Pediatric practice question: is this normal?

[Ben E Lou]

Our only current point of reference is the practice my father-in-law and brother-in-law are in, and there, if you want to be seen by a physician on the weekend, you are seen by the on-call physician from the practice. Our child is ill today, so we called our pediatrician's office and were quite surprised that not only do they not see patients on weekends, they don't even talk to them. We were referred to a 1-800 line where we didn't even talk to a doctor but a nurse practitioner. Seriously??? (FWIW, my father-in-law was appalled when we told him this story, but I'm wondering if that's because his practice is small-town and in a very competitive market.) I'm curious if this is just where pediatrics is headed in medium-sized communities like ours.

[Mustang]

Might be the way it is going although, I didn't think there was any other way as our regular doctor doesn't see patients on the weekend and we are routinely handed over to the nurse or someone that can answer our questions or given a 800 number to call. Although, most of the time we are just asking dosage or generic questions. If we absolutely need to bring her in, they have hours during Saturday and Sunday, just not our regular pediatrician.

[Scoobz0202]

FWIW, Ive had nothing but good experiences with the NP I see

[JonInMiddleGA]

I'd say that's pretty normal these days. NP's are doing a ton of the work these days, and that isn't just weekends.

It's not pediatrics but my parents can't speak to anyone but the NP at their doctor's office & you have to get through a nurse just to get that far. It's even rarer that you could get even an NP on the phone with any pediatrician we've dealt with through most of Will's 13 years.

The one thing that seems a little unusual to me here is that you didn't have an option that involved talking to a doctor somewhere on the weekend. Even if it's to reach a call service doctor by going through their NP, there was usually an option for overnights & weekends.

[fpres]

Originally Posted by Ben E Lou

Our only current point of reference is the practice my father-in-law and brother-in-law are in, and there, if you want to be seen by a physician on the weekend, you are seen by the on-call physician from the practice. Our child is ill today, so we called our pediatrician's office and were quite surprised that not only do they not see patients on weekends, they don't even talk to them. We were referred to a 1-800 line where we didn't even talk to a doctor but a nurse practitioner. Seriously??? (FWIW, my father-in-law was appalled when we told him this story, but I'm wondering if that's because his practice is small-town and in a very competitive market.) I'm curious if this is just where pediatrics is headed in medium-sized communities like ours.

If the 1-800 NP line was not somehow affiliated with your pediatrician and not able to access your child's medical records from their location, then I would say that this is not the norm in my neck of the woods. The practice I currently work in is primary-care (all ages), urban/suburban and we have physician coverage 24/7/365. Some practices staff their off-hours coverage with mid-level providers though. The majority of practices I'm familiar with in this area (whether its solo, partnership, multi-provider, or academic/training) are the same. In fact, many local health insurance plans and hospital affiliations will not take on a new practice unless detailed information is provided for emergency/weekend/holiday coverage (a generic 1-800 line wouldn't be sufficient here).

[Ben E Lou]

Originally Posted by JonInMiddleGA

The one thing that seems a little unusual to me here is that you didn't have an option that involved talking to a doctor somewhere on the weekend. Even if it's to reach a call service doctor by going through their NP, there was usually an option for overnights & weekends.

My understanding from reading our Pediatrician's web site is that in some cases the NP service will refer you to the "on-call" physician. (I use quotation marks because that term evidently means something entirely different here. In my wife's family, it means that we don't go to the extended family Christmas or Thanksgiving dinner if it's more than 20 minutes from the office when one of them is on call. ) In our case, we were referred to the Urgent Care facility that, by the time we had gone through all that rigamarole, my wife and daughter were already sitting in.

[Ben E Lou]

Originally Posted by fpres

If the 1-800 NP line was not somehow affiliated with your pediatrician and not able to access your child's medical records from their location, then I would say that this is not the norm in my neck of the woods. The practice I currently work in is primary-care (all ages), urban/suburban and we have physician coverage 24/7/365. Some practices staff their off-hours coverage with mid-level providers though. The majority of practices I'm familiar with in this area (whether its solo, partnership, multi-provider, or academic/training) are the same. In fact, many local health insurance plans and hospital affiliations will not take on a new practice unless detailed information is provided for emergency/weekend/holiday coverage (a generic 1-800 line wouldn't be sufficient here).

