will happen in your individual case but wish you the best.

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UltimateZo OP t1_iu2qlcx wrote

No problem I understand you can't give medical advice, but nonetheless your response is encouraging. Thanks for taking the time to write and hope you have a long healthy future!

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sarahmolly12 t1_iu3o8pa wrote

I would advise skipping urgent care and going to the er if you remain highly concerned. The er will have capabilities for MRI and CT, but you may have to wait a few hours to get them done. Hope this helps.

In regards to what other posters have said, Boston hospitals are world renowned and nearly all are Harvard affiliated. As such, they do a significant amount of research meaning not every doctor is treating patients 100%. Additionally, patients come here from all over New England (and New York) as well as from all over the world for care.

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j_allosaurus t1_iu414nt wrote

Yes, go to the ER and they will be able to do the scans, etc. if it happens again (not urgent care.)

Also, having an ER referral/record can speed up the system for you. My insurance also doesn’t require referrals, but specialists do in part because it helps evaluate whether or not you can wait. I recently had a medical emergency. I went to the ER and got treatment I needed to stabilize me. My PCP saw me a few days later and sent referrals into specialists at Brigham and Women’s. Even though my insurance doesn’t require them, the hospital did in order to 1) make sure I was matched with the right doctors 2) I was getting timely care.

One specialist at BWH originally scheduled me for the end of November, but after a nurse in the office reviewed the referral, they were able to offer me an immediate appointment for the very next day. Another specialist’s office scheduled me for December. That’s frustrating for me because they’re likely the one who will be able to tell me what’s going on and the long-term plan, and I’m eager to get in there—but the nurse who reviewed the referral explained to me that the treatment course they put me on for the next three months stabilized me and that as long as I’m seen before the end, it’s fine.

It’s really frustrating and scary to know something’s wrong and to be told that you have to wait for answers. I know how panicky it feels and how bad waiting feels.

And the American health care system IS broken and it is incredibly frustrating to navigate, and the pandemic and staffing shortages are making it so much worse. These hospitals are busy, because people do come from all over, and they also have to weigh who needs to be seen ASAP and who can wait a few weeks. And as you said, you are stable and you didn’t go to the ER.

If it happens again, definitely go to the ER, preferably one associated with the specialists you’re hoping to see.

Good luck to you and I hope you get some answers soon.

From personal experience, I’d avoid CHA—they’ve been hit super hard by staff shortages.

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Common_Screen9450 t1_iu2niza wrote

The entitlement of “I postponed urgent care, was impacted by my own decision, so now I’ve decided that based on my highly subjective experience the best hospital system in the world is garbage”… I can’t, I just can’t.

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UltimateZo OP t1_iu2o4uu wrote

Do you have a non-highly subjective opinion on why the best hospital system in the world books out 3-6 months? Seems to be counter intuitive to book out half a year if its the best. No?

Glad the title got you to read the post though, that was the intent.

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Particular_Ad_7831 t1_iu2pjdl wrote

Because. Busy. Is that not really obvious? Not enough providers and too many patients.

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UltimateZo OP t1_iu2w6p9 wrote

Yes because busy. Thank you for your contributions Particular_Ad_7831.

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Common_Screen9450 t1_iu2p1ft wrote

Yeah, actually. This wild thing has been happening over the last few years, it’s called “Covid-19”. If you haven’t heard of it you should definitely look it up

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No-Sheepherder-6257 t1_iu2jqn2 wrote

Your problem is that you didn't have a PCP or a relationship with a PCP. And that is your fault.

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UltimateZo OP t1_iu2moxa wrote

How do I create a relationship with a PCP if I can't get a PCP?

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jtet93 t1_iu2prp5 wrote

When you move to a new city… you need to establish care with a PCP RIGHT AWAY. Like you’d change your address with your bank, update your car’s registration etc… you needed to immediately establish care with a PCP. A lot of people don’t know this. I’m not saying it’s necessarily your fault. But you waited for a serious medical event to establish care with any provider. A wait is to be expected. Lessons learned.

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UltimateZo OP t1_iu2r2a7 wrote

I agree 100%. I learned that lesson and won't make it again. I just think that beyond establishing the PCP, seeing a specialist seems to still be an unreasonable wait time. People don't pre-emptively see specialists, its usually in response to something happening.

ACL Tear? Orthopedics.

Eye issue? Ophthalmology.

Migraine? Neurology.

But when the wait times are 3-6 months, how do you deal with that? You just live with a torn ACL until they can get you into an appointment and surgery?

Seems nuts to me.

