Finding a New Primary Care Physician Without Insurance
New patient wait times for doctor appointments are appallingly long.
The San Francisco Bay Area is teeming with some of the world's most outstanding medical professionals. According to the Council on Graduate Medical Education, adequate physician-to-patient ratios for the United States are 60 to 80 primary care physicians(PCPs) per 100,000 population, and 85 to 105 specialists per 100,000. The California Health Care Foundation shows that of the Bay Area counties, all but Solano County meet or exceed these ratios. So far, so good. However, many residents, especially the uninsured, opt to simply skip doctor's visits for financial reasons. Still others have trouble visiting a doctor because of the sheer hassle of the process.
Across 15 major U.S. metropolitan areas including San Francisco average wait time for a new patient to get a (non-emergency) appointment with a primary care doctor is 24 days. In the densely populated Bay Area, it is not uncommon for doctors to be fully booked and unavailable to see any new patients for several weeks or even months. Some patients have to choose between visiting their preferred doctor and being seen within a reasonable time frame; still others have trouble being seen at all. The California Department of Managed Health Care has set legal limits for the maximum wait times for members of managed care plans: 48 hours for urgent care, 10 business days for non-urgent primary care or mental health, and 15 business days for non-urgent specialty care appointments. For telephone inquiries regarding whether to seek medical care, health plans must respond within 30 minutes.
Wait times for uninsured patients are even longer.
Still, these wait times may be unacceptably long if you are worried about your condition and want to see a doctor as soon as possible, but aren’t sure if you need to go to the ER. Worse, if you’re not a member of a managed care plan, the limits may not even apply to you. For the 412,000 or more residents of the Bay Area, wait times for appointments tend to be even longer than average, and the search for a doctor is almost certainly more difficult. A 2004 report revealed that a staggering 85% of uninsured San Francisco residents often or almost always struggle when attempting to schedule an appointment with a specialist. The situation has improved since then: for example, as of 2017 the San Francisco Health Plan’s e-Referral project has “decreased wait times in Endocrine from 232 to 87 days, in Cardiology from 47 to 26 days, in Pulmonary from 148 to 3 days, and in Rheumatology from 141 to 72 days.”
Even with these improvements, it remains difficult for the uninsured. Some Bay Area physicians belong to concierge practices that do not see patients for one-time visits, while others are overwhelmed and refuse to accept new patients, or only accept patients with certain types of insurance. 90% have privately insured patients, while only 69% have at least one Medi-Cal patient and only 65% have at least one uninsured patient. While 84% of Bay Area physicians report that they are accepting new patients, only 50% are accepting new Medi-Cal patients, and only 42% are accepting new uninsured patients.
What can uninsured patients do to find a doctor quickly?
If you are uninsured in California and think you might be eligible for Medi-Cal, you can find out by filling out an application online or by visiting your nearest County Social Services Agency for assistance. If not, you can still apply for Covered California, which offers affordable private insurance options that are partially federally subsidized under the Patient Protection and Affordable Care Act. If you still cannot qualify for nor afford any of these options, or if you prefer to opt out of health insurance for whatever reason, then you will need to visit a doctor or clinic that accepts “self-pay” patients any time you need professional medical treatment.
If you are still struggling to find a doctor who is both suitable and available, try calling early in the morning, following up frequently if you are placed on a waitlist, asking for referrals from previous doctors, and scheduling multiple appointments far in advance if you know that you will need them. An affordable alternative to urgent care that is on the rise is the retail healthcare clinic, in which basic primary care services are offered by nurse practitioners and physician assistants on a walk-in basis. Retail clinics operate on a cash basis and are a good option to consider if you are uninsured; many of them also accept insurance, and are a great option to consider if you can’t wait weeks to see a doctor.
If you are eligible for Medi-Cal, you have a better chance of finding a primary care physician through a community clinic (88%), Kaiser Permanente (78%), or other group practice (66%) than through a solo or other type of practice (44% or less). Conversely, if you are uninsured, you are probably better off looking for an independent doctor than one belonging to a major group. Many California physicians are affiliated with concierge practices, Kaiser Permanente, or other direct primary care practices that function on a membership basis and either discourage or refuse accept new self-pay patients. Stanford Healthcare, for example, charges over $500 for new patient office visits, even after a 50% discount for paying cash up-front. By contrast, some independent doctors see self-pay patients for $150 or less, and may even offer steep discounts to those who pay up-front in cash for their medical services.
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