Where is Marcus Welby MD?
 

In anticipation of the opening of the new Creekside Medical Center, I called to set up an appointment for my wife and I five weeks ago. They wouldn't give us an appointment, but instead, set us up for an "initial meeting" for May 6. I received a call yesterday stating that they are not doing the initial meetings and that they were scheduling "new patient appointments." I said that was great and we would like one as soon as possible. The soonest they could get my wife and I in was September 22!
So far, I am not too impressed with the "new delivery of healthcare model" that was being touted by The Villages.
Looks like the same old model to me.

Marcus Welby, MD was a fictional television character.

The developer's use of the Welby concept was to convey the goal of paying the physicians an attractive, flat salary so they could hopefully have time enough with the patient to actually learn more about them and their conditions instead of having to see dozens of patients per hour and spending only 3 minutes with them in order to get enough reimbursement from Medicare and insurance to pay the bills of running the practice. Reimbursement is low and going lower, and insurance companies often call "reasonable and customary charges" what Medicare calls reasonable and customary.....and THAT is less than the costs the providers have to pay to keep the place running.

Obviously people are racing to try to get into these practices in TV, thus the length of time to get an appointment.

The good part is that the TV health system is intent upon getting quality primary care doctors, and apparently they are. Any time somebody asks if they like the dr. they have in one of the existing clinics, there are very good reviews of them.

Considering each doctor was to have no more than 1,500 patients and the fact that you cannot even get an initial appointment for almost 100 days, the numbers do not seem to work. At 20 patients per day, your contemplated doctor is going to see 2,000 patients before he can ever see you for the first time. This does not bode well for ongoing care unless you are rarely going to actually see your doctor on each visit.

It sounds like these healthcare centers are developing more as a model for a national healthcare system: scarce appointments, long delays, and most exams by other than a medical doctor.

I started going to Pinellas. I am very pleased with the personal servive and the time they spent with me. On a scale of 1 to 10; I give the Villages Health Care system a big 10!

Like anything new there will be some bumps along the way.

Marcus Welby M.D is hiding, in Dr. Feliz Agbo's body. 352.753.2224 at 910 Old Camp Rd, in LSL.

You can schedule a meet and greet with him, at no charge to you. My M&G, lasted 40 minutes. I asked a lot of questions,and he was trained at Mt Sanai Hospital, in N.Y, as well as England. A personable guy, who will not rush you out of the examing room.

Bring popcorn, as he always has TCM, on the lobby television. LOL
His office staff is super nice, and very efficient.

In addition to all the above, he leaves a couple of appointments open, in case there is an emergency. You won't get the line that, "you have to go the emergency room", as we are "too busy". Staff will try to accomodate you.

I have not seen my primary in the last 4-5 visits at Colony. Luckily the PA's seem as competent as the Drs.
Never had this problem in Orlando and our Dr. knew both of us.
Here they have no clue who you are because it's a different PA each time.
Not complaining it's just not as advertised aka Welby....

Here's how it's gone lately for the two of us: Went to the orthopedist, saw the PA; went to the gastroenterologist, saw the PA; went to the Ear doctor, saw the PA; went to the primary care physician and saw the PA; went to the dermatologist, saw the PA. Who will we see when they run out of PAs?

My initial opinion of my primary care doctor at Colony was positive but it does seem that they try to hook you up with a PA instead of the Dr unless you insist! Not so keen on one PA that I've seen several times! She probably knows her stuff but there is a bit of attitude that turns me off!

Where is Marcus Welby M.D.?
 

Marcus Welby is alive and well in fantasy land. This new healthcare system in The Villages is big business run be a big HMO. And one thing big business is good at is selling you a dream, a bill-of-goods.

Before it even started, I questioned it many times and, essentially, I was condemned for being too negative. It was suggested that one should have faith in the developer. And if you don't have faith in him, you must be against him. And the worst thing you can be in The Villages is "anti-developer". It's probably worse than being an atheist.

And when the wrath of well respected posters comes down heavy on you, it provides an example to others, so no one will dare complain or have doubts, until now.

One thing that didn't make sense to me, and still doesn't, is how it would work out economically with only 1,200 patients per doctor. Someone is paying the doctor's "generous" salary. Where does that money come from, the tooth fairy? And now everyone is being seen by a P.A. The doctor was supposed to have enough time so that he could spend 20 to 30 minutes with each patient and you wouldn't even need an appointment and there would be no waiting. Now nothing is anything like what it was advertised to be.

