Differences in routine physical exams by independent PCP's and large HMO PCP's.

My medical insurance is currently through a large California HMO that also operates in other states. Prior to joining them I was with a local medical group HMO that was available to me because of the insurance I had. I have not had a complete physical since joining the large HMO. The physicals have been more of an office visit than an exam. The prior medical group PCP doctor did a thorough physical exam each year, leaving no stone unturned. He discovered issues that led to surgery.

Friends that go to the same HMO have the same issues in that no actual physical exam is done. During my last dermatology exam I was only asked to remove my shirt. Other friends, who are seniors also, have thorough exams by their doctors every year including a DRE and genital check. Their doctors are in private practice or part of a small medical group.

I'm aware that there is discussion in the medical field on the validity of physical exams. Some say it is wasting everyone's time and others say its important. While reading posts on here I find that some still have doctors that do complete physicals and others like me get no physicals worth the time fro the doctor. I'm curious what type of plan posters have - large medical HMO or smaller independent doctor groups. I believe that my HMO instructs their doctors to do the minimum, basically assembly line medicine.

Haven't had a DRE in 26 years. Every physical that I have had in the last 10 years or so have been exactly as you have described yours to be. My experience has been that it is more if the doctor is affiliated with a large hospital conglomerate or not.

I have not had a physical including a genital exam since I was 18. My current doctor is part of a large hospital/chain in the area; I have to request anything get brought up like a skin check. between pediatrician and now I was seeing primary care residents at a hospital run by a medical office.

I have not had a physical in 22 years. I stopped getting them when I realized that not one physician ever detected any of my health issues as a result of a physical. They couldn’t detect even a deviated septum I had until I was 50, despite all of them looking up my nose. They didn’t diagnose a hernia, asthma, allergies, knee problems, vision problems, and a few more.

I found out about the deviated septum because I went to an ENT to have my hearing checked. Well he checked my ears, nose, and throat. He found the deviated septum easily.

Almost all my physicals up to that point were CPE. One doctor tried to bully me into one but I flatly refused. I have only had HMO’s for most of my life.

I think the futility of Complete Physical Exams which are qualitative at best has given way to quantitative laboratory, and imaging technology. That doesn’t leave much for a doctor to do as far as physicals go.

I should add that I visited a dermatologist for a skin check. The practice was part of the HMO that manages my care. It was a thorough skin check.

I have not experienced a difference in terms of the nature of my physical exams. I would say that being seen for a sick visit was a lot faster going to the HMO when I had that arrangement. It was a staff model so there were ample docs and nurse practitioners. For my exams, all were thorough. The only difference was the nature of my rapport with the doc. Some were very easy to relate to while others were indifferent or seemed distant.

I think you are on to something. When I first moved to California and selected insurance through my employer, I chose a smaller HMO, not the hugest one. But a coworker said I should have picked the largest one, because they were so much more efficient and convenient. So at the next insurance open enrollment, I switched. Sure enough, when I went to the new doc, instead of different departments being in different buildings, everything was in one huge hospital building, at most on a different floor. But I never even was asked to take off my shoes, much less my street clothes. It was all about the blood and urine tests.

I’ve had similar experiences to most below it seems like. Mostly just a conversation, going over labs, are you having any issues, any changes since last time, etc, then a quick listen to heart and lungs.

Once had a form I needed filled out for school that had a long list of checkoffs on it including genital and rectal but the doctor got to that point and said “eh, we’re just going to say everything’s good there” and moved right along.

Having been self employed most of my life and before that working for places that didn't provide us with health insurance I always paid for my own. I didn't like what an HMO did so I never bought that type. I don't trust someone sitting in a swivel chair with a calculator deciding what my health care should be. I always chose my own personal physician and hospital. The only problem was doctors are forced to be associated with a hospital so you lose some choice there. Now that I'm on Medicare I'm kind of stuck with something similar to an HMO especially having part C “Medicare Advantage”. That's only been available to me starting this year so I shall research other plans to see if there is one I like better. I feel I got much better care from my other doctor than I do now. Nothing against her she takes good care of me but the visits appear to be limited by some other entity. My old doctor had me strip naked as soon as I was in the exam room. He spent about 30 minutes examining me and discussing whatever, then I got dressed and made the next appointment on the way out. With my new one she listens to my heart and breathing through my shirt and seems to be reluctant to look at any part of my bare body. I had a rash in my groin I asked her about and she wouldn't have looked at it if I hadn't quickly dropped my draws in front of her so she felt obligated to take a peek. After my 3rd year with her I had to ask her to do a prostate check where my old doc did one every time. Same thing with checking my testicles only she was showing me how to do it myself. I don't want to do it myself, I want someone who knows what they're doing to do it.

Until this year if you went to a hospital and they brought in someone who wasn't on your plan you had to pay them yourself. A typical scenario was for an operation your surgeon was on your plan so all you paid him/her was the $30 fee described in your plan but the anesthetist typically was not and you would get stuck with however many thousand dollars they felt like charging. That seemed to be some sort of arrangement for the hospital to get more money too. My US Senator was one of the sponsors of a bill that passed and took effect in January limiting non plan participants chosen by the hospital like that anesthetist to the same fee as others in your plan. However I still had to pay my fire department's ambulance service $270 to haul me 1.5 miles to the hospital.

Interesting note: when I was in cardiac rehab 27 years ago Dartmouth/Hitchcock sent someone to survey us about our whole experience. One question was how did we get to the emergency room. There were about 50 of us there and only one went by ambulance, the rest of us either drove ourselves or our wives did. The woman who used an ambulance was on a boat cruise off the coast of Alaska and the captain had the ambulance meet them at the dock so does that really count?

Different physicians perform their physical exams differently. Period. My last three physicians were all part of the exact same small, local, medical group. The first two physicians were in the the same practice, so they were even in the same office building. One exam room was one hallway over from the other. All three were completely different, from one extreme to another. I don't think this is a large vs small, male vs female, old vs young thing. I agree that there are certain nuances, advantages, and disadvantages that come with large vs small medical groups. But I don't think that is the only thing that defines what kind of physical you will receive.

Once you retire and go on Medicare its called a Wellness Visit all they do is test your mental state and check if you have a pulse you don't even get into a gown

Get in. Get quick vital signs - no need to even remove your heavy combat boots for the weighing. Doc comes in, asks if you've been jabbed for covid; lectures you if not. Doc prescribes a blood test at a lab to check for all the things they used to. Doc dismisses you. You pay your co-pay and leave promptly. Next.

That's healthcare in today's United States.

Get in. Get quick vital signs - no need to even remove your heavy combat boots for the weighing. Doc comes in, asks if you've been jabbed for covid; lectures you if not. Doc prescribes a blood test at a lab to check for all the things they used to. Doc dismisses you. You pay your co-pay and leave promptly. Next.

My sub only gets blood work done once a year to check his current uric acid levels. The PCP doesn't check for much else.

His kidney doctor checks blood work for his things every 6 to 9 months. The cardiologist checks those numbers at his visits.

I remember physicals from school needing a urine sample, more hands on of the body to check for anything to be felt out of the ordinary and just a general feel that the doctor was actually checking on you. Not what any of sub's “physicals” have been.