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jtet93 t1_iu2y1rt wrote

Now that you’ve seen a provider, I will say it’s a good sign that they’re not referring you with any urgency. During Covid I worked in an hematology-oncology clinic answering phones and trust me, if anything serious was suspected (like cancer, or a risky blood condition in pregnancy) we would make room ASAP for those appointments. We would FIND room.

If you’re feeling that your symptoms are unmanageable or if there’s something that your provider isn’t addressing, I would urge you to be more communicative. What you’re dealing with is an expected wait for a non-urgent issue. If there are urgent symptoms you might need to be loud about them. I wish you the best and hope you get well soon!

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UltimateZo OP t1_iu34uki wrote

My PCP is remote in Amherst, MA, but I would say she was pretty vocal about getting an appointment right away. Maybe she was under the impression that would be sooner than the timeframes quoted.

The risk is a potential prolactinoma - a tumor. I was vocal about this when attempting to schedule, but it was all the same. No urgency, no sympathy. Just the normal quotes timeframes.

Potential brain tumor has nothing on me!

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jtet93 t1_iu3yggr wrote

Well, there’s another issue. You’re using a PCP who likely has a limited relationship with these hospitals you’re trying to see a specialist at. You need to call the PCPs office and ask them if they can move things along. If there is a concern for a tumor they should be able to get in touch with the specialist’s office and get you in earlier.

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Particular_Ad_7831 t1_iu2pgbb wrote

I’m confused why you’re confused. Best hospitals in the nation. Everyone comes here. We’re busy. I know providers on a personal level that yes…are booked every day for the next 90 days. When you’re busy, you’re booked. Go to urgent care next time. Have you tried outside of Boston? CHA? BW in Waltham? November is next week, so if MassGen is scheduling then…then do it.

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UltimateZo OP t1_iu2shnd wrote

Hi there! Yes I see everyone says they are the best in the nation, but I think it depends on your definition of best. Best at providing timely care? Best at providing efficient care? Best at providing safe and skilled care? Best at prompt and timely follow up with patients?

I use USNEWS for my rankings and I won't quote their rankings, but we can lookup all the hospitals in the nation and every category of healthcare. My definition of best would be #1 in that category. "If you ain't first, your last". *Shrug*

Anyways... Yes I am waiting on Mass general. Unfortunately they won't let me book until they are properly evaluated my referral and it is sent to the correct department. Which takes up to 2 weeks. In that time frame, who knows how far they will book out? Maybe they'll quote me January/February by then.

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DialJforJasper t1_iu2ylpd wrote

Neurology resident at one of the hospitals you mentioned.

I’m sorry you had this experience, but it’s not uncommon. It’s the equivalent of walking into a very high end restaurant on a Saturday evening without a reservation and wondering why you cannot be seated.

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BermudaTwiangle t1_iu2pfi2 wrote

The hospitals serve not just the 650,000 people in Boston but the whole region and even country when it comes to specialized treatment. You gave San Fran's metro region population but only the population of Boston proper. I do wish the wait times were shorter but it is what it is.

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nkdeck07 t1_iu4kv74 wrote

>but the whole region and even country when it comes to specialized treatment

Seriously, my FIL visits us 2-3 times a year to see a Parkinson specialist at MGH. I live out in Western MA now and will be bringing my baby into Childrens in a few weeks to see a plastics specialist and specifically made sure my PCP out here was MGH affiliated so if i need a specialist I can see one in Boston and not in Springfield. When we lived in NH Dad got his hip replaced in Boston. Everyone is making the same decisions my family does.

I'd say it's even larger then the standard Boston metro region. Essentially the entirety of Vermont, Maine, NH, MA, RI and parts of CT and NY are gonna end up in Boston for "big" stuff.

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UltimateZo OP t1_iu2reff wrote

Yes totally misquoted the numbers and I've updated the post with 5million Boston metro area!

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pollogary t1_iu3n9tp wrote

There is a PCP shortage. That’s why concierge services like One Medical (which I highly recommend — there’s my advice) exist.

Specialists are tough everywhere. I saw a specialist in the Midwest that was booked a year in advance. You’ve always needed a referral for a specialist, every part of the country where I’ve lived.

Maybe you wouldn’t have gotten aggressive responses if you hadn’t called the city with some of the world’s top hospitals “total garbage.”

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UltimateZo OP t1_iu4izxr wrote

Hello! Appreciate the recommendation to One Medical. Do they have connections to the bigger hospitals/specialists? Or do they have their own internal specialists?

The title was created with intent. People respond quicker to titles with bold exclamations. Go look at Twitter, CNN, whatever news source you like and compare. They all do the same.

