Your Doctor Retired — Now What?

When Janet Reynolds’ primary care provider — a nurse practitioner who she’d been with for 30 years — left her private practice, Reynolds had no idea how challenging it was going to be to find a replacement. “I called 20 doctors before getting through to someone who was actually taking new patients,” says Reynolds, a 69-year-old Connecticut-based freelance writer and editor. “And this experience has been echoed by at least five people I know in my age group — Baby Boomers who are suddenly trying to find a new doctor because theirs have retired.”

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Reynolds’ plight is not uncommon: In fact, the US is expected to face a shortage of anywhere from 21,000 to 50,000 primary care physicians by 2033. Blame it on an aging population of patients who will require heightened care coupled with an aging population of doctors on the verge of retirement. Or, the fact that the pressures of managed care, rising patient loads, and dwindling support are causing burnout among an increasing number of primary care providers (PCPs). But the imbalance between patient needs and primary care physician availability is, according to Sherri-Ann Burnett-Bowie, MD, associate professor of medicine at Harvard Medical School and an endocrinologist at Massachusetts General Hospital, “the biggest threat to our health.”

In some areas of the country, PCPs have long waiting lists. Even when you do find a doctor, you might have to wait half a year to get an appointment. That’s what happened to Reynolds. “You finally get through to someone who is taking new patients, and let’s say it’s April. They say, ‘You can see her in December,’” says Reynolds. “But what if I get sick between now and then? If I actually have a ‘thing’ I need to talk to the doctor about?”

Finding a New Doctor in Midlife: Dealing with an Ever-changing Body
For midlife women, whose risk of osteoporosis, heart disease, diabetes, and many other chronic illnesses increases with menopause, having a trusted doctor who can shepherd you through new health care challenges is crucial. As Stephanie Faubion, MD, director of the Mayo Clinic Center for Women’s Health and medical director of The Menopause Society explains, “[About] 80 percent of 50-year-old women have one chronic condition, and 50 percent have two or more.” It’s not just that insurance companies often require a referral from a PCP before you can see a specialist. “You need a quarterback as your primary care provider who can adjudicate differing recommendations or differing opinions, who can coordinate care for multiple conditions that require different interventions to manage them,” Dr. Faubion says.

Findings from the Study of Women’s Health Across the Nation (SWAN) — an ongoing, multi-site, decades-long study of more than 3,000 midlife women representing a range of ethnicities — suggest that many of the diseases typically associated with aging actually begin earlier, in midlife, often coincident with the beginning of the menopausal transition.

“For example, osteoarthritis tends to present in the 40s,” says Siobán Harlow, PhD, professor emerita of epidemiology, public global health, and obstetrics/gynecology at University of Michigan, who was a principal investigator of the SWAN study. And bone loss — which is greater during the menopausal transition than at any other time of a woman’s life — begins even a few years before the last menstrual period. “Being aware of your bone status before the transition, of whether you are at risk of falling below a healthy level of bone density, can help reduce the risk of fracture later,” she adds.

The hormonal changes that occur during the menopausal period don’t just impact bone density. “The loss of estrogen affects every tissue and organ in the body,” notes Dr. Faubion. “It’s not just hot flashes and night sweats — it’s bone health and joint health and cardiovascular health and skin and hair and nails.”

Unfortunately, US physicians receive very little training in managing menopausal care. Women who are experiencing menopausal symptoms may need specialty care — i.e., a gynecologist familiar with the symptoms and treatment of menopause. (You also need a gynecologist if your PCP does not perform PAP smears.) But surveys of post-graduate trainees in both primary care and gynecology residency programs reveal that many have significant knowledge gaps when it comes to menopausal care — not to mention being uncomfortable treating patients with hormone replacement therapy (HRT).

This compounds the challenge faced by midlife women: Finding a doctor who is accepting new patients — and who is comfortable addressing the changes that women experience at this stage of life.Receiving the Care Needed for Healthy Aging
The SWAN study has revealed that one of the most common symptoms of menopause — hot flashes — can be more than just bothersome to a certain subset of women. Women who experience frequent, severe hot flashes may have an elevated risk for heart disease.

