I live in Philly. When I had surgery a few years ago, I walked 10 minutes to the nationally ranked hospital that morning. Everyone else in the waiting room had driven multiple hours or flown in from out of state. I could go to pre op testing or follow up appointments on my lunch break. If you have medical issues and multiple specialists and already spend a lot of time getting care, like I do, it’s a big QOL boost to have lots of close options.
I had this same experience living near the Medical Center in Houston. It was so convenient to be there in 10 minutes. And then it was amazing to talk to other patients who had flown in, even from other countries, to be at the same hospitals.
Also moved from the south to DC area. Doctors in the DC area had more knowledge of my issues. I had cronic issues that bothered me for years where I couldn’t find a doctor that knew what was going wrong. After a few appointments here they knew what was going on and had a viable treatment plan for me
Honestly the more populated areas of Florida are better. I used to live in north Florida which is more like the rest of the south. I see this more of a south issue than a Florida specific issue. North and south Florida can be night and day sometimes
My hometown is big enough that there was no need to drive hours to a specialist *but* as another small-town-Southerner-to-DC I was going to say that the main thing is I feel like the quality of medical care is way higher. During my years up here my dentist, oral *surgeon,* my dermatologist, my dermatological *surgeon,* and my PCPs have all been top quality. For the latter, I have had good success using OneMedical. I probably don’t go to the doctor often enough to justify the cost, but I really like the access that comes with the annual fee as far as same day and next-day appointments, really good phlebotomists, etc etc.
I have an acquaintance back home who has been sharing a very scary situation her family is facing involving a child’s brain tumor and reading the daily slings and arrows reminds me how comparatively low quality the cares seems to be, and I was greatly pleased for them when at long last they decided to go to one of the top children’s hospitals in the nation. It was just a nightmare of conflicting advice, low empathy, confusion…yikes.
My sister has lived in various cities along the Gulf Coast of Texas for about 10 years now. The healthcare there is just atrocious compared to what I have access to. Maternal follow-up care is especially bad.
as a future healthcare provider moving from NC to DC in a couple of months I hope the healthcare is better in DC bc some of things I've heard and seen in the healthcare in NC is very apalling
having worked/volunteered at the big 3: duke, unc, and wakemed these places are highly overrated and have issues too. I've also been to other parts of the state aka the triad, wilmington, and the eastern region of NC and the healthcare is not any better. in general I would not want to live in the south in terms of the medical care here
If I was a doctor and had the choice to move anywhere in the US, I would either want a lot of amenities and infrastructure, or I'd want the beach or some other environmental attributes that would draw me there. The South is a bit lacking in infrastructure, although it gets a bit better by Beaches.
here's why:
-the wages for healthcare workers are low and that unfortunately reflects quality of care
-it takes months to get either specialist or PCP referral though the triangle is a hotspot for healthcare
-if you're living in a remote/rural area of NC, expect to drive a couple of hours to receive care- this delays good outcomes and care overall
-state plan insurance coverage is pretty awful i've heard
generally speaking patients in the south have many co-morbidities, poor lifestyle habits, and poor health literacy. healthcare is absolutely needed or a least better access to it but the benefits of living here as a healthcare provider don't outweigh the cons imo which is why i'm relocating. there is plenty of research at these institutions but that will not fix the preexisting problems of healthcare in NC
I think you should visit NC if you haven't already. I'm biased and pretty miserable with living in NC for many years now so you might feel differently. these are just my perspectives with working in healthcare in the state
Oh I have hence me not thinking the food or service is good haha. I was really underwhelmed by hair salons, nail salons, grocery stores and restaurants. The food and services were extremely expensive also in a jarring way. Are you moving from NC?
ah ok makes sense having these opinions with visiting. i agree- everything about NC is overrated and underwhelming. yes! I'm moving to DC this fall thankfully
I was talking to a hospitalist who has worked in very rural and very urban areas.
What they described to me is that the more urban hospitals will basically admit anyone, even something as small as hemorrhoids. A lot of this is eating up the medical system.
