Do I HAVE to find a local doctor?
January 31, 2023 8:53 PM   Subscribe

I had a Telehealth appt with my endocrinologist recently and she asked me if I'd been able to find a doctor local to me. I don't want to. I'll explain why inside.

My endocrinologist has been treating me for over ten years. She listens to me. She takes my concerns seriously. She doesn't blame my health issues on me being fat. She's great.

I relocated from her area 18 months ago, but I only live 2.5 hours upstate from her office. It's not a big deal for me to take a half day of PTO for an appointment. I have Hudson Valley friends who commute 90+ minutes or more to see specialists in NYC, so I don't see this as much of a difference than that.

I DID try to get into a local endocrinologist practice here. They refused to give me an appointment at first (I wrote a question about that here a while back). They eventually relented; turns out they didn't understand the words "Hi I'm new to the region and need to find a local endocrinologist for transfer of care" and refused me solely based on my A1C being slightly over the limit to be considered T2D. Additionally, one of the reasons why I wanted to talk to an endocrinologist was to get me off of Metformin which has made my life hell for two decades - I can't just go off of a med with no medical guidance or new medication. This experience with the local practice left a bad taste in my mouth. They do not listen.

In the meantime my endocrinologist downstate put me on Ozempic and my sugar levels are way down (and I've lost ten pounds - only
50 more to go to be at a healthy weight, so that's a nice bonus!). She listens to me. I feel safe with her.

I don't want to stop seeing her if I don't absolutely have to. I don't want another doctor using the new patient excuse to fuck.with my medication regimen (I had this happen a long time ago with a psychiatrist and also a GP). I don't want to EVER go back on Metformin. I am on Team Ozempic - I haven't felt this healthy and high energy in a long time and my sugar levels prove it. I do not trust the local practice to listen or respect me. They have terrible Google, Yelp, and Facebook reviews too (and only like three of those reviews sound unhinged lol).

Is there any reason why I can't just commute 2 hours to see my endo 2x a year? It's not a problem for me. And she does Telehealth as well.

I don't know if she asked me if I had found a local endo bc she wants me to do that or if she was curious. Is it ok to say I have not had success finding a local endo and would prefer to stay with you?

(I've already had this conversation with my gynecologist downstate who I absolutely adore; he said he'd treat me for however long I wanted him to. He and my endo are a part of the same medical group. This medical group accepts my insurance which makes sense bc it's frikken Blue Cross Blu Shield and basically everyone takes that.)

Any input would be appreciated. If there are doctors out there who have concerns about patients not having a local doctor would love to know why. If this is a non issue and I can keep seeing her would love to know that too.

posted by nayantara to Health & Fitness (14 answers total)
Best answer: This is 100% normal where I live. It’s good to have a plan for which urgent care or ER you will go to that’s local, and a GP if you need to go in frequently. But traveling for a good specialist is very common. I know people who fly cross country twice a year for their specialist and one person who travels 14 hours each way *monthly*. I would just tell your Endo that you are happy with your care and are in the area frequently, and that your efforts to find someone local have not panned out.
posted by Bottlecap at 9:05 PM on January 31 [4 favorites]

Did she ask if you could find "a doctor" or "an endocrinologist" near you? Is it possible you would benefit from having, say, an internal medicine PCP nearby, and that was what she meant?

I mean, you probably thought of this already and just didn't phrase things that way in your question -- but just in case there's a misunderstanding, here's this.
posted by amtho at 9:27 PM on January 31

Best answer: Is there some kind of insurance concern in this situation?

I drive to my childhood eye doctor office (about an hour and a half away) because I only go there once a year, so no big deal. And hell, my therapist moved across the country, but there's phones and FaceTime. For me it would depend on how frequently I have to go to the medical office in person. if you're only going twice a year and you're fine with doing that in a half day, no skin off your ass, so why did she bring it up?

I'd ask her if she's going to force you to quit/see someone else, point out what you have said here about trying to find someone else + your concerns, and then see if this is a forced situation or if she'd be fine with you staying.
posted by jenfullmoon at 9:55 PM on January 31

Best answer: Is it ok to say I have not had success finding a local endo and would prefer to stay with you?

You've been under her care for ten years: in that time, have you had to see her on an emergency basis that would have been hampered by her being 2 hours away? If not then I really can't imagine why there'd be a problem.

(Congrats on getting the Ozempic to work.)
posted by fingersandtoes at 9:57 PM on January 31 [1 favorite]

Best answer: Is there any reason why I can't just commute 2 hours to see my endo 2x a year? ... Is it ok to say I have not had success finding a local endo and would prefer to stay with you?

This is your endocrinologist's discretion, and there's no reason not to have this discussion with them. You don't need all the backstory to get the conversation started. Asking this question is a very straightforward opener, and you may get a straighforward response.

I can understand not wanting to have patients outside a specific geographic area. The likelihood of last-minute cancellations increases with increasing distance. Having some non-local patients increases the chance that those patients will recommend me to other distant people who want to be part of my practice. If you get a response to that effect, respect it. See if you can get recommendations for contacts who are personally known to your very good endo and set up intake discussions. Yes, you might clash with some practitioners. No, you won't clash with all practitioners (and, dare I say it, you might end up working someone with even greater skills and sensitivity).

