Using a large teaching clinic as my primary care provider: good idea?

October 2, 2008 12:34 PM

Using a large teaching clinic as my primary care provider in Seattle: good idea?

I need to find a new physician for annual checkups and unexpected needs. I work for a med school, and it is quite tempting to make an appointment with their General Internal Medicine Clinic for a checkup. I will likely be seen by a resident if I do so. I am trying to decide whether this is a good idea.

Pros:

• The location is highly convenient to where I work and convenient to where I live. This is a special concern since I do not have a car right now. This means any appointments will have a minimal impact on my other life, which means I am more likely to make those appointments.
• The clinic can refer to specialists within the university healthcare system, some of whom only accept referrals from within the system.
• I will be seen by physicians more familiar with the latest research.

Cons:

• Residents have less experience
• Residents are only here temporarily, so I might have less continuity of care.
• This clinic seems to be in high demand, and I think I will have longer waits for appointments here than at a non-university provider.

Any other thoughts on this? Another option is that I could ask to be seen by an attending, at least for annual physicals which I can wait for (and I imagine there will be a long wait, if it is possible at all). Would this go over well? If not, would it be a better idea to go with a more experienced resident, or one that will be in the program longer and able to provide more continuity? Should I just go pot-luck with the first available appointment?

I would also appreciate specific recommendations for an internist or GP convenient to Fremont or the University of Washington.

posted by grouse to health & fitness (19 comments total)

Teaching colleges can have good care because of the teachers. Watch out for those times they ask you to hang out after your treatment, and then just display you for a group of students.
posted by StickyCarpet at 12:43 PM on October 2, 2008

I just started seeing Dr. Kruger at the Sand Hill Polyclinic as my PCP. His office is over near the University Village, which may or may not be a hike depending on your specific location on campus. And he seems both competent and nice, so there's that. I got an initial appointment fairly quickly, although getting a followup ultrasound at another Polyclinic location has a bit of a wait.

Admittedly these are first impressions based on a grand total of one office visit, so grain of salt.
posted by fuzzbean at 12:59 PM on October 2, 2008

One thing to keep in mind: your own medical history. If you've got anything even remotely interesting going on, you're going to have the noobs paraded through to poke at you and ask you questions. I have a Chiari Malformation and I went to the U of Chicago hospital for an eye checkup. I was seen by a neurophthalmologist, two residents, and three interns. I should have been in and out after seeing one guy. But no. They had never seen a Chiari Malformation before, so they all had to come in and poke at me and ask (the same) questions. Which was fine, actually, as I'm sympathetic to the plight of the student, but it does get old and you have to be patient.
posted by phunniemee at 1:06 PM on October 2, 2008

Teaching colleges can have good care because of the teachers.

Yes, indeed. I guess my concern is how little I will interact with the teachers.

I work next to the health sciences center on the south end of campus so the University Village is a bit of a hike. Still, a direct recommendation is worth having, so thanks!
posted by grouse at 1:07 PM on October 2, 2008

In my experience with UW Physicians group, the permanent staff members try really hard not to be anyone's PCP, preferring instead to act as consultants in conjunction with the students.
posted by nomisxid at 2:06 PM on October 2, 2008

I work for a med school,

Personally I like to keep my confidential medical records and my workplace colleagues separate.

I mean, I wouldn't want to go to hospital with my erection that persisted for more than eight hours, and then see the doctor who treated me the next day about me rejecting his travel expense claims. And if the first doctor called in some experts and showed my unusual problem to some medical students, my problem would be (pardon the pun) several times larger.

Of course, if your problems are mostly boring you don't have this problem, but that begs the question: why does it if they are familiar with the latest research?

I'm just kidding in my embarrassing description above - I don't actually approve expense claims
posted by Mike1024 at 3:04 PM on October 2, 2008 [1 favorite has favorites]

doh. Meant to say why does it matter if they are familiar
posted by Mike1024 at 3:06 PM on October 2, 2008

If you don't have any serious health problems that require regular maintenance, I think it would be a fine idea. Even in a regular clinic (I've worked in a medical clinic), you often have to see a different doctor than on your previous visit, and they'll still have access to your previous records, so you shouldn't worry about that too much for just annual visits and the occasional sore throat.
posted by kattyann at 3:18 PM on October 2, 2008

Hi. I am very familiar with the clinic you speak of. I used to whole heartedly recommend it because the care really is first rate. Smart docs, lots of attention to detail, residents get tons of supervison these days and as a result I believe the medicine is much more carefully practiced.

As I see it, there are two possible issues. Because the residents sometimes need to precept their visits (or ask questions) it is more difficult to make the schedule run on time. Furthermore, the super-complex patients at the university (ie transplants, major trauma survivors, unusual cancers) tend to find a primary care home at that clinic and odds are greater that the patient in the schedule just ahead of you may need a lot more time than they were given. So be prepared to wait (which is sort of par for the course in any office of course but worse at the university). The other issue is whether you are comfortable with the intersection between your work and your medical care, obviously you have considered this. Personally, I never would have gone there as a patient when I worked there even though I told my friends to go there, just because of the privacy issue.

BTW, assuming you don't need emergency surgery or CPR or something, I think it's kind of neat to be seen by someone who is learning to practice medicine, they are not so jaded and your dumb little ear infection will get so much more attention and it's fun to see the student or resident's enthusiasm.
posted by Slarty Bartfast at 3:34 PM on October 2, 2008

The issue of seeing colleagues is not one I thought about much because I am unlikely to have a colleague relationship with an internist, given my area of research in genomics. But you bring up two points of concern. First, MD/PhD students in my department may do a clerkship where I am being treated. But they will only do this after their PhD is done, so I will already know who they are and can ask for them not to be involved.