I did expect these types of responses, but I’m surprised how passionate people are with no regard for the issues with the current healthcare system in Boston. It’s like they’d rather just sweep complaints under the rug and keep preaching they are the “premier” and “best” hospitals. Doesn’t do much good if you can’t even accept that improvements can be made. There are many people who have commented on this post the exact same issues I’ve posted about, so I’m not a one off.

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nkdeck07 t1_iu4lfr9 wrote

>Doesn’t do much good if you can’t even accept that improvements can be made.

Oh please good sir, tell us how us unwashed masses can improve our hospitals! I'm dying to hear how you oh random redditor who can't even figure out that Boston hospitals CLEARLY serve a population area larger then 1 million is gonna magically fix this issue.

Seriously there's a nation wide PCP shortage and we have some of the best specialists in the country. To give you an idea I just moved further West in MA and the soonest I could get a PCP booked with literally ANYONE with a particular hospital was September and there's been a lot of complaints about that PCP. Based on that standard 6 weeks is amazingly fast.

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UltimateZo OP t1_iu4ly9w wrote

Weird you’re being so emotional about this. I was duly informed about the incorrect population value and fixed the figure about 12 hours ago. If insult of an incorrect numerical value is your stepping stone to act superior, I suggest therapy.

Yes I am aware of the PCP shortage.

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nkdeck07 t1_iu4o69i wrote

Exactly as suspected, zero ways to improve.

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UltimateZo OP t1_iu4unjj wrote

Sigh... I will give some advice on how to improve the current healthcare infrastructure. This is not all inclusive and just what I am thinking about off the top of my head in 5 minutes. Not even getting paid for this either...

  1. Reduce the PCP wait times: PCP is the gateway into the healthcare system in Boston, so this is a no brainer. Virtual appointments are a relic of COVID, and are actually a good thing. I am glad this has been fully integrated into the regular swing of healthcare and I am sure improvements can continue to be made with telehealth to increase capacity. How about PCP clinics? Or days with open walk-in PCP visits? What about incentivizing our future medical practitioners to focus on primary care? How about more investment into supporting the mental and physical health of PCPs? How about flexible appointments like group visits or after hours/weekend visits? Spitball ideas.
  2. The administrative burden is heavy: I am calling, waiting, and told to call this number. Then I call again, wait more, and no wait call this number. Boston's healthcare is built on a spiderweb of phone lines that is very inefficient. For every phone, there must be someone to pickup that phone. The entire registration process to get a Medical ID for MGH and BI is done on the phone. Get this online and get it online now. I am sure there are many other administrative duties that can be automated.
  3. Lose the unhealthy pride: If you want to improve the system and provide better care, you can't lash out when someone speaks ill of it. This post was born of frustration because the system is flawed, and that is OKAY. There will always and forever be criticisms in every field. Being able to think rationally about the information being presented and distill that down to something useful is the name of the game.

Have a good one nkdeck07.

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sarahmolly12 t1_iu8fzu4 wrote

As someone who works in this industry, yes your examples in #1 are clearly thought out, but I'll offer you some rationale why they're not feasible. You simply cannot prioritize the mental well-being of PCPs whilst also offering after hour and weekend care. It's an oxymoron. To offer open walk in days you'd have a 3 hour wait before the clinic even opened. And group visits? Not sure what you mean by this but it really doesn't seem HIPAA compliant. I know I'd personally never be seen as a group for a medical concern.

I do strongly agree that we need to incentivize more people to go into primary care, but sadly it's just not flashy the way specialties and sub specialties are. On top of that, you commented on the burden being a PCP has on one's mental health, when you could make double or even triple that as a specialist, it's rare to chose the lower paying option.

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UltimateZo OP t1_iu91yk9 wrote

I agree their are flaws in my suggestions, maybe thinking on it for 5 minutes gives me some leeway. Who knows the people in the comments are merciless so maybe not. shrug

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sarahmolly12 t1_iu8fnrs wrote

Perhaps if you feel strongly about improvements that need to be made for hospitals that literally serve the entire planet, you could work as a clinic manager. Hospitals are always seeking more employees.

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twowrist t1_iu2sfcf wrote

This depends on specialty. I’ve had no trouble booking an allergist or ENT within a couple of weeks. When I broke my finger, the urgent care sent X-rays to BI and I had an appointment the best day. When I had an afib attack I was booked the next business day at the BI Cardiac Direct Access unit. (It’s basically urgent care for cardiologists but needed a referral from my PCP, which we did by phone).

But a sleep specialist took several months.

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UltimateZo OP t1_iu2v27n wrote

Huh okay that's good to know. I figured the specialty would factor in - orthopedics is probably more fluid. Sorry to hear that you had an afib attack. I hope you have recovered and been healthy since!