Side note: It sounds like you've got a weight management process in place. If someone's an asshole about it in a clinical setting, bring it up. They're probably following a script they picked up in their training and it might not reflect personal, regional, current etc. best practices. If you mention this at intake—"I really am not keen on being on the receiving end of judgment about weight, I've got goal X and we can talk about it in an appropriate way so let me know if this isn't something that resonates with this practice"—I guarantee you you'll get a straight answer. Sometimes I think this is a matter of advocating for yourself and saying, up front, "I want to make sure we talk about what I'm looking for from square one—I do not plan on ever taking metformin again, etc." Get that discussion, get those notes put on your chart, get that understanding of your trajectory early. Some proportion of people don't want this approach, and I love it when I find out that someone does.

Good luck! Changing regions is such a headache when you move. I moved about 6,000 miles in the recent past and am still trying to sort out my care... and I'm in the clinical field.
posted by late afternoon dreaming hotel at 1:32 AM on February 1 [3 favorites]

Best answer: I live in a small city with few doctors and most of the available specialists are in a major city 50 miles away. With traffic it takes almost two hours to drive there. Everyone in my small city does this as a matter of course. And patients from more remote rural areas always have to travel to the doctor. Maybe they drive one hour. Maybe two? There are so many medical "deserts" in this country that really, driving up to two hours to the doctor is just an ordinary thing for many people. As long as your'e still in the same state, so not affecting their license requirements in any way, I really think this is YOUR choice.
I do hate driving two hours on the highway to the city with my specialists when the weather is very bad for travel. That's pretty much the only downside.
posted by ojocaliente at 4:36 AM on February 1

Best answer: A good endo is hard to find and when you have one, stick with her. I have both a congenital adrenal disorder and Hashimoto's thyroiditis. More than a decade ago, my great endo retired and I switched to her partner and he proceeded to destroy my health--seriously, he put me on massive doses of steroids for my adrenal disorder and didn't tell me about all of the side effects and I suffered.

I finally found a doctor in NYC (I'm in NJ) and even though I had to take two trains and the subway to get to him, I didn't care. He couldn't reverse all of the damage done to me, but he was a great doctor and I made that trek twice a year for years, until he retired. I luckily found a really good doctor here. I don't regret the years of traveling to the Upper East Side at all. If there's no reason on your doctor's side that she can't see, I would stick with her.
posted by ceejaytee at 4:36 AM on February 1

Best answer: Two thoughts:
1) Maybe your endo was really asking "...and are you taking care of yourself?" when they asked if you had found a doctor near you. That could be a useful (positive) indicator that you are - in general - being proactive about your health despite upheaval/transition.
2) Maybe your endo was trying to determine if you would be leaving their practice or continuing remotely, for their own planning purposes.
posted by nkknkk at 4:36 AM on February 1 [2 favorites]

Best answer: My suspicion is that she’s asking if you’ve found a local PCP, not another Endo. Or rather, that she thinks it would be advisable for you to have a local primary care physician for all the million annoyances that she couldn’t and shouldn’t cover, like a sinus infection.

It is perfectly fine to keep a specialist that is not local as long as you abide by the (stupid) insurance rules. My insurance says that you have to be in-state for a telehealth visit, for example.
posted by lydhre at 5:14 AM on February 1 [4 favorites]

Best answer: I moved to away from NY and where I now live is basically a healthcare desert. Not many specialists, and if you find one they either aren't taking new patients or there's a 6 month to 2 year wait to see them. I kept my endocrinologist in NYC...nearly 10 hours from where I live now. I'm a thyroid cancer survivor, and that's his specialty, and I've been seeing him for 15 years. I spend time in NY every year, and make my annual appointment to see him. If I have any issues, he's more than happy to call in a blood test to LabCorp, and I just go to my local office, and he gets the results. Unlike my other doctors, he doesn't have any issues calling in a new prescription to a pharmacy in a different state. It's been working out pretty well for 5 years.
posted by kimdog at 5:51 AM on February 1

My insurance says that you have to be in-state for a telehealth visit, for example.

This is probably your state law. Whether telehealth with out-of-state doctors is allowed depends on laws of the state the patient is in. This document showing telehealth laws by state is updated regularly.
posted by FencingGal at 6:29 AM on February 1 [1 favorite]

Best answer: I love telehealth, and since the pandemic I haven't seen most of my doctors in person. They aren't particularly far away, but going to appointments is a pain and I just don't need to physically see most of them in person. It's totally okay to keep seeing a practitioner you like, and if they offer telehealth I'd highly recommend that when it makes sense because it's so much easier!
posted by radioamy at 3:55 PM on February 1

Response by poster: Thanks all!

To clarify, I am still in the same state. My endo is located in the mid-Hudson Valley, NY and I live two hours north in NY's Capital District. My insurance has not given me one lick of trouble covering the appointments I've had with her and with my Hudson Valley-based gynecologist as well.

Next time I speak with her I'll let her know that I would strongly prefer to stay with her as I haven't had success in finding a local endo who I feel comfortable entrusting my care to. I'm a very recently-diagnosed type 2 diabetic (November of last year) and I don't feel like this is a great time to make a big change while I'm adjusting to a new medication and new lifestyle changes with this diagnosis. Also, I like my endo, I see her 2x a year max, and I can schedule my appointments with her during non-inclement weather seasons. Or just do Telehealth, she's cool with that.

Thanks again!
posted by nayantara at 12:38 PM on February 2

Late to the party, but I live 2 hours away from my endo (in NH), and it's not considered weird at all. I bet it will be fine!
posted by nosila at 1:12 PM on February 2

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