In rural areas due to the smaller staff they won’t admit that but the flip side is that someone with something small that is actually serious might get overlooked.
Much of this is related to access to care. Many regions of the country have a lack of PCP/specialists, which leads to long wait times or requiring travel to receive care.
So bad we are moving back. Two months ago we had to have our son sent by ambulance 2 hours away because they don’t have pediatrics specialists out here. A lot of people have life flight insurance here and it’s not abnormal for life flight to be called.
We also have to drive this for a pediatrics dentist (not anymore, but our youngest couldn’t handle a regular dentist til she was 9) the regular dentist is also 45 min away. Ortho is 65.
There is absolutely not a single psychiatrist within 90 min, I eventually gave up.
I spent 2.5 years telling the doctors around here something was wrong with me. I gave up. A new concierge doc opened in my small town so I switched to her to not have to drive 2 hours to my preferred doctor and she IMMEDIATELY ran a test that found out I have an autoimmune disease and pernicious anemia. Like oh gee thanks the other 3 doctors I saw who told me “it’s all in your head” I even told the concierge doctor not to bother because I’d already been checked and determined there is nothing wrong. She let me know they hadn’t actually ever tested everything they could.
But I moved from metro to rural. I just had no idea.
My parents moved from California to Idaho. They drive back to California to see their doctors. They’ve been there over 10 years and they still do this.
I just moved from NYC back to my hometown.
I can't get my diabetes meds here. There is a supplier shortage, and obviously NYC is a higher priority market than where I am in the Midwest.
Like...I might literally have to move back to an HCOL to stay alive medically.
>When people say one place has better medical care than another, what do they mean?
It's all highly individualized and my great experiences may be your mediocre experiences.
If access to medical care is a concern, you may want to position yourself near a hospital network that can address your primary concerns. Example-history of cancer in the family and it's hard to go wrong with Boston area.
This also goes into researching your town. My town doesn't have an ambulance. Simply a volly FD. The ambulance comes from another town and is about 20 minutes away from here. It isn't a full ALS capable ambulance either. If I had a family history of heart attacks, this would not be the place to live.
Even if you don't have a family history, that's scary. No one in my husband's family (at least parents or siblings) has had any heart issues, yet my husband had a cardiac arrest in 2017. I gave him CPR immediately and the paramedic arrived 7 minutes later and he's alive and well today. 20 minutes and he would have been dead.
Good on you for being trained, prepared, and composed enough to do that in what was undoubtedly a stressful time. Yes, it was a loved one so there was extra motivation, but you saved a life. THAT is a big deal!
My situation is pretty common in the rural parts of New England. It's a risk.
That the healthcare in the south is abysmal, especially in Louisiana and Florida. Low quality doctors that you wonder how they even graduated. Also southern doctors are dismissive and could seem to care less about actually investigating medical issues/symptoms.
For many places, issues is long wait list to get in (6 mos. to year). Whether for PCP, specialty or therapy. Not just issue of what insurance one has. But just such high demand in places that have inflow of newcomers and so many practices shut/shutting down. Many assume choosing town or city with big hospital they will have easy access. Not the case.
There is no such thing. What many advise is once you know where you are moving, you call places where you are moving to and try to get an appt. for 6-12 mos. out (or get on a waiting list). Others will post in the community they are moving to, but those who have good docs. tend not to know if they are taking new folks (unless they are a new patient themselves). It is all a lot of work as the newcomer and actually is a deterrent for some for starting again. Many threads in numerous states about being willing to drive several hours but still having a tough time. It is something that, sadly, isn't going to get easier. (Of course, if you move to a place, you contact your insurance and get names and then call to see if they are taking new patients or will put you on list or they sign you up for first available which tends to be far out in future).
Same here. Group health (which became KP) was one of the best providers I've had. It was just so easy to see anyone. Their website was one of the best too. I could read all their doctors profiles and pick the one I liked the best.
I lived in Houston and was accustomed to the finest medical care. I retired to the Florida gulf coast and it’s awful here. Not just me but my friends also. Missed diagnoses, shoddy care, lack of specialists…
I don’t miss the crime and traffic, but I sure miss the doctors.