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Pinwurm t1_iu2uubs wrote

By definition, we are still in a pandemic.

Those that did not get severe COVID symptoms in the last two years have delayed seeking basic medical care until they felt safe enough to do so.

Because preventative care was avoided, patient numbers are way up now. It will take a few years for things to even out a little more and meet staffing demand.

If you try to get a specialist of similar quality in any major city, scheduling is a mess. Bay area included. I know folks in other parts of the country that've run into the same issues as you.

What makes Boston unique is that is has the best Hospitals in country, so there is additional demand and strain on the system.

Still, you don't have a PCP. I know, I know - you just moved here. And the timing is unfortunate. But once you're all set with a PCP, scheduling should be easy.

For example, I saw a specialist recently.
I messaged my PCP through a healthcare app asking for a referral, they sent it the next day (it didn't require a checkin), and I was scheduled for the same week. Bip, bam, boom.

If you can establish yourself at Brigham & Women's or Beth Israel, it's worth the wait. If you really cannot wait, Boston Medical Center is perfectly fine, though many folks are biased because it is a Safety-Net Hospital.

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Full_Alarm1 t1_iu3l8tl wrote

I honestly disagree with the brigham and womens recommendation. My pcp of many years is B&W affiliated, and anytime i have had to see a specialist, it takes months, whether i am seen in Boston or their Foxboro location. Currently waiting for a rheumatology appointment in February— i booked it two months ago.

I would switch providers, except as OP detailed, finding new ones in this region is incredibly difficult. My delayed care is better than no care, which is what i have sadly come to accept.

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UltimateZo OP t1_iu4j5dx wrote

Thanks for commenting and good to hear differing perspectives. Seems like this is a larger issue than people want to admit.

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UltimateZo OP t1_iu2x728 wrote

Appreciate the response and 100% I agree the affects of COVID are as prevalent as ever with the healthcare system.

The timing is definitely unfortunate. Hindsight is 20/20, but I would have got on PCP the waitlist as soon as we locked down our apartment had I known!

I think I'll probably get on the waitlist for a PCP at one of the bigger hospitals and for now just work with the remote PCP I have in Amherst, MA for prescription refills, bloodwork, referrals if necessary, etc.

Seems like from what you said, once you are in the system things start to smooth out, but getting in is the battle.

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Full_Alarm1 t1_iu3lffz wrote

OP, not to frighten you, but i dont think “once you’re in, you’re in.” I am in, and it still takes months to see specialists.

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Pinwurm t1_iu2ynzj wrote

Yeah, once you're in - you're okay. Getting in is hard. Especially for psych right now.

I have an established relationship with my doc, so I have no issues getting urgent sessions or off-cycle prescriptions. But I know folks that struggled finding local therapists for months. COVID put a lot of pressure on that field.

I mean, there's plenty of licensed online therapy companies these days allowing you to Zoom with someone out of town. Insurance can be tricky then. And medication management is trickier.

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ChubbsBry t1_iu2iyjb wrote

Boston healthcare is fucking amazing. Learn to navigate it. I get specialists and pcp visits relatively fast.

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UltimateZo OP t1_iu2mltq wrote

How? What does learn to navigate it mean? I have been calling everywhere and not gotten anywhere. This seems like a gatekeeping response and isn't helpful at all.

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ChubbsBry t1_iu2nbj0 wrote

My wife recently got a PCP at tufts (she’s new to US healthcare) without too much effort. It shouldn’t be that difficult as there are so many hospitals and doctors in Boston.

This is literally one of the main reasons why I live in Boston because I’m so paranoid about My health, especially as i get older 35+ now.

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UltimateZo OP t1_iu2pizr wrote

Great I appreciate this response. I was planning to call Tufts tomorrow so maybe they have some more reasonable timeframes. Thank you very much!

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alexblablabla1123 t1_iu30lx4 wrote

A kindly reminder to verify the specialist you’re using is in-network for your insurance. Otherwise thousands of $ will be asked of you. Actually verify everything with insurance all the time. The system is pretty broken for billing and any oversight (even no faulty of your own) can cost thousands of $.

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Significant_Beat9068 t1_iu57w34 wrote

Its actually quite dependent on your insurance. For me, I pay the same for in and out of network for the most part (100% for the first 3k, then 10% up to 5.5k, after that in network is no charge, out is still 10%).

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Severe_Rhubarb_3200 t1_iu40w3c wrote

Calling the system “total garbage” isn’t criticism, it’s lashing out. I don’t want you to be going through a hard time scheduling a medical appointment, but you can’t go around calling any city’s healthcare system garbage and expect kind replies, especially the top in the world, because of the terrible overall system of American healthcare and insurance that determines how we can consume healthcare. That’s not a Boston issue, it’s a U.S.-wide issue.

