Why Losing Your Doctor is A lot Like Losing Your Barber

After I first moved to the town that I live in now from the town that I grew up in, I still went to my old barber. It was a 45-minute drive, but it was worth it. He knew how to cut my hair without asking. We caught up on family, talked about what was new in town and swapped stories about mutual friends. 

Then, disaster struck. He retired. 

For the next five years, I bounced between haircut chains and franchises. I went to a friend of a friend who was a hairstylist. I tried to cut my own hair once. Talk about a disaster. Eventually I found a great barber in town to replace my first barber.  We’ve been together for more than 20 years now. 

My experience and journey are not unlike that of patients who lose their primary-care physician. At least according to a new study in JAMA Internal Medicine, which you can read here.  

Researchers from Notre Dame, Harvard and a few academic medical centers in Boston wanted to know how the loss of a PCP affected a patient’s continuity of care. They assumed continuity of care is good for patients, and the lack of it is not good for patients.  

So, they compared the outcomes of about 170,000 Medicare beneficiaries who lost a PCP from 2010 to 2015 with those of about 190,000 Medicare beneficiaries who didn’t lose a PCP over the same period. Prior to losing a PCP, the outcomes of the test group of patients were statistically similar to those of the control group of patients. 

But, after the test group of patients lost its total of 5,939 individual PCPs to retirement, movement to a nonclinical position or death, things changed. Compared with the control group of patients, patients in their first year after losing a PCP had:

• 18.4 percent fewer primary-care visits
• 17.8 percent more urgent-care visits per 1,000 beneficiaries
• 6.2 percent more visits to medical specialists
• 5.5 percent lower flu vaccination rate 
• 3.1 percent more emergency department visits per 100 beneficiaries
• 2.2 percent higher annual average total Medicare spending
• 1.7 percent more inpatient visits per 100 beneficiaries 
• 1.2 percent more prescriptions for chronic illnesses

“Increased rates of urgent care and emergency care visits may be a direct consequence of decreased access to care, moving patients to non-primary care settings for urgent issues,” the researchers said.

The good news is patients who lost a PCP had the same mortality rate two years later as those who didn’t lose a PCP. In-other-words, losing a PCP wasn’t any more fatal than keeping one.

Just like getting your haircut at a chain or franchise (think urgent care) or trying to cut it yourself (think emergency department) won’t kill you. But, you’ll likely let it grow longer before getting it cut (think flu vaccines), buy more hair products to keep it looking presentable (think prescriptions), consult a hair stylist (think medical specialist) and spend more when you do get it cut (think total Medicare spending).

The lesson from the new study is clear: Keeping your PCP is just as important as keeping your barber if you want to stay healthy and looking good. Outcomes matter!

Thanks for reading.

Stay home. Stay safe. Stay alive.