If everyone is being seen by a P.A., what is the doctor doing in the mean time? Sounds like bait-'n'-switch to me.

Villages Pl - I was wondering the same thing. What are the doctors doing if the PA's are seeing everyone??? I was completely and totally disenchanted with the whole system in the beginning, starting with how they "invited" people to join to my experience with what I will loosely refer to as a doctor. Well I don't have Medicare and still have a high deductible so I only go to the doctor when I really, really need to. That situation occurred in the past week when I couldn't even get out of bed because of the back pain I was having. The morning I woke up vomiting with pain beyond belief I called Colony and much to my surprise they asked if I could be there in 15 minute. I assured them I could and was more than pleasantly surprised by my experience with the PA. She was outstanding - listened, asked questions, wrote a script for the pain and off I went. My only complaint - too much typing on the computer. I go back on Monday for my annual physical and supposedly will see the doc. Curious to see how this will go and if I will actually see a doc or the PA.

Dr. Agbo...can you understand him? I would not recommend him.

Gomoho, my doctor is in The Villages, a few blocks from where I live but not part of The Villages Clinics. When I first started going to him, it seemed as though he didn't have many patients. So I never had to wait and he would spend a lot of time with me.

As the years went by, he got more and more busy, and I got less and less time with him. I once waited in the waiting room for about an hour. The last time I went for a routine exam, he introduced me to his P.A.. Something he never had before. They were both in the room because he was breaking her in, so to speak. And what did he do but spend 95percent of the time looking at the computer and typing on it. Essentially, I was looking at his back. This provided no encouragement whatsoever for me to raise any issues that I may have had. I had a list of 2 or 3 questions in my pocket that I completely forgot about. I kept waiting for him to finish with the computer and turn to me. When he did turn toward me, he got up and walked toward the door. That was the signal for me to scram. I left but he didn't. I could see them in the room while I was waiting for my next appointment to be decided. He was talking to his new P.A. That must have been more important to him than whatever I might have had to say.

So, I see the hand writing on the wall. Healthcare is not going to get better, it's only going to get worse.

To those who say they love their doctor and everything is wonderful, it's always wonderful in the beginning. Just wait a year or two.

Welby
 

This lengthy time period is only because it's your initial visit. Once you're a patient, they will get you in the same day or the next if you have some type of issue that needs attention. Even if you have an issue prior to your first appointment, you are to call. I can't believe that people who aren't even in the system are quick to criticize when they don't even know what they are talking about. I'm not talking about the poster, but about other people who aren't even using the system being critical. In the 10 years that I've been here, the medical services are about the only thing that I haven't been impressed with. This system deserves a fair chance for an appropriate amount of time before people make their judgements.

Then listen to people in the system. They are saying they only get to see a P.A. This is not the Marcus Welby model that was sold to the public. We were told the doctors would have 20 minites or more to spend with their patients. Now they have zero time to spend with you - instead, they give you a P.A.

I'm in the system and I've been a patient at both Colony and Pinellas, and none of what is stated here is consistent with my experiences with the many appointments I've had. If I want an appointment with the doctor, I get scheduled with my doctor. If I want to see the PA, I'm also free to make my appointment with the PA. No problem! The only reason I can see why anyone would say they can't see the doctor and just the PA is because the doctor isn't available for an appointment when the patient wants their appointment, or they simply didn't communicate that they wanted the doctor when making the appointment.

I've been free to see either one I want so long as they're available when scheduling. I have at least seven or more regular, special purpose or semi-urgent visits per year, and with my next two appointments I have one with the doctor and the other with the PA. No problem, no disappointments, no dissatisfaction!

One more thing I'd like to mention is that when I see the PA, my primary doctor (or another doctor in her absence) is always available for the PA to consult with if necessary. It's happened more than once since I joined up and with both primary and alternate doctors. The time it was with the alternate doctor, he (Dr. Reilly) resolved what I was told was the worse case of hives they ever saw, and to my relief and thanks to him, it cleared up within 48 hours!

This matches our experience at Pinellas.

I just started with the Villages Health system in January but am very pleased and have seen the doctor each time. I've never felt rushed with him. The medical team that supports the doctor is very responsive if I have a question or need. I especially like the electronic records that are immediately available with all lab tests etc. I've been recommending the system.