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UltimateZo OP t1_iu4kwar wrote

The criticisms lie within the larger body of the post. The title was intentional to draw a large audience. I always expected there to be a large outpouring of prideful individuals unable to look at the post objectively. I’ve said this multiple times now.

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Constructestimator83 t1_iu2u78j wrote

I can only speak from my experience but my insurance does not require a referral for a specialist and my wife was able to find one she wanted to see, called to make an appointment, and was in to see her within less than 3 weeks. This specialist was very good and once meeting her I was pretty impressed with our quickly we were in but as my wife said we have great insurance so they got us right in. Our PCP is outside of the city but we routinely make appointments in the city with specialist as necessary. If finding a PCP in the city is difficult look outside with an affiliated practice.

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UltimateZo OP t1_iu2w0yw wrote

This exactly what I did and I found a PCP outside of the city. We have only met virtually, but it works for now. Do you happen to know what hospital your wife was able to see the specialist so quickly?

I realize this may also depend on this medical field specialist she was seeing.

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SkiingAway t1_iu2tcin wrote

> The Massachusetts Department of Health lists 15 acute care hospitals in Boston Metro area and the population of Boston is roughly 650,000 people. The San Francisco Bay Area has 16 hospitals and 7.5 Million people; I can attest I was never ONCE quoted 3 to 6 months for a nurse, doctor, specialist, or a surgery. It doesn't take PhD level math to see that things just don't add up here.

Correct. Specifically, the way it doesn't add up is that you've compared one municipality to an entire region. Your comparison makes about zero sense.

The Boston Metro area has 4.9 million people.

The SF metro area has 4.6 million people.

Additionally, Boston is where people get referred for the most advanced/specialty care and procedures in most of New England. It is not uncommon to see patients sent to Boston from as far away as the Canadian border, far outside the metro area.

The average wait time to see a neurologist in the US was well over a month a decade ago and the shortage of neurologists has become far worse by most reports. I can't find any recent data for neurology waits specifically but I wouldn't be surprised if the average was 2+ months now. (tl;dr - old people nee

The average wait time to get a new PCP is also quite lengthy.

Basically nowhere, including CA, is doing any better with this and I doubt you'd have a substantially different experience there. CA has one of the worst shortages in the country.

> I can attest I was never ONCE quoted 3 to 6 months for a nurse, doctor, specialist, or a surgery.

Have you tried getting a new PCP since 2020?

Have you ever needed an appointment for a medical specialty with one of the most notoriously long wait times in all of medicine? (and again - since 2020?).

> Beth Israel have every single day and time slot (90 days worth) booked for all their Neurologists until March? Yeah okay seems legitimate.

This is likely 100% the case.

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UltimateZo OP t1_iu2vv0j wrote

Yes I realize the error of comparison and have since added the correct information of 5 million people. Not sure why the post doesn't update, but it looks updated from my end.

Through this post I have realized that these specialist hospitals serve a large portion of the population, but the same can be said for CA. Both UCSF and Stanford are nationally recognized hospitals with high honors in many fields and I can assure you people travel from far away to go there as well.

I have not tried getting a new PCP since 2020 in CA, but I had a surgery in 2021 with 100% elective ACL revision surgery with an orthopedic surgeon. A different surgeon than had performed my previous ACL surgery. in 2019 No crazy wait time, readily available for appointments (2-3 weeks). Again as I commented on another, this may be due to the specialist as orthopedics is likely more fluid than others (Neurology, etc.).

Appreciate your response to specific points. Very concise. Thanks!

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G2KY t1_iu2hj4m wrote

I agree that the hospitals are laughable if you want to see a specialist. I was referred by my PCP to see a rheumatologist in March. Got appointment for November. Then the rheumatologist cancelled and got another appointment for December. It was a very bad experience as I was having rheumatological attacks and needed to be evaluated ASAP.

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UltimateZo OP t1_iu2mtlm wrote

The people above seem to believe you can just call and get an appointment same day, but I have been having the exact same experience as you. These seem like two completely different worlds. What am I missing here?

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G2KY t1_iu2ng7r wrote

I don’t know. I am on a PPO plan which requires referrals. And this happened at the hospital of my college which makes it mlre egregious imho. Also, I was willing to travel to other parts of MA just to get evaluated due to the urgency of my problem but I was not able to get any appointments at all.

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UltimateZo OP t1_iu2p9kw wrote

Crazy. Some of the people here are so entitled and prideful about the Boston healthcare system that they are blinded by the inherent flaws present. I am also on a PPO plan, but it requires nothing - referrals, pre-authorization, etc.