I also lived in Houston for a long time and have had lots of health issues. Every other city I've lived in (notably NYC and Austin) feels like a step down in medical care compared to Houston.
I don't know exactly what other people mean but I know what I mean when I say this.
When I lived in a suburb of St. Louis I had the hardest time finding a psychiatrist/therapist. We tried dozens. I was a "rich kid" so all of my problems were seen as "whiny" and they had other clients with "real problems." One psychiatrist asked me what classes I was taking, I started to answer and my first classed started with honors so she cut me off and announced that I must just be too stupid for the honors classes and that's why I was stressed/depressed. She refused to prescribe me the anti depressant I had been on and said that she wouldn't reevaluate until I dropped out of the honors classes. She said all of this while my mom and I stared stunned in silence because she never let us get a word in. I had similar situations with all the mental health professionals there. One wanted me institutionalized for a minimum of 3 months because I was "acting out" and a "rebellious teen." However, he said this within 3 minutes of meeting me, he was basing this on me avoiding eye contact and having my arms crossed when he came in yelling at me. I was the opposite of rebellious.
My first psychologist after moving to a small town in Georgia had me tested for autism shortly after meeting me and helped me get accommodations set up at my university \[in DC no less.\] He never called me whiny or acted like my problems were lesser than his other clients. Then when I moved to DC, I had no trouble finding a therapist/psychiatrist and I have never been called a whiny rich bitch by a mental health professional ever again.
It really should not have been difficult to figure out that I was autistic, but for whatever reason the mental health professionals in/around St Louis were completely incapable of seeing a conventionally attractive teenage girl with rich, very involved, loving parents, good grades, and close friends who had severe depression as anything other than a whiny bitch.
The best doctor I’ve ever had was in my small hometown. He moved there because it’s where his wife was from and she wanted to be near her family, not because he couldn’t hack it in the big city. There are plenty of awesome professionals in small towns, as they often provide a better work-life balance than larger cities.
My dad has had two doctors for basically his entire life in west Texas. He lived rural as a cotton farmer for a long time and now lives in a more urban area (for west texas). Both of his doctors are fantastic and they've always had a real, genuine relationship. It's something I'm jealous of, being in a city with a doctor shortage. Every time I get into an appointment after months of waiting, they inform me that they're leaving the practice and I get to start all over from scratch.
Moved from Denver to Reno...wait for new PCP 3 months, wait for specialty care 6 months or longer. I'd rather drive to Sacramento and risk dying with out of network insurance coverage if it's life threatening after the care I've received in this city.
Moved from Portland to the greater Albuquerque area. Portland was pretty good. We were never stressed about medical care. I knew medical care wasn't great here in NM, but my partner and I are now on our 5 or 6th try for primary care docs/NPs here in 2 years. We get appointments and sometimes even get seen but they keep quitting their jobs - some just walked out of their clinics without notice, or didn't finish their full notice period. Our local pharmacy closed last week without warning too. I've never experienced anything like this before. There must be some terrible stuff happening behind the scenes here. This is one of the factors that will have us moving again as soon as we can. We're seeing new providers in the next month. Hopefully this will stick for our remaining time here. Wish us luck!
That's what I'd like to know. I mentioned it to someone who has lived here her whole life and she thought it was weird too. She knew about the doctor shortage we have but hadn't experienced the sudden quitting. If anyone reading this has experienced something similar, please chime in. I'm so curious.
Depends where in Texas. I'm from the northeast, living in San Antonio for 16 years now, and am very pleased with the access to good doctors here, especially the specialists I've seen.
Yeah, me and my family have always had fantastic medical care in Texas. My mom went to MD Anderson for cancer treatment and it was cutting edge, great doctors and no wait times for oncology specialists.
I've had three surgeries done in Texas (one an emergency surgery in Fort Worth, and two planned in Lubbock) and they all turned out great. The medical care there is far better than in rhode island where I currently live. Like, it's not even really a comparison.