Well said skyguy79. That's been my experience also. For an emergency visit I'm scheduled with the PA, who consults with my Dr. if necessary. Another tool I've never had in the past is the secure Patient Portal, and being able to email my Dr. and get a same day response. My regular scheduled Dr. Appointments have always been very thorough and doc has spent at least 30 minutes with me making certain that he has covered all my issues.

A nurse practitioner (NP)

And because the physicians are being paid an attractive flat salary, do people believe that there won't be pressure from those higher up on the corporate ladder to see as many patients as possible?

My experience in dealing with and working for big businesses is that the people on the front lines whoa re dealing with the customers are the ones that want to give good service. It's the people above them that don't allow that to happen.

Did I read that every doctor will have "only" 1500 patients? If you do the math and a doctor sees each of his patients once every six months then he has to see 58 patients a week. If he gives each patient a half hour, that will take up 29 hours of a forty hour work week. That doesn't include time for paperwork or reviewing a patient's record ahead of a visit. Many doctors also need to see their patients when they are in a hospital and of course if the patient is having a specific problem, the doc might need to see him more than twice a year. In fact, my doctors sees me every six months.

The trend in health care is toward the PA'S and NP'S. This is not just in TV it's across the country. The Doctor has become more of a "manager" or "Adminstrator" if you will.

I have a doctor friend who told me recently that the paperwork is just overwhelming. You wonder where the doctor is-----he is doing paperwork on the computer system or overseeing it for the purpose of avoiding or defending a lawsuit.

We have trained too many lawyers and not enough doctors.

Could health care be better, sure, but in TV especially, the facilities and number of health care personnel has been unable to keep up with the growth and expansion.

Of course there will be pressure to see more patients per hour once the developer is subsidizing the system less after its formation is complete. I was addressing the "Marcus Welby" concept and goal of not having the doctor pay directly dependent on how many patients they see and how many tests they run--because with Medicare and insurance that pays only what Medicare pays (less than cost), which is the only way to both pay the bills of the practice and to stay afloat financially.

To me it looks like they're using the less costly employees (PA's who are good at their scope of practice) to do the less complex work for which medicare and insurance pay less, to free up more time for the drs. to do the most complex work that the more complex patients present. But so far, the mandate to feed the computer files on every patient is eating up time that could/should be spent on patient care.

How many chief financial officers of a large company have to spend 40% of their time doing data entry on an iPad instead of financial analysis and decision-making? That is what the mandated electronic medical records software (different in every practice) is doing to drs.

Marcus Welby didn't have to do data entry and then buy costly malpractice insurance for when he got sued and his patient records would be put under a microscope in court for not doing every expensive, technological test known to man, only to cover his butt for just such an occasion.

My urologist at Duke University Medical Center told me that tethering to the computer is due to requirements imposed by the Affordable Health Care Act. During my last visit, he sat there typing and three times dropped his chin to his chest, groaned, and sighed "Obama Care."

My first appointment at Pinellas with a doctor is this Monday. I called to schedule about 3 weeks ago, so have no experience yet with any of the doctors or PA's (not "physicians' assistants", but "physician assistants" (more appropriately "physician associates"). I will say something, however, about PA's in general, because my daughter and son-in-law are both PA's, so I am familiar with the training.

After a full, unrelenting year of didactics, the student rotates for another year in various medical disciplines. They have become familiar with all areas of anatomy, physiology and pharmacology during their training. When they go into private practice it is under a doctor's supervision, which allows them to seek advice of the doctor if they are unsure of a set of symptoms. They know your life is in their hands and they don't want to make a mistake.

I have no problem seeing a PA, who is able to spend more time with a patient. Let's face it: This is the direction of healthcare. If the medical condition is beyond the knowledge of the PA, then the doctor will be brought in.

I remember when a doctor would come to the house, but those days are merely fond memories. We need to realize that change, whether for good or bad, is what we have to accept.

There are incentives in the ACA to move to electronic records. There are huge administrative and patient benefits to move away from forms and dictation which are cumbersome and lead to errors and non compliance. Of course, with a new system there is a learning curve. But all of us have made it through technological changes before and after a little griping things got better.

I've been cared for by Dr. Pead in the Santa Barbara office. I always am seen by the Dr., with his nurse practitioner attending. PA's and nurse practitioners spend a great deal of time training to be able to work in their field, under a doctor's guidance. I applaud them. The doctor may not be available due to another patient in greater need of his care. So, try to put yourself in the place of the patient needing the greater care. I'm betting, at that moment you would be glad the doctor is at your side. So, be patient people.