It was a fairly generic 1-800 line, as best as I could tell.
800-665-2931.

To be clear, this is mostly an academic exercise at this point. When we passed the 60-minute mark with no callback whatsoever from the initial call to the answering service, we were pretty sure we'd be looking for a new Pediatrician come Monday morning anyway. (We never did get a call back until I called a *second* time, 2 1/2 hours later. Good thing we have Pediatricians in the family or, as first-time parents, we might have been kinda freaking out. This is by a pretty long shot the most lethargic we've ever seen her, but likely only because of numerous conversations with SWBMO's dad and brother about various scenarios and symptoms were we mostly laid back about her condition.

[JonInMiddleGA]

Originally Posted by Ben E Lou

(I use quotation marks because that term evidently means something entirely different here. In my wife's family, it means that we don't go to the extended family Christmas or Thanksgiving dinner if it's more than 20 minutes from the office when one of them is on call.

My experience has been anywhere from 1 hour to 4 hours for a return call. Typically much much closer to the 1 hour, but I've been told "within 4" and "within 2-4" a couple of times ... but never more than once by the same people

[Swaggs]

That sounds pretty much like our pediatrician's practice. They have hours from 7:00 AM to 7:00 PM and have an similar emergency line (we generally use urgent care if we need it on the weekend).

I think the trend is toward using PAs and NPs, as most medical doctors don't work 90 hour weeks anymore.

[Ben E Lou]

Originally Posted by JonInMiddleGA

My experience has been anywhere from 1 hour to 4 hours for a return call. Typically much much closer to the 1 hour, but I've been told "within 4" and "within 2-4" a couple of times ... but never more than once by the same people

Heh. F-I-L could just be old-school then. He said anything over 30 minutes was "totally unacceptable."

[Draft Dodger]

Originally Posted by Swaggs

That sounds pretty much like our pediatrician's practice. They have hours from 7:00 AM to 7:00 PM and have an similar emergency line (we generally use urgent care if we need it on the weekend).

I think the trend is toward using PAs and NPs, as most medical doctors don't work 90 hour weeks anymore.

yep, when something short-notice comes up our regular doctor is usually booked so they have us see a PA at the clinic. I've had no issues with that.

Any calls I've ever made have only gone as far as a nurse. Again, no real complaint

[cougarfreak]

Pretty normal here. Anymore, for illnesses that aren't too serious, I hit a walgreens clinic. The wait time is usually shorter than our doctor, even if we have an appointment, and the care is just as good, if not better.

[BYU 14]

Pretty much the norm here in Phoenix too, though our current family Doctor will call back within an hour or so, he is an anomaly. For the most part in past years it has been general health service lines manned by a NP or RN and they usually end up directing you an an urgent care or the ER.

We are fortunate to have the doctor we have now as he is very patient friendly, even calling in prescriptions from phone calls, which most doctors here will no longer do without seeing you.

[CU Tiger]

Heh...funny just had this conversation over Thanksgiving. A good friend of mine from childhood who was over recently opened a Pediatric/GP facility locally and they are exploding in growth.
The reason?

They spilt shift everything. No doctor works more than 4 days per week or 10 hours per day. But they split shifts where 2 work 6A to 4P each day and 2 work 10A to 8P.
4 work wed-sat
4 work sun-wed
The ones who are off cover after hours phone duty. They employ no NPs and only 2 nurses. The docs do all the hand son and even answer the phones some on the weekend.

Business is crazy good, their rates are above average and people are happy. Now the problem is wait times are getting long so they need to add a doc or two (2 for balance)....but these 8 are all friends and can't find an agreed upon partners.

[albionmoonlight]

Originally Posted by CU Tiger

They spilt shift everything. No doctor works more than 4 days per week or 10 hours per day. But they split shifts where 2 work 6A to 4P each day and 2 work 10A to 8P.
4 work wed-sat
4 work sun-wed

Dude, that sounds like an LSAT logic problem.

As for Ben's question, our service does have an NP line, which is what you get after hours. But they are very competent. And, there are limited Dr. hours in the mornings on the weekend, so if something happens overnight where you need to get in, you can do it.