I hope you are able to solve everything in the near future and happy to hear you have an appointment for the future. Wishing all the best!

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Particular_Ad_7831 t1_iu3kmwg wrote

Prescription ≠ referral

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UltimateZo OP t1_iu4l6gl wrote

It says no pre-authorization. A prescription is a doctors way of authorizing you to receive something that can’t normally be accessed.

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Full_Alarm1 t1_iu3lxed wrote

Booked a rheumatologist appointment for the soonesf available through brigham and womens. Waiting for my appointment in february, booked it two months ago. Really excited to be ignoring all my autoimmune symptoms while i wait for medical care. /s

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No-Garlic-2664 t1_iu2rfan wrote

The first thing you need to learn about Boston is that most people here, even the transplants (especially the transplants actually) get super defensive over any criticism of Boston. It's actually bizarre how defensive people get on this subreddit, especially considering how many are transplants like I said. I really do think this area is full of some insecure, immature people.

Anyway, yes there is a huge problem around here with wait times to get a PCP. Once you actually get a PCP, you will notice that there is a huge push to funnel you to a nurse practitioner (possibly a virtual visit too) instead of an actual medical doctor. I really dislike that, when I have a medical problem I want to see a medical doctor, it's as simple as that. Sometimes I have an urgent issue and have no choice though, I also do admit that if you are calling your PCP specifically to acquire a specialist referral, then it doesn't really matter if you speak to a practitioner or MD about that.

Regarding specialists, depending on the type you need to see, you could be looking at several months. Communicate to your PCP that you're seeing very long wait times and ask them for any referrals that might have a shorter wait list. Keep calling around to hospitals, try Mt Auburn Hospital. I was pleased with their Neurology department, and they were able to see me within 2-3 weeks, this as before covid though.

Overall, there is a shortage of medical providers in this area and there are longer wait times than a lot of other parts of the country, even places that have great care too. Don't expect many of the people on this sub to admit that though.

Good luck!

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UltimateZo OP t1_iu2u48t wrote

First off, thanks for the level-headed and sincere response. I appreciate you.

Yes I have quickly realized how defensive people are, and its certainly strange. I understand having pride in Boston, but if you aren't open to criticism, critique, or helping those struggling with the systems that are vital to Boston then how will it continue to improve in the future?

Anyways, I am definitely going to reach out to more places and realize my mistake with reaching out to the "top 3" in the Boston area. Truly it wasn't because I think I am superior or should skip the line, that's just how I did it back in the Bay Area. Want to see a specialist? Call UCSF or Stanford and they will get you into a doctor in something like 2-4 weeks.

Thanks again for the response and all the best!

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atrailofbreadcrumbs t1_iu2sywa wrote

You need to call more than 3 hospitals, probably a few outside of the top 3 in the city as these are going to be heavily booked for specialty care. There's like 20+ in the city limits alone, probably dozens in the Greater Boston area, I'd reach to some of those. Probably could reach out to MGH/Brigham/BI off their main campuses to see if they're available as well if you're dead set on one of those.

Honestly November is in 4 days, so MGH sounds like they're a good bet. If you need to see someone within the next week or something I would call around & if you still can't find a spot then talk to your PCP you got and see if it's worthwhile to go to urgent care. Also did your PCP not give you specific contacts w/the referral?

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UltimateZo OP t1_iu2uriz wrote

Yes I am definitely going to reach out to places outside of the "top 3". I wasn't really deadest, I just assumed they would actually have the most availability because they are the largest. Clearly that was a mistake.

As far as MGH I am waiting on them to evaluated my referral, and once that has happened they will be able to schedule me for an appointment. I am not sure how long it will take, and no one will call me about it either. It just sometime within now to 2 weeks out. Weird that its just so arbitrary and in the air?

No the PCP is located out in Amherst, MA and she did not send contacts with the referral. I was told to call around to hospitals nearby and then tell the patient care coordinator where to send the referral once I had figured out where I want to be seen.

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atrailofbreadcrumbs t1_iu2whj8 wrote

Ok I would try some spots outside of Boston but nearby, I see some other recommendations in the thread that you have like Tufts, so go with those. I would add in others outside of Boston proper, BIDMC Milton for example may be able to accommodate you sooner than the main campus (assuming they're only checkin at main if you're calling main). Definitely go to the ER if it happens again, and if it's possible to speak with that Amherst PCP again I would maybe try to confirm you can wait a couple weeks, or if it's something that needs to be looked at in terms of days.

Definitely start the process to get a PCP here in the city as soon as you can, for example I have a BI associated PCP & I get referred to people within the hospital to get appointments rather than just a general referral. Will be way less stressful in the future for any kind of medical treatment including annuals physicals with a PCP.