OK, the PA gets more training but a Physician is a medical student for what? 4 years, then an intern for 1 year, a resident for 4 more years? Now whose experience do you want?
I've gone to a Physician here in The Villages who I was told does not see "clinic patients" - I would have to see only PA. Obviously I don't go there. From what I read and this is my opinion,,,,, we all are in for a very rough ride -- I want a physician who listens to me and does not have to worry about inputting into a computer…No answers please, I won't change my mind…

Forbes: Why Is Your Doctor Typing?

"..... In the last year or two, there’s been a shift. Much of my time with doctors has been spent watching them type. In one case, the doctor tapped away on his laptop, occasionally looking up to ask questions before returning to the main focus of his attention: his computer. In another case, the doctor intermittently tapped on an iPad while we spoke. In a third instance, the doctor had a conversation with me and then apologized that he would be spending the next half of our session typing up the results of our conversation. All this typing was required, he said, if he was ever going to be reimbursed for his services. It was getting in the way of being a doctor.

Surely, I said, computerized medical records generate benefits. They are easily retrievable. They can be transferred from one practice to another and accessible to the many different service providers—hospitals, laboratories, specialists, radiology and so on—that might be involved in any one patient.

“In theory, perhaps,” he replied. “But in practice, it’s a horrible and costly bureaucracy that is being imposed on doctors. I spend less time with patients, and more time filling out multiple boxes on forms that don’t fit the way I work. Often I am filling out the same information over and over again. A lot of it is checking boxes, rather than understanding what this patient really needs..........”

Why Is Your Doctor Typing? Electronic Medical Records Run Amok - Forbes

The only problem with this is that prior to ObamaCare kicking in, I saw the same problem in hospitals. Really what changed is that docs now have to document what is going on (in part to make insurance happy and their malpractice insurance even happier) - before they could simply note something no one else could read and move on.

Also keep in mind that docs are like the population in general. Some took to computers years ago and some fought against it. The ones that fought it are having trouble adapting to electronic medical records.

In the late 60s, there was a movement from clinical medicine to lab medicine. Doctors started diagnosing not with their observations, but based on lab results. Increasingly, they ordered batteries and batteries of tests before they even saw a patient. I fired my doctor in 2005 because she would never look up from my chart and actually look at me. And in 10 visits, she *never* actually touched me. (which is pretty hard to manage while doing a physical exam!)

Todays doctors are trained to wheel their computer stands around. They can't actually go into the patients room anymore (not enough room for 10 people and their computers), so they stand out in the hall, stare at the screens and discuss the patient. The residents and students don't examine patients - they look at the stats and test results on their screens. Maybe, if you are lucky, one will actually go in and speak to the patient,

Yeah, primary medicine in the US sucks. Complain all you want about "socialized medicine", but primary care under British National Health is much better than here and doctors often do make house calls if the patient is too ill to come to the office. And the district nurse will visit seriously ill folks daily if need. (They have decided to invest the money in primary care. Specialty care, well, sucks really badly)

At least PAs and ARNPs are likely to actually talk to you and examine you.

If The Villages healthcare system had been completely explained we wouldn't be having this discussion and confusion. For example, every Sunday they devoted one full page in the Daily Sun to talking about (and showing pictures) of their new doctors and P.A.s. But did they ever explain exactly in what way and under what circumstances a P.A. would be used? No!

They just kept stressing the point that the doctor would have plenty of time to get to know you (20 minutes or more per visit). You have to wonder about their organizational skills if they couldn't come up with a simple plan to educate current and prospective patients as to how this plan would work.

They just assumed that everyone would know what the duties of a P.A. would be? They are there to assist, yes, but in what way? How do their duties differ from that of a nurse who works in a doctor's office? Will those of us who are well be permanently assigned to see a P.A. instead of our doctor? People like to know what to expect and they shouldn't assume that everyone will automatically have it all figured out.

Look at all the heavyweights they introduced like medical doctors with multiple degrees and decades of experience including experience in office management etc.. And not one of them could figure out that the presentation to the public was lacking important information? Yet they kept saying, over and over, that this new healthcare system would be "patient centered".

Can a doctor be sued for malpractice if he has never seen the patient? Isn't he responsible for his PA who actually represents him? If so I'd say he can be held liable. If he could be legally responsible than I'd put a lot more faith in the PA, otherwise we're paying for a doctor and not getting one.

