Access to Health Care is Not the Same for Everyone

Dr. Tom Hopkins:

Welcome to Prescriptions for Your Practice, a podcast by doctors, for doctors. Here, we delve into some groundbreaking topics in patient care, practice management, and physician well-being. Brought to you by Hill Physicians Medical Group.

I’m Dr. Tom Hopkins, your host in this unique journey. And joining me today is someone who, every time I talk to him, it seems like everything ends up being about a podcast. You might have run into him as well, Dr. Gould. We’ve discussed many things, and it’s a privilege to have him here today to talk about physician access.

Before we dive in, Dr. Gould, could you introduce yourself and tell our listeners a bit about you?

Dr. Richard Gould:

Yeah, absolutely, Tom. It’s always great to talk with you. I’m a pediatrician here in Sacramento.

I’ve been practicing for about 37 years now. It’s been a long time, all in private practice, then in group practice, and now what I call interdependent practice. That’s what we do.

Dr. Tom Hopkins:

Great. The topic today is something we talk about often, but it’s become even more important now—access to care. I remember just recently, during a leadership conference we were on, access was a major topic.

We’ve had some discussions about physician access. I want you to share what access to care means to you as a physician and how you define it.

Dr. Richard Gould:

Yeah, I think one of the things, being active with the IPAs, is that we hear about access a lot, and there’s a difference in perception depending on who’s defining it. For insurance companies, it’s often metrics like the third next available appointment or capacity for well and sick visits.

But from my perspective, it’s really about the patient’s access to me, my practice, and my ideas. When a patient calls, do they navigate through our phone system to resolve their problem? If a patient needed paperwork signed for an athletic program, and it was handled efficiently, in their mind, they’ve experienced good access—even if they never talked to me directly.

Dr. Tom Hopkins:

That’s interesting. How does access differ for a pediatric practice compared to primary care or other specialties?

Dr. Richard Gould:

We focus heavily on same-day visits. If a patient needs to be seen, we strive to get them in that day. We don’t usually wait a day or two unless they’re older and we know the symptoms may resolve.

It’s often not the patient themselves requesting access—it’s the parent. And for them, by the time they’ve called, it’s already an emergency in their minds. We have to balance that perception and respond in a way that’s reassuring and appropriate.

Dr. Tom Hopkins:

I have to say, most pediatricians I know do an exceptional job with same-day appointments. For adults, it’s a little different. We assess the acuity and try to balance immediate demand with true need.

How do you handle those challenges?

Dr. Richard Gould:

Yeah, we face similar pressures, especially as patient complexity increases. It’s about listening closely to understand what the patient—or the parent—is really worried about. For example, if a parent calls saying their child has a fever of 104, the concern may not be the fever itself but fear of meningitis or vaccine reaction. Understanding the underlying concern helps us manage access better.

Dr. Tom Hopkins:

Exactly. It’s about managing expectations and deciding when they need to be seen or if another type of care is appropriate.

What have you done in your practice to manage these challenges?

Dr. Richard Gould:

One thing we did around the time of COVID was integrate video visits. Even after hours, if a parent wants to go to the ER, I offer a video visit first. Sometimes that’s enough.

If a parent says, “My kid’s in school till 3, but I need them seen,” I assess how urgent it is. We also use telemedicine during the day to provide immediate advice and reserve in-person visits for when they’re truly necessary.

Dr. Tom Hopkins:

I agree—telehealth has helped bridge gaps in access. Now, let’s talk about referrals, which can be another barrier to access. Tell me about the challenges you face in referring to specialty care.

Dr. Richard Gould:

Referrals are often like juggling slushies. Parents sometimes demand a referral, and I have to assess if specialty care is truly necessary. Often, I’ll start treatment and say, “Let’s check back in a few weeks. If there’s no improvement, I’ll refer.”

It’s about managing expectations and ensuring the referral is warranted, based on clinical needs—not just a parental request.

Dr. Tom Hopkins:

Absolutely. Setting expectations is crucial. Letting patients know there may be a wait or a different process helps manage their concerns. Case management can be a great tool here.

How does your practice utilize case management?

Dr. Richard Gould:

We have a pretty robust referral process, but in complex cases, we involve case management early. For example, if a child has a complicated issue, the case manager might find alternative practices that fit the family’s needs.

It’s about connecting them to the right resources and ensuring someone is helping navigate the complexities.

Dr. Tom Hopkins:

It’s all about setting expectations and communicating clearly with patients. So, as we wrap up, what would you say to doctors listening about prioritizing access in their practices?

Dr. Richard Gould:

Stay curious about what happens to the patient after they leave your office. Just because you have room in your schedule doesn’t mean you have good access. Ask yourself: Are there ways to improve access without increasing your own burden, and how can you problem-solve the rest of the patient’s journey?

Dr. Tom Hopkins:

Exactly. It starts with us. We need to understand the problem, look at what’s working in our offices, and leverage tools like case management and community health advocates.

Thanks again, Dr. Gould, for being here, and thank you to our listeners for tuning in. We look forward to seeing you again on Prescriptions for Your Practice!