The quality of the nurse line does matter. Their nurses are very good. There is also a 1-800 nurse line as part of my insurance. The couple of times we used it, they were totally useless.

[Swaggs]

Originally Posted by CU Tiger

Heh...funny just had this conversation over Thanksgiving. A good friend of mine from childhood who was over recently opened a Pediatric/GP facility locally and they are exploding in growth.
The reason?

They spilt shift everything. No doctor works more than 4 days per week or 10 hours per day. But they split shifts where 2 work 6A to 4P each day and 2 work 10A to 8P.
4 work wed-sat
4 work sun-wed
The ones who are off cover after hours phone duty. They employ no NPs and only 2 nurses. The docs do all the hand son and even answer the phones some on the weekend.

Business is crazy good, their rates are above average and people are happy. Now the problem is wait times are getting long so they need to add a doc or two (2 for balance)....but these 8 are all friends and can't find an agreed upon partners.

It sounds like business is good, but at some point they will have to decide whether to grow (likely with PAs and/or NPs, unless they want to work more hours themselves and risk burnout) or stick with what is working and be happy with what they are making. It is a fine line, as more money always sounds good, but burnout from hours or managing too many employees/clients is easy.

For what it is worth (in regards to the thread as a whole), I know our children are largely the most important thing in the world to most of us, but the folks that work at the doctor's offices have family and outside lives, too. Unless they advertise 24-hour coverage/7-days a week, it seems reasonable to give them some slack on availability. Maybe we are just lucky in the areas that I have lived (Pittsburgh, Durham, Morgantown), but I have always been pleased with the care we have received at various urgent cares. Less so with EDs, but they are generally unpleasant under any circumstances.

[Flasch186]

Its been my short experience that no matter what the symptoms the answer we receive is "Take him to the hospital". "But doctor it looks like a small splinter..." "Take him to the hospital"

[fpres]

Originally Posted by Ben E Lou

It was a fairly generic 1-800 line, as best as I could tell.
800-665-2931.

It looks like that is the phone number to an after-hours telephone triage service in Plano, Texas called 'Triage 4 Pediatrics.' Just going off of their website, it's nurse owned and operated and they use evidence-based protocols developed by Dr. Barton Schmitt when they interact with patients/parents over the phone. I would assume that they have been contracted to provide off-hours coverage for your pediatrician. (Dr. Schmitt's name is fairly well-known in the pediatric and primary care community, BTW).

Hope everything ended up turning out okay.

[Galaxy]

Originally Posted by Swaggs

That sounds pretty much like our pediatrician's practice. They have hours from 7:00 AM to 7:00 PM and have an similar emergency line (we generally use urgent care if we need it on the weekend).

I think the trend is toward using PAs and NPs, as most medical doctors don't work 90 hour weeks anymore.

I think it's more than just the long hour weeks, but that's another topic.

[gstelmack]

At our pediatrician's office:

- They have Saturday hours
- Someone is always on-call
- When you call you often talk to an NP first to see what's going on, and they get the doctor on the horn if they need him or her
- If you call off-hours, it rolls over to a local hospital pediatric nurse line, who does the same thing
- You can call that line directly or through the office, and the charge is $10 added on to your next bill. Was very nice as first-time parents with all the "stupid" questions like "she's doing X, should we be worried?"

In at least one instance we have had to take our daughter to the emergency room, but the pediatrician met us there to handle her care instead of the ER doctor, and it was all handled by calling the office line which bounced through the nurse and on to the on-call pediatrician. Note that my primary care physician is the same way: notify the office if you have to go to the ER during off-hours, and the on-call physician will get there as well if possible.

As a side note, my mom was a nurse, spending much of her career in ICU. She'll tell you that even back then nurses provided much of the care, as they spent the most time with the patients, and often know as much as the doctors on care topics. The medical industry has finally caught up with reality and is allowing the nurses more and more leeway on being that first line of defense.

[chesapeake]

After reading this thread, I am even more pleased with the office we picked for our kids. The on-call doc came into the office on a Sunday morning just to see my 2-year old two weeks ago when her antibiotics weren't getting the job done.

You do get bounced directly to what I expect is an 800 line in the very wee hours of the morning to talk to an NP. The one time we had to do that, the advice turned out to be right on, so I can't complain.