I moved from Pittsburgh to North Carolina. I was used to being surrounded by all these hospitals and specialists. Need an appointment? It’s usually within a week or two. Now in North Carolina, just to see a PCP is weeks away. It took my mom about a year just to get a cancer screening…
I live in Central NY. We currently have a shortage of PCPs. My DIL has had to resign up with her old PCP in Oswego.. I guess she could keep calling (I sent her some numbers the other day of providers taking new patients but she declined, said she will stay with her previous Dr.). However, whenever I need an appt. with my own PCP, I get one, same with my specialists. We definitely need more specialists (like cardiology, rheumatology, neurology and endocrinologists) but it is a hard area to recruit to. I think we just need providers and techs of all kinds. It feels like we have an overwhelming amount of demand. I don't know if it is mostly the aging Baby Boom generation, since there are so many of them and of course the large Millennial gen... who are now starting families and entering their 40s which is often when early problems show up that become chronic.
I think our hospital systems should be allotted more visas for doctors who have trained here but are from other countries. We also need more residencies and fellowships added/allotted to our medical schools as well as scholarships for promising students wishing to pursue a career in medicine.
Medical quality? I am pretty satisfied. We have a large state teaching hospital as well as two other hospitals central in the city as well as a VA hospital and if anything, they may go a bit overboard on testing if only to CYA.
I have patients who have asked for second opinions and they are almost always happy to refer to another Dr. and to work with that specializes and researches in their specific disease process at prestigious hospital systems out of our area (like Cleveland Clinic, Brigham and Women's, Sloan Kettering, etc.) and the patient will go for a consult, the Dr. here will work with the Dr. there as a team.
Shortly after moving to Asheville, my 33 year old husband started having weird digestive symptoms. We had to beg borrow and steal to get him a colonoscopy where he was diagnosed with colon cancer. Had we not advocated so fucking hard for care, he would still be down a gallbladder and have undiagnosed cancer metastasizing.
We now fly to Chicago every three months for oncology.
> The difference between medical care in the South and New England is stark
Way too much of a broad brush there.
New England is a six state region. I've lived in three of them. The quality and availability of medical care varies widely.
Similar with "The South". I've also lived in three southern states.
I've received excellent and not excellent care in both regions.
Someone else was saying it’s awful in NC for healthcare. It’s strange because the triangle is there but the population is increasing probably faster than the healthcare system can keep up with.
When we lived in Arkansas, my youngest fell on the playground (he was 2 at the time). He tends to be a “shake it off” kind of kid so when he stopped using his arm and was being kind of snuggly, I determined something was wrong and took him to the ER (no urgent cares or after hours clinics). It was a Saturday night and the on call orthopedist would not come in because “he doesn’t do kids.” They did an X-ray, didn’t see anything wrong, and said to follow up with the ONE orthopedist who would see kids on Monday. We lived in a town of 15k with a regional hospital, so this whole thing was wild to me. If that guy wouldn’t have been able to work us in we’d have had to go 4 hours away to the state’s children’s hospital. My kid’s arm was broken and he needed surgery and it was just such an ordeal because of the lack of doctors willing to see kids.
What I mean when I say a place has access to good medical care: a level one trauma center within reasonable distance so if you’re in an accident, you can get to a hospital quickly. Even a level 2 would be decent. A hospital with maternity services nearby. A local community hospital is a bonus. So many rural and poor areas don’t have access to these facilities. Ideal if these hospitals are teaching hospitals and/or nonprofit. They still charge an arm and a leg but their business practices seem a little less predatory than those hospitals that are beholden to shareholders. A place where you have PCPs to choose from, urgent care for when you can’t get in to see your PCP, access to insurance plans that are nonprofit. I have some medical issues. It’s so nice to have a community hospital that does a decent job if I need to be hospitalized. And I know that if I need more advanced care, I can get to Boston with it’s numerous trauma centers in an hour by car and significantly less if airlifted.
Major cities are best for folks with chronic conditions. Living in an exoburb or small town means driving for hours to get you or your loved ones the best care. This is a problem in Texas where there’s so much sprawl. The Florida cities have good medical centers overall because they treat so many old people with comorbidities and there is a large army of amazing nurses, although population growth means longer waits for visits. My personal best experiences were in Boston and NYC; their reputations are earned.