Good luck and hope it's not too seriosu!

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UltimateZo OP t1_iu2xelz wrote

Yup this is exactly what I am going to do. Thank you for taking the time to respond, I really appreciate. Wishing you all the best as well!

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sneakinsnake t1_iu32doy wrote

>A referral is necessary to see a specialist in Boston regardless of your insurance.

This isn't true.

​

Go see any PCP who is able to see you in the next day or so and get a referral - don't worry about where they are.

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randomlurker82 t1_iu3prjm wrote

I have PPO insurance and I've never needed a PCP referral. That sounds more like Ops insurance. When I've thought I needed a specialist I've just called places til I found somewhere that was scheduling. Then again I don't immediately equate a bad headache with being a brain tumor...

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UltimateZo OP t1_iu33j8u wrote

I’m confused, you say it’s not true, but the end of your comment says go see any PCP to get a referral? That would infer that a referral is necessary to see a specialist. Aka I can’t call a specialist department, give my medical ID, insurance info, and schedule an appointment. There must be a referral from a prior doctor to verify my symptoms.

Want to make sure I’m reading what you said correctly?

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sneakinsnake t1_iu34p98 wrote

Your original statement that a referral is necessary to see a specialist in Boston is simply untrue. I'm not sure where you heard that from.

I'm assuming your insurance plan requires a referral from your PCP to see a specialist or the specialist you are trying to see requires a referral. In either case, go find a PCP that can see you in the next day or two to get a referral. It doesn't matter who the PCP is - find anyone who looks decent and can see you as soon as possible.

https://www.zocdoc.com/search?address=Boston%2C%20MA&city=Boston&insurance_carrier=-1&insurance_plan=-1&state=MA

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UltimateZo OP t1_iu35746 wrote

I promise you my PPO plan requires NOTHING from me to schedule with anyone anywhere in the country. If you call the scheduling office for any of the specialty departments they will ask for your referral. Or they will ask for your medical ID and lookup if you have a referral in the system to their department. They will REFUSE to schedule without that referral, regardless of insurance.

This was the case for both Neurology and Endocrinology. Maybe my blanket statement of “specialist” is too broad, but I assume Many many more specialty areas require the same.

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sneakinsnake t1_iu35o7e wrote

Sure, so then the specialist(s) you called require a referral to been seen sooner or at all. In that case, go see any PCP.

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Particular_Ad_7831 t1_iu3kkfg wrote

Your PPO probably requires a prescription for a specialist, not a referral. An insurance referral is for HMO plans. PPOs can require an order.

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Wilmamankiller2 t1_iu5pcap wrote

No. Many specialists now require a “referral” (not an insurance referral) from another physician which they then evaluate to see whether they will see you or not. It depends on many factors but if they dont feel that the referral is appropriate or they dont want to deal with your issue that can refuse to see you. Again it has zero to do with insurance. There are many more patients than drs available to see them which is why there are such long wait times.

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sneakinsnake t1_iu5qu3w wrote

>Many specialists now require a “referral”

Correct, but not all require a referral.

Also, it MAY also have to do with insurance depending on your plan. Saying it has zero to do with insurance isn't accurate.

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Wilmamankiller2 t1_iu5ryml wrote

As I just explained, the referral required has nothing to do with insurance. It is a completely separate process. Source- work in medicine at a major Boston hospital

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sneakinsnake t1_iu5y3st wrote

"Many HMOs require that referrals be approved prior to any scheduled appointment with a specialist. " - https://www.bidmc.org/centers-and-departments/general-medicine-primary-care/healthcare-associates-hca/insurance-and-managed-care-guidelines

"If you have a health maintenance organization (HMO) or point of service (POS) plan, you'll probably need to go to your primary care physician (PCP) first. If they agree that you need to see a specialist, they'll refer you to one and make note of it in your medical file. Some health plans require that the referral be made in writing while others accept a phone call." - https://www.verywellhealth.com/what-is-a-referral-health-insurance-1738605

"Some health plans require referrals or prior authorization before you receive services from health care providers other than your primary care provider (PCP)." - https://content.naic.org/article/consumer-insight-understanding-health-insurance-referrals-and-prior-authorizations

"A few services require both a referral from your PCP and prior authorization from The Health Plan. This means that your PCP has to OK the service and get an OK from The Health Plan, too." - https://www.healthplan.org/for-you-and-family/tools-resources/referrals-prior-authorizations

"The term Insurance Referral refers to the permission or authorization of your insurance plan that they may require in order to see a recommended specialist, doctor, hospital, or type of treatment." - https://www.scarsdalemedical.com/patient-information/patient-forms/referrals-patient-resource.pdf

​

You're right, though. Referrals have zero to do with insurance plans. 🤔

The OP had originally made the claim of "A referral is necessary to see a specialist in Boston regardless of your insurance" which isn't true in the sense that there are no Boston-specific regulations around this that I'm aware of. All I'm stating is that some insurance plans like HMOs may require a referral from your PCP before you're able to see a specialist. What's also true is that some specialists require referrals to be seen sooner or at all regardless of your insurance plan (which is what I think you're trying to say?).

