In this essay I will describe how the evaluation of a medical problem seems to work in at least one large not for profit big city hospital system and how that differs from how it used to be in a physician owned fairly large internal medicine practice in the same big city.
The basic events described are true but some non-essential details are altered in the following narrative to shield the identity of the innocent and the not so innocent.
William G,a retired 78 year old accountant has a routine annual visit with his primary care doctor who is a board certified ( and re certified ) internist.WG thought it was an annual exam but in reality, it was a modified Annual Wellness Visit (AWV) in which there was no physical touching involved between patient and physician. WG's red blood cell count was reduced from the previous year and the iron studies were done and they were consistent with ( but not diagnostic of) iron deficiency anemia. Based on his age a GI workup ( ie upper and low GI endoscopy) was in order and WG set off to get an appointment with a GI doctor in the same hospital system who had done a coloscopy for WG three years earlier. Although he was an established patient it was 3 week before an office visit could be scheduled and the another 5 weeks before the endoscopy procedure could be scheduled, a frustrating 2 month delay.
When I was in internal medicine practice in the 1970s in a physician owned group the time from one partner having a patient needing a GI endoscopy to seeing one of the GI docs in the group would have been one or two days at the most and the procedure would have been scheduled in another one to three days at most.
In the private practice group the clinic administrator worked for the doctors and in the large big hosptial system to some degree it is the other way around.The staff who do the scheduling are hired by the hospital and work for the hospital