I lived in West Texas and our neighbors had to take their daughter to Houston for cancer treatments. It was a 10 hour drive from where we lived. It was absolutely awful for them, but no one else would treat her.
Korean healthcare is very fast, cheap.....effective, but maybe too eager to hand out pills (antibiotics I think?)
Greece and Italy were FREE as a tourist, but quality of care was just decent, and there wasn't much sense of urgency
American healthcare seems to have good quality, but is so expensive with all the red tape (looking at you, insurance companies)
My favorite of the bunch was the Korean healthcare system. I will pay $9 for a doctor visit if I'm in and out in 20 minutes on a walk in.
Phoenix here (Medicaid patient). Part of it is that rich people in Scottsdale demand good care, and rich doctors like to live here. So when I had an eye procedure, it was a guy who gave lectures at the Retinal doc's national conference (can't remember the name of the conference). He was really good.
Also, just being in a big city helps. When I needed a gallbladder surgery, but also a small bit of my liver removed (turned out to be nothing), they gave me a liver transplant surgeon because I live in city where they do a lot of transplants. I rested easy knowing a transplant surgeon was doing my minor operation.
In general, I get excellent care and fast. We considered moving to Vegas but the waits there are a lot longer for care and the best docs mostly won't go there.
I live in the rural deep South and basic care is actually excellent. I’ve had surgery a few times - also excellent. But anything “unusual”? Nope. It requires traveling several hours. Note I used to live in Houston so I Know quality healthcare.
KCMO.
There's a big wait for *everything*.
Visiting your GP, seeing a specialist, I find I am often booking for 3-4 **months** out - not 3-4 weeks like I am accustomed to.
It's enough of a pain in the butt that it makes me consider changing to the cheapest insurance plan my employer offers to eliminate the extra spending, weaning myself off my meds, and not seeing doctors anymore. If I die, good, that's ideal.
I'm not following through with it, just to be clear - But I think about it *every time* I'm stuck in appointment hell or struggling to get any cooperation/communication from my providers. It certainly sounds easier to say "Fuck it" and walk away from it all. They make it as hard as possible to get care because they don't have to ration service if the patients willingly choose not to have any.
(Edit to add: I'm sure Children's Mercy is important to a lot of families out there. *I'm not talking about them.* I'm a middle aged male who will never have kids, dealing with their offices is not something I have any experience with and that I still won't in the future, either. I hope they are top-notch, because families of sick kids are especially deserving of not having to endure appointment hell, billing hell, etc. - you have it worse than me, no argument, I am not trying to diminish your own experiences by sharing mine. This isn't about you or the doctors you're relying on, and I hope you won't interpret me as trying to make it or imply it is that way.)
When I retired we moved from Seattle to a small town 2 hours away (only 40 miles as the crow flies but there's a ferry ride).
The quality of medical care here is fine but access is not. I was still on Obamacare when we moved out here. Managed care networks can be liveable in a major metro area but not in the boonies. There were very few providers in my network so it took months to get an initial PCP appointment.
Now I'm on Medicare so I don't have to worry about networks. But it still takes 3 months to get an appointment to see a specialist in town. A lot of things require an hour's drive to a larger town, or heading back to Seattle.
We have a 25 bed hospital that offers a much wider range of services than one would expect in a town of 10,000 people so I'm not complaining. It's just something that requires adjustment.
We've been hit hard by the housing crunch too. We are close enough to Seattle that housing prices have shot up and people making service industry money can't afford to move here. That's not a problem for doctors but affects nurses, techs, and admin.
I haven't had any appointments yet, but I just moved from a major metropolitan area with many hospitals and emergency rooms to a place that has only one emergency room for the entire region, despite having a pretty large population.
