Forced to change endo

Good Day Group:

What follows is an excerpt from a letter from my soon to be former endo.

"Dear Mr. G,

After much consideration and extensive discussion with my team, I have concluded that my practice is not able to provide you with the seamless, efficient service that you deserve. My staff and I have become overwhelmed with the paperwork necessary to make sure that you stay on track with your prescriptions and supplies. Specifically, we are unable to adequately stay ahead of the tremendous amount of paperwork required by Medtronic, Medicare, and other pharmacies/pharmacy benefits manager entries…

Therefore, I am forced to withdraw as your endocrinologist. Thirty-one days from the day you receive this letter I will no longer be your endocrinologist. Since your diabetes is best supervised by an endocrinologist, you should establish a new endocrinologist. For example, one of the larger, hospital-based endocrinology groups.

At your written request, and for a nominal fee, I will send a copy of your chart to a physician you request.

It has been an honor, and a pleasure, to have been your endocrinologist up to now".

Sincerely,

Dr. D. J. P M.D., CDE

My question at this point is how much of a paperwork hassle awaits me as I transition from my former to my new endo ?.

Enquiring minds want to know.

Tom G, Sr.

Not an answer to your specific question but this seems really odd. I mean, it’s an endocrinologist. Pumps, pump paraphernalia, and rather lengthy lists of supplementary pharmaceuticals kinda go with the T1 territory. Hard to figure why your particular needs are being singled out as problematic. Gotta wonder if maybe it’s the Medicare bit…

Exactly

Occam’s razor (also Ockham’s razor or Ocham’s razor : Latin: novacula Occami; or law of parsimony: Latin: lex parsimoniae) is the problem-solving principle that states "Entities should not be multiplied without necessity."

As a one-time professional medievalist and a student of medieval philosophy, Occam in particular (his “Logic of Terms” is amazing), I take great pleasure in seeing the quotation accurately rendered.

Your endo sounds like a LAZY, MONEYGRUBBER. Paperwork is taken care of by staff and all he has to do is sign. If he can’t accomplish that, he needs to fire the staff and start over with a new crew. Good god!

Furthermore, it sounds like “patient abandonment”. You might take it up with the Medical Board.

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Is Tom G., Sr., really being singled out. We don’t know that the same letter did not go to every one of this endo’s patients. Maybe he is planning to retire or change the nature of his career choice, or go on an extended fishing trip…

That doesn’t sound like a retirement letter. They are vastly different in tone and meaning.

I think most of their patients are probably type 2 and not type 1. But maybe they are dropping everyone with a pump or medicare and type 1 or??? The doctors will have to pay for an office that has the people used to dealing with medicare, too many people are on medicare, so I doubt it’s just medicare that’s caused excluding you. In groups of doctors more than one doctor are paying into the pot for the personnel. In a big group say of 4 endos, they all would pay towards the people needed and have a bigger percentage of type 1’s.

It probably has something to do with the different pump companies, and the different paperwork required by medicare or insurance companies and all the different insulins people are on, some not on approved lists etc. And endos are so busy and backed up I bet this one doesn’t care about losing a small percentage of people. If they deal with just people on insulin shots say, the doctor can say to everyone I only prescribe Humalog and Lantus type thing.

I think this should come with the territory of being an endo, some patients are more profitable than others. But I know doctors are being buried under paperwork, obviously this one has decided it’s not worth it. (Or he’s mad at you for some reason and using it as an excuse.)

In the past year I switched from a small practice internist with no dedicated staff for diabetes technology, to an endo practice that takes up pretty much the entire floor of a good sized medical building. The new practice has all the staff to deal with insurance pre-approvals and technology, in a way my old internist had absolutely no staff to help him.

In my case it wasn’t that I was fired by my old doc - he retired and in fact became a park ranger!!! So I had to switch and ended up at a VERY LARGE endo practice that has a half dozen endos and more than a dozen support staff to deal with technology.

I can completely see why a small-practice endo that didn’t have extensive front office staff, would prefer to deal with simpler cases.