Either way, if the OP has an insurance plan that requires a referral, they should get one. If their plan does not require a referral, seeing a PCP first may expedite the process in seeing a specialist sooner rather than later.

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Mumbles76 t1_iu33t9m wrote

Hehe, wait until you go to book a dermatologist. I hear they all stay in the Bahamas for 9 months out of the year...

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UltimateZo OP t1_iu33xfi wrote

I bet they are the Best in the country though! The best I tell you!!

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ashhole613 t1_iu3y1me wrote

We moved from another region and have been unhappy with medical services and wait times as well. I swapped over to Atrius for all but one of my needs (hair loss specialist) and it's been a vastly better experience than dealing directly with the large hospital systems.

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UltimateZo OP t1_iu4ljfj wrote

I’ll check it out thanks for the recommendations. Sorry to hear you have the same experiences with the larger hospitals.

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ashhole613 t1_iu4r1l6 wrote

Hopefully you make some headway with Atrius. They partner with Beth Israel when need be and I was able to get in relatively quickly (2 weeks) recently for another cancer scare.

I saw you mention trying Tufts. Spouse and I both initially went there because it was the only hospital system we could get into with any expediency, BUT they have dropped the ball so many times leaving us without care. Both of us have had appointments (spouse for a somewhat intensive procedure) made and then...nothing. We disappeared off their schedules. I've heard several others have similar experience, and several ex-staff told me it was not particularly uncommon at Tufts. Just our experiences, though.

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UltimateZo OP t1_iu4vhzy wrote

Awesome this is such great information. Really appreciate the post and will definitely be checking out Atrius. Good to know they are partnered with BI.

Unfortunate to hear about your experience with Tufts since they are such a large medical institution. I’ll keep it in mind.

Thanks!

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tehsecretgoldfish t1_iu4a4jb wrote

Replace all instances of “healthcare” with “health insurance” and you’re probably now heading in the right direction for blame-laying. Also, you neglect to mention when you moved here, but you only now began looking for a PCP after you had a health scare? That’s a bit like putting a smoke alarm in your house after the fire started.

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Traumadan t1_iu4wxax wrote

I think Neurology is its own unique problem. Since CT scans and MRIs have gotten so good and are available everywhere very few med students have gone into the specIalty over the last 20 years. In rural areas there are often none or very few available. In the city there are many more but still it’s a low volume for the needs

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werther57 t1_iu7875k wrote

> Beth Israel have every single day and time slot (90 days worth) booked for all their Neurologists until March? Yeah okay seems legitimate.

They don't, they have plenty of open slots even this week but they will fill up with more urgent cases. When your referral comes in they will make an assessment and schedule you accordingly. When I had a PPO plan, I tried to see a specialist for something urgent but was quoted 3 months. It was something urgent care couldn't deal with but it wasn't life threatening so ER wasn't appropriate either. I got a referral and was seen the next week.

PCPs also have plenty of availability. I can get an appointment with my PCP a week from now for non urgent care. New patient appointments are artificially delayed because onboarding a new patient takes longer than seeing a regular patient and to keep waiting times acceptable for current patients.

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NightWalk77 t1_iu4masm wrote

I've been in the medical system since I was 10 months. Most trouble I've had was getting a sick appointment to see my pcp but even that hasn't happened in years.

My sister-in-law who lives in NYC recently mentioned to me that access here (MA) is much better than NY.

I would say it depends who you need to see combined with insurance you have. I once had to get insurance from the connecter and didn't realize the plan I got was crap. Luckily I was able to change it. I have decent insurance now through work. It's no medicare for all but better than many other private ones.

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Significant_Beat9068 t1_iu58cmg wrote

I also have united and have never been asked for a referral for anything. If the doctors office is telling you you need one, tell them your insurance doesn't require it and to book you anyway.

Try dr. reczek's office in concord. My stepfather was able to get an apt with her in 3w, others in her office might have shorter wait times. Can order mri etc through mgb system. Step-dad went for an urgent on in Chelmsford within 2 days.

Glad you're doing okay, hope you figure this out soon, and sorry you've gotten such a runaround!

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