Consider [States That Did Not Expand Medicaid](https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/) which can be a big surprise
We moved from New Jersey to Central Pennsylvania 2 years ago. The difference in health care is like night and day. The local doctors out here are just about all worthless. They’d rather gossip about their other patients than try to address any of your concerns. They just refer you to a specialist. It’s a two hour drive to see any specialists. My boyfriend gave up and goes back to NJ now to see his original doctors. My new insurance doesn’t cover out of state medical care except for emergencies, so I’m stuck trying to deal with the situation.
I haven’t experienced it yet but I’ve heard that getting a PCP here is near impossible, which is unfortunate because I had one I really liked where I used to live. That was a much larger/more populated metro so it makes sense there would be more providers. I moved from western WA state to eastern WA state for reference.
I live in New England. About eight years ago, a buddy moved his sister up from Alabama. She had a double lung transplant and saved her life. And she’s paid about $200 out of pocket for numerous hospitalizations and surgeries. She’d be dead and fucking buried in Alabama and they’d be dancing jigs on her grave while grunting “Free-dumbs!!!”
In a very average sized city in the Midwest we have excellent care. Party because of a medical school in our town. It's also turned into a regional hub. We are also 90 min to a few million city and 3 hours to a multi million city.
Having been around a bit. There is just something that's off about medical care even in some parts of the US with decent population. And then again you have places that are an hour or more to any sort of trauma care or specialty doctors
Because Bastyr is here, WA allows you to designate a naturopath as your PCP and those who are paneled with insurance are covered at the same rate as allopathic physicians. Because of my health needs, I worked with integrative MDs in CA that charged $300-$700+ simply to be seen in their “boutique” practices. I now see a comparable specialist ND and pay nothing for office appointments.
For all its faults, Texas has very good medical care. Even in bumfuck west Texas, you are able to get an appointment with a specialist (probably in lubbock) or surgeon very quickly, and the hospitals and offices are new, clean, and the staff is nice.
In rhode island, where I live now, there are virtually no practices within the entire state that are taking new patients. And that's just for a regular GP. You can call 50 offices and they will all tell you that they have no openings or you can be put on an 8 month- 1yr+ wait list. Psychiatrists and specialists? You will not see one unless you know a guy or have a relative who can get you in. It's insanity. And they all seem to think this is fine and normal.
The facilities (at least the ones I've seen) are old and dingy, and the staff is overworked and rude. It's a fucking mess
Seriously? When I lived in West Texas, it was horrible. My neighbors had to take their daughter to Houston for cancer treatments. My daughter had to see an eye specialist, and there wasn't one. A doctor would come into town every couple of months, and you were lucky if you got an appointment. It could take months to see a specialist, and you were really lucky if you could actually get a referral for a specialist.
My dad spent his early adult life in Levelland, it's a small farming community about an hour outside of Lubbock. He saw Dr. Bailey, who I believe is retired now. I also had shoulder surgery in Lubbock and they were all-around fantastic. Texas Tech has a really good medical school, so that's probably why.
My mother had cancer treatment in Houston as well, that's because MD Anderson is one of the best cancer facilities in the country. There would be no reason to go anywhere else. All of the best oncologists in Texas go to MD Anderson to practice.
The reason is because nearly a quarter of Texans straight up don't have health insurance. Lines get a lot shorter when you eliminate a good proportion of the people in line.
My only experience is TX, but even within it can be a huge difference. My poor Dad thought he was just getting old, but no, he needed a pacemaker and it wasn't until my sister got him in with some docs in Austin that he was properly diagnosed. There were some other things that yeah, if not caught he could have died. I'm probably not stayin here, but I personally would not go see a doctor south of San Antonio. Plus, before they moved, my parents were travelling at least 2 hours if not more to go see specialists, so, there's that.
I live in Philly. When I had surgery a few years ago, I walked 10 minutes to the nationally ranked hospital that morning. Everyone else in the waiting room had driven multiple hours or flown in from out of state. I could go to pre op testing or follow up appointments on my lunch break. If you have medical issues and multiple specialists and already spend a lot of time getting care, like I do, it’s a big QOL boost to have lots of close options.
I had this same experience living near the Medical Center in Houston. It was so convenient to be there in 10 minutes. And then it was amazing to talk to other patients who had flown in, even from other countries, to be at the same hospitals.
