Sarah Morse recently sought out a new physician after moving to Annapolis, Md., to take a job as a college admissions official. She opted for a large medical practice that offers extended walk-in hours, email access and an online portal where she can make appointments, request prescription refills and get test results.
Ms. Morse's previous doctor, a traditional solo practitioner in Baltimore, had no such amenities.
"In this day and age, people need to provide those kinds of services," says Ms. Morse, 57 years old. She recently made use of the extended hours after coming down with a sudden case of poison ivy that needed treatment first thing in the morning.
Things are changing at the doctor's office, giving people who need to find a new family doctor more options to choose from—and some things to watch out for.
A growing number of primary-care physicians, who traditionally provided basic checkups and treatment for everyday medical problems, are aiming to take on a more ambitious role overseeing all aspects of their patients' health. Many are giving up self-employment and are going to work for big hospital systems, which might push up certain costs for patients. Other doctors are opting out of insurance-payment systems and asking patients to pay them directly, sometimes through monthly fees. And primary-care practices can increasingly be found in some nontraditional settings, including clinics in the workplace set up by employers.
Choosing a new doctor can be confusing, and many people rely on recommendations from friends or co-workers. Among other reasons, people may seek out new physicians if they move to a new city, or if their doctors relocate or stop accepting their insurance. Experts say it is increasingly important for patients to lock in a primary-care doctor soon because of expected increased demand for physicians starting in 2014, when the new federal health-overhaul law will add millions of people to the health-insurance rolls.
Primary-care practices that coordinate automatically with specialists, track patients to ensure they get the right tests and generally oversee patients' broad health needs are commonly known as medical homes. Nonphysicians are taking on a greater role in this team-based approach, so patients should make sure they feel comfortable with a practice's nurses and physician assistants. The number of medical-home practices is growing, according to the nonprofit National Committee for Quality Assurance, the biggest certifier of medical homes. The group recognized about 4,770 medical homes nationwide as of August, up from about 1,500 at the end of 2010.
Ted Davidson, who lives in Washington, D.C., recently found a primary-care practice on the recommendation of a physician acquaintance. The 25-year-old likes how his new doctor has his medical information on a digital tablet during visits. After Mr. Davidson was recently referred to a cardiologist because of some incidents of dizziness, his primary-care doctor at his next visit had the specialist's notes and test results available electronically. "Having someone there to guide me through the whole process was so much more reassuring than doing it all myself," says Mr. Davidson, who works at a business-valuation firm.
Some doctors say they can't offer patients the best care under the current insurance-payment structure. This typically provides fees for visits but not always other services, such as drawing up a care plan for a person recently discharged from a hospital. As a result, some doctors are refusing to accept insurance, and are requiring patients to pay them directly. For instance, at Qliance Medical Management Inc., which doesn't take part in traditional insurer networks, patients typically pay between $49 and $89 a month for care at the health provider's five clinics in Washington state, says Erika Bliss, Qliance's chief executive.
David Usher, a doctor in Menomonie, Wis., recently left the Mayo Clinic to start his own solo direct-pay practice. He now offers his patients longer visits, typically 30 minutes or more, for a charge of $55, he says. The prices of other services are posted in his waiting room and online. "Patients like the extra time, as do I," he says.
Some practices cater exclusively to the well-heeled. So-called concierge physicians may offer house calls, constant cellphone access and personalized assistance navigating the health-care bureaucracy. Patients may pay a yearly fee of $1,500 to $5,000, and even as much as $20,000 or more, for these extras, in addition to the fees their insurers pay the doctors for treatment, says Tom Blue, executive director of the American Academy of Private Physicians, which represents direct-pay and concierge doctors. His group estimates there are 4,400 direct-pay and concierge practices, up about 25% from last year.
Hospitals increasingly are hiring primary-care doctors and buying up practices. For patients, this can bring benefits, since hospitals often are better able to invest in technology such as electronic medical records. The hospital systems also may foster greater integration between primary care, specialists and hospitals own operations. But physicians employed by hospitals may be more likely to refer patients to hospital imaging departments and labs, where services are often more expensive than at independent facilities.
A growing number of employers are launching workplace clinics, aiming to reduce health-care costs, improve their workers' health and offer convenient care that may reduce time away from work.
Oerlikon Fairfield, a Lafayette, Ind., maker of gears, hired a medical-management company called WeCare TLC LLC to set up a clinic at its factory in 2010. It includes three exam rooms and a small pharmacy, and has a doctor and a nurse practitioner on duty full-time. The manufacturer, which has about 1,225 employees, says patient visits at the clinic cost about half the amount Oerlikon Fairfield pays when its workers go to doctors at local practices and hospital systems that have contracts with its insurance carrier, says Jane Wolfe, the company's employee benefits manager. The clinic also promotes preventive-care efforts such as a weight-loss program.
Some workers initially had privacy concerns about seeing a doctor at work, Ms. Wolfe says. Now, the clinic is usually booked up and recently added more hours and a physical therapist, she says.