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Bureaucracy knows no bounds, you got to wonder how much of a bureaucratic burden a small practice can absorb until it it is no longer worth it. Sounds like this doctor has met his financial or mental breaking point.

Everyone demands proof that their regulation or policy has been followed or that their payments are justified. We put doctors thru years of extensive training then we second guess their every move with red tap that saps their time and efforts.

Tom G, Sr. was not the only one harmed in this story, Mr G lost his doctor and his doctor was forced to send away a valued patient. I’ll say the loss was great on both ends, Sad!

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I understand what he is talking about to some extent. The paperwork Medicare requires is extremely tedious, time consuming and annoying in comparison to other plans. If you are using a DexCom, Medicare requires chart notes every six months, signed and dated by doctor and must contain specific verbage. On an insulin pump, you have to send documentation every 3 months that the patient has been seen in the last ninety days (heaven forbid if you are seen in 91 days…the world will end). It is a lot to stay on top of and, if you multiple that by lots of people, it’s REALLY a lot to stay on top of. I could understand if, as someone else said, he has reached his breaking point.

The one trend I see though happening in the medical community (at least locally) is that none of the endos want to treat diabetes. Diabetes is much more intensive and time consuming compared to thyroid or pituitary disorders. The providers in the big hospital organizations (again, at least locally) get paid by “productivity”. They can see more thyroid patients in a day than diabetes so that is what they want.

Quite frankly, what is occurring currently is disturbing and most people aren’t even aware. Hospital should not “own” physicians outside of the hospital itself and the insurance companies should not be able to pay a hospital organization for “keeping the costs down” or charge them if the costs exceed predetermine parameters. (To clarify, the concept behind this is reasonable-- in a perfect world. We are far from perfect and, unfortunately, decisions aren’t necessarily getting made with the appropriate goals in mind). Nor should an insurance company be allowed to own a hospital organization. It is a conflict of interest.

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Definitely lots of conflict of interest in healthcare! I have watched the change from doctors determining which hospitals they take their practice to, to hospitals “owning” the doctors and insurance companies “owning” hospitals. There is a third layer of non-contributing “ownership” and that is the health management corporations that oversee and manage everything from pharmaceuticals to insurance and on down. All these layers syphon money out of our healthcare system for their unnecessary “services.”

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I could see why they say this. I suppose they are being honest. But, I have never heard this stated explicitly before.

It won’t be much paperwork hassle, on your end, to change endos. But, it might be hard to locate one. Have they made any recommendations? You might call them for a specific recommendation. Endos are in short supply. It can take months to get in. Schedule immediately. Hopefully, you live in a metropolitan area.

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A friend of mine was a PHD psychologist treating care givers before she retired. She had a staff of three to handle all the paperwork. It wasn’t just Medicare, some of the insurance companies would put her staff on hold, change address etc. I go to a CDE in a clinic because that’s who I could see first. I have not had a problem with getting prescriptions and CGM supplies.

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Ugh. I am sorry. I have had my fair share of Endos- mainly because I move around the country quite a bit as my spouse is in the military. I will say I have come across many endos who do not specialize in treating T1’s. It has been a learning experiencing trying to figure out what I need and the practice that will meet my needs. It’s quite common for me to start with one and then switch after the first appointment. I have learned over the years that Endo’s connected with large (especially teaching/university) hospitals generally have what I am looking for- ability to hand my prescriptions, deal with pump companies, etc. because they have a large enough staff as well as a trained staff. I’ve also found that diabetes centers connected with hospitals/endos are helpful as well for managing all the paperwork, training on new devices, support, etc. Not every endo specializes in treating type 1. There are a large variety of diseases/disorders that send patients to the endocrinologist. Our most recent move, I found an endo that I thought met all my requirements only to find out that they didn’t download my Medtronic pump information- they only used Dexcom so I had to switch. It’s disheartening to be given the letter, and it’s a major hassle to find a new doctor, but I hope in the end it only benefits you and makes taking care of your diabetes easier in the long run!

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