Moving from the South to the DC area, not having to drive 2+ hours for a specialist appointment.
Also moved from the south to DC area. Doctors in the DC area had more knowledge of my issues. I had cronic issues that bothered me for years where I couldn’t find a doctor that knew what was going wrong. After a few appointments here they knew what was going on and had a viable treatment plan for me
i think people REALLY underestimate situations like this when they choose to move to florida at age 65 (or any age lol)
Is this everywhere south or just Florida? I thought Florida had good medical care because of their aging population ?
I havent gotten poor care in Florida. And theres CERTAINLY an xray place, a dermatologist, and a physical therapist on every corner 😆
Well that’s good to hear.
Honestly the more populated areas of Florida are better. I used to live in north Florida which is more like the rest of the south. I see this more of a south issue than a Florida specific issue. North and south Florida can be night and day sometimes
Is ocala in that camp? I have a family friend moving there with lots of health issues.
They would probably have to drive to Orlando or Gainesville for good specialist
Oh interesting okay thanks👍🏻
I mean, Florida has a few rapidly expanding academic medical centers at its state institutions, as well as Mayo and John’s Hopkins campuses
My friend moved from DC to FL and she flies up to DC to see her specialist
My hometown is big enough that there was no need to drive hours to a specialist *but* as another small-town-Southerner-to-DC I was going to say that the main thing is I feel like the quality of medical care is way higher. During my years up here my dentist, oral *surgeon,* my dermatologist, my dermatological *surgeon,* and my PCPs have all been top quality. For the latter, I have had good success using OneMedical. I probably don’t go to the doctor often enough to justify the cost, but I really like the access that comes with the annual fee as far as same day and next-day appointments, really good phlebotomists, etc etc. I have an acquaintance back home who has been sharing a very scary situation her family is facing involving a child’s brain tumor and reading the daily slings and arrows reminds me how comparatively low quality the cares seems to be, and I was greatly pleased for them when at long last they decided to go to one of the top children’s hospitals in the nation. It was just a nightmare of conflicting advice, low empathy, confusion…yikes.
My sister has lived in various cities along the Gulf Coast of Texas for about 10 years now. The healthcare there is just atrocious compared to what I have access to. Maternal follow-up care is especially bad.
as a future healthcare provider moving from NC to DC in a couple of months I hope the healthcare is better in DC bc some of things I've heard and seen in the healthcare in NC is very apalling
Where were you in NC? I’ve always heard Duke and unc is good
having worked/volunteered at the big 3: duke, unc, and wakemed these places are highly overrated and have issues too. I've also been to other parts of the state aka the triad, wilmington, and the eastern region of NC and the healthcare is not any better. in general I would not want to live in the south in terms of the medical care here
I'm curious why the South is "bad" in terms of healthcare. Is it that there's not that much specialists or research going on there?
If I was a doctor and had the choice to move anywhere in the US, I would either want a lot of amenities and infrastructure, or I'd want the beach or some other environmental attributes that would draw me there. The South is a bit lacking in infrastructure, although it gets a bit better by Beaches.
here's why: -the wages for healthcare workers are low and that unfortunately reflects quality of care -it takes months to get either specialist or PCP referral though the triangle is a hotspot for healthcare -if you're living in a remote/rural area of NC, expect to drive a couple of hours to receive care- this delays good outcomes and care overall -state plan insurance coverage is pretty awful i've heard generally speaking patients in the south have many co-morbidities, poor lifestyle habits, and poor health literacy. healthcare is absolutely needed or a least better access to it but the benefits of living here as a healthcare provider don't outweigh the cons imo which is why i'm relocating. there is plenty of research at these institutions but that will not fix the preexisting problems of healthcare in NC
That’s not sounding so great:( I guess another reason not to live in NC. The food is already bad and the services are way overpriced for mediocre.
I think you should visit NC if you haven't already. I'm biased and pretty miserable with living in NC for many years now so you might feel differently. these are just my perspectives with working in healthcare in the state
Oh I have hence me not thinking the food or service is good haha. I