If anyone has any concerns about PA, they should talk to their doctor with those concerns instead of drawing conclusions from the opinions, conjectures or concerns of others that may lead a person to misconceptions about the profession. In the mean time, if one's truly interested in learning about PA's and the role they play, there's plenty of good information and facts to be had at the American Academy of Physicians Assistant's website. Here is the link to that information:

AAPA | What is a PA?

Excerpts from the website:

"The physician assistant (PA) profession was founded on — and remains committed to — the concept of team practice. Working in all medical and surgical specialties, physician-PA teams enhance coordination and quality of care. The physician-PA team is effective because of the similarities in physician and PA training, the PA profession’s commitment to practice with supervision and the efficiencies created by utilizing the strengths of each professional in the clinical practice setting."

"PAs extend the care that physicians provide and increase access to care. Studies have consistently shown that PAs provide high-quality care with outcomes similar to physician-provided care. Additionally, studies have shown that incorporating PAs into office or hospital practice can improve outcomes. Studies have also shown that patients are just as satisfied with medical care provided by PAs as with that provided by doctors and do not distinguish between types of care providers."

"PAs have been recognized by Congress and the President as crucial to improving U.S. healthcare. In the Patient Protection and Affordable Care Act, Congress recognized PAs as one of three healthcare professions in primary care."

The Villages/USF Health Alliance gave many lectures far in advance of the first clinic opening. Also, the Daily Sun devoted at least one full page per week on Sunday. That effort was to provide information so that Villagers would know what kind of care to expect from this new "revolutionary" health care system. They didn't say, "if anyone has concerns about PA, they should talk to their doctor with those concerns instead of drawing conclusions from the opinions, conjectures or concerns of others that may lead a person to misconceptions about the profession."

To say that we would need to wait for the clinics to open, then join, and then ask our doctor how this system would work, reminds me of someone who once said, "If you want to know what's in the bill, you have to sign it first." It's disingenuous. A lot of people had good reason for wanting to know in advance how it would work because they would have to leave their current doctor in order to make the change to a clinic doctor. The fact that they might often be expected to see a P.A. instead of their doctor might have kept them from joining. They were deprived of that choice, the choice of not joining. Maybe it was more convenient for this new healthcare system to promote the following misconception: "If you like your doctor, you can keep your doctor." :) But as we now see, you will be expected to visit with a P.A. when they decide it to be appropriate. You will be expected to flow with the system as they have designed it.

When I started this thread, I was just stating my disappointment with the fact that after all that has been hyped about this new healthcare delivery model appeared to be just that, hype, since I couldn't get an appointment for 5 months. As a f/u to that, I called a physician's office in Lake Sumter who was highly recommended and they got me an appointment in two weeks.
BTW, thanks to the poster who informed me that Marcus Welby is a fictional character. Can you imagine my disappointment when I went and he didn't show up?

Yes. And when a person's re-enrollment comes up, they can vote with their wallet just as many do when enrolled in typical primary-care practices across the country.

For all the system's flaws, we still can fire our dr. and insurer or medicare-supplement insurer and get a different one.

THAT is the capability to be protected amidst the current plea for nationwide single-payer government system. But many turn a blind eye to it by believing everything they're told and by not doing their own homework.

I kept wondering how the Villages Healthcare Clinics would make enough money if each doctor only had 1200 to 1500 patients. They claimed they would spend about twice as much time with each patient compared to regular doctors in private practice. But with a P.A., a doctor will perhaps be able to carry nearly twice as many patients as we were told would be the case. And P.A.s, I assume, are much lower salaried employees than regular doctors.

So, if I am correct, perhaps 1000 or more of the doctor's patients will be expected to see a P.A. on a regular basis. The doctor could end up with a total of 2500 to 3000 patients.

Of course this information is not going to be divulged, whether you ask your doctor not. This will be considered private business information and none of your business. So I still believe it was all about "bait & switch" from the very beginning.

Marcus Welby morphed into a "concierge doctor" where we used to live. He promised fewer patients and much more personal care in exchange for a yearly $1500.00 fee (office visits were still charged). A surprising amount of people signed on.

Just left Mulberry facility of The Villages Health System. Spent twenty minutes with an assistant followed by over an hour with the doctor who addressed all my issues and then some. Changed some dosages, ordered some new meds and explained why. Ordered labs and x-rays plus return visit in four weeks. Recommended two publications for me to read, and even gave me a shoe catalog to address my heel pain. Couldn't be more pleased.

Excellent!