“Many women entering their 40s have a pretty heavy symptom burden,” notes Dr. Harlow. “Not just menopausal symptoms, but a range of physical and mental health symptoms that really deserve attention and attending to in the 40s and 50s in order to optimize healthy aging.”

So how do you go about finding a new internist or gynecologist who can help guide you through the medical obstacles of midlife? Try asking your retiring doctor or your practice for a referral to someone else in the group. Or ask your insurance company for the names of covered doctors accepting new patients. If you have doctor friends — or any friends who are happy with their providers — ask for recommendations.

The Menopause Society has a search engine  that can help you locate doctors certified in midlife women’s health in your area who are accepting new patients. If you’re lucky enough to live in a region with a dedicated women’s health center, you can start there. You can also check  doctors’ websites to see whether they list women’s midlife health as one of their specialties. And look online at a doctor’s reviews, though, as Dr. Faubion points out, “Just because you see a good review for a provider it doesn’t mean he or she will be right for you — and it doesn’t mean they are going to have an opening. There’s a balance between finding an opening and finding the perfect person.”Knowing What to Look for in a Doctor
CoveyClub asked our community what they look for in an internist or gynecologist at this stage of life, and for many of the women who responded, age and gender are important criteria.

“I’ve slowly moved to mostly women doctors,” admits Dawn Colossi, 56, a marketing executive in New Jersey. When she needs a new specialist, she says, she asks her women doctors to recommend other women doctors. “There are commonalities of what we all go through — men just don’t have an understanding of what childbirth or menopause is like, their bodies don’t work the way ours do. They are going on what is in the textbook, what the data tells them.”

Many midlife women agree that they feel female doctors understand their issues better. “The intimacy part is also more comfortable with a female doctor,” notes Monique de la Cour, 60, a health and fitness coach for women over 50. When she moved from New York to New Orleans last year and tried to find a new internist, she ran into a frustrating roadblock. “I wanted a woman around my age and it was impossible to find,” she says. “Doctors who themselves are in their 50s have full practices and no longer take on new patients, and I wasn’t sure the younger ones would understand my issues.” Ultimately, de la Cour went with a doctor in her mid-30s — about 10 years out of medical school — and was pleasantly surprised. “She seemed to be up to date on all the latest issues and technologies and testing — and she is absolutely lovely.”

For Reynolds, the sweet spot for a doctor’s age is late 40s: “I’m looking for a doctor I can create a history with,” she explains. “It’s funny, they all start to look like Doogie Howser at some point.”When evaluating potential new doctors, midlife women should be asking a few pertinent questions beyond age and gender:

• Is the doctor comfortable managing midlife women’s health — issues like menopause and midlife sexual health?
• If HRT is something you are considering: Do they prescribe it? Not all doctors feel comfortable treating women with HRT — you need to find a physician who is aligned with your view of care, says Dr. Burnett-Bowie.
• Midlife is a critical time to prevent chronic illnesses and optimize health, notes Dr. Harlow: Will the doctor keep you apprised of which screening tests you need, and when? Will they prescribe and interpret those tests?
• Is the doctor in your insurance network? You are likely to require more referrals to specialists as you age: If you have to be seen by your PCP first, how long does it take to get an appointment? Can you call for a referral?
• Ideally, your new doctor will care for you during midlife and beyond: Does the doctor take Medicare?

Because of the shortage of PCPs, Dr. Burnett-Bowie points out, the onus is increasingly on the patient to be thinking about and keeping track of all her health care needs. “We as patients have to be more aware of the testing and screenings we need in order to reach out and say, ‘I’m due for this test and that test,’” she says.

Both the American Heart Association and the American Cancer Society have patient-focused lists of screenings you should have in your 40s, 50s, and beyond. The U.S. Preventive Services Task Force website provides many pages of preventative health recommendations, including advised screening for osteoporosis to prevent fractures.

Midlife is a time for women to refocus on thinking about their health and how they may set themselves up for healthier aging, according to Dr. Harlow. “It’s a time that women have to advocate very strongly for themselves so that their symptoms are not ignored,” she says. “What’s important is that you feel that your doctor is listening to you and addressing your concerns — not just doing a checklist.”

This post was originally published on coveyclub.com and was reproduced with the consent of the author.