Second, there is the possibility that those colleagues of mine who have access to medical records (very few of them) could abuse it to access my medical records outside the course of their duties. This is something that I might worry about more if I were on the tenure-track, but it's hard to imagine anyone doing this at this stage in my career, especially as the penalties for doing so are steep.
posted by grouse at 3:52 PM on October 2, 2008

My current dental provider is a faculty practice within a large, prestigious dental school. I am waiting for the day that I can change my insurance to another provider.

The university swore up and down that their faculty practice was the best in the region, and all it is is a zoo. They might be the most advanced in the region, but it's still a zoo atmosphere. If you're ok with your doctor being part of a zoo, by all means go for it. If you're like me, find a good ol' fashioned regular PCP, and be happy.
posted by Geckwoistmeinauto at 4:49 PM on October 2, 2008

Geckwoistmeinauto, could you please clarify what you mean by "a zoo?"
posted by grouse at 4:50 PM on October 2, 2008

I've gone to this clinic for >10 years. The first 2 years I saw a resident, and he was great. Then he left and since then I've seen the same doctor, whom I picked. Occasionally I've had a slight emergency and had to see someone in my doctor's work group (medical assistant? I can't remember his exact title.) He was at least as good as the regular doctor. Once I had to see someone completely at random because I was very sick. This visit was the worst, but it was also the sickest I've ever been, so, yeah, that may have affected my perception. During this visit the doctor had a student with him, but he didn't say much.

Won't you still pick a primary care physician or else pick a particular doctor if you don't have to pick a PCP and ideally stick with them? Can't you pick a particular doctor from the clinic list when you sign up with your insurance, or else choose a doctor from the list when you make your first appointment?

I've never really had a long wait for any appointment--even physicals. I guess I don't really know what a long wait is. Mine have usually been 2-3 weeks or so at most. Maybe that is a long time. I imagine the doctors have few clinic days compared to many private practices. The clinic has been busy in the fall/winter, but I don't think that's unusual. Even then my appointments have rarely been late starting. A few times I've been referred to other UW specialty clinics which has also always been fine.
posted by sevenless at 6:03 PM on October 2, 2008

Won't you still pick a primary care physician or else pick a particular doctor if you don't have to pick a PCP and ideally stick with them? Can't you pick a particular doctor from the clinic list when you sign up with your insurance, or else choose a doctor from the list when you make your first appointment?

I don't know. The problem is that since I don't know anything about the individual physicians, picking the first time is pointless.
posted by grouse at 8:33 PM on October 2, 2008

I agree with phunniemee and slarty: the level of interest is a plus, and even the super-experienced specialists I've at university medical centers seen have shown a lively curiosity when I've met with them, perhaps part of the reason why they're involved in education. I have an idealistic belief that supporting education is the right way to go, consistent with the career path I've chosen in academia.

It sounds from the comments up-thread that the UW center offers excellent service, and convenience is important, too: when you're feeling miserable, you don't want to be coping with a long ride on public transportation. If the best specialists in the area are at the university medical center, and some only take referrals from their own clinic, that's a strong argument for going that route. It's also the time you're most likely to become a living classroom exhibit. I had a not-so-great experience with that during a minor operation on my chest: I was still conscious enough to hear the lesson, which kind of creeped me out. (Hopefully that won't happen to you.)

My cousin recently graduated from med school, and from conversations with her, I know that ethical training / awareness of latest privacy regulations should still be fresh in their minds. I doubt that anyone who has invested time and money to get an advanced degree would want to jeopardize a career by snooping where they shouldn't.

Take good care of yourself, grouse.
posted by woodway at 7:27 AM on October 4, 2008

I saw a faculty member at UW for a problem, because I thought he'd be up on the latest research. He wasn't. He laughed at my suggestion for a certain treatment because it wasn't "officially" approved in the US, even though it's been done in Europe for almost fifteen years, and had been done for several years in the U.S. Less than a year later the treatment was approved in the U.S. and was "big news" in the New York Times and several other major papers, being heralded as the best new thing. He also told me to wait as long as I could for surgery, and a year or so later I was being told that I needed to have surgery as soon as possible, and shouldn't have waited.

He was also a prize jerk, both to me and also to the intern he had following him around. He ended up throwing my x-rays at the intern as he slammed out of the room.

I've never seen such uncomfortable silence as that. The intern picked the x-rays up off the floor, and had trouble meeting my eyes, speaking barely above a whisper.

I made a stupid assumption, and I'll never again think of faculty as a good first choice. For one thing, he had even less time to consult with me than any other specialist I've ever seen (and I've seen quite a few). Our consult time was less than five minutes, and that includes him reading the x-rays. He constantly interrupted me while I was talking, which made those five minutes even less productive.

If you don't have any major issues and don't expect to, then sure, go for it. No harm done. But if you're really concerned with the care you get, pick a good GP. I would recommend mine (who I've been seeing for over five years), but she's not particularly close to your location.
posted by tejolote at 12:02 PM on October 6, 2008

How awful. Glad you have good care now, tejolote. I guess the faculty member in question (specialist?) wasn't part of a patient communication initiative launched nine years ago.
posted by woodway at 12:58 PM on October 6, 2008

When I visited this clinic for my checkup, I thought they were pretty thorough, and did not rush me. Bedside manner was good.

I had a question for those of you still watching. A visit to this clinic, like others in the UWMC system, generates two bills sent to me and my insurer two bills—one from UWMC and one for UW Physicians. Are total costs still equivalent to what I would get visiting a clinic that billed only once?
posted by grouse at 4:58 PM on December 14, 2008

I have interacted with these folks a couple more times and have only good things to say, really.
posted by grouse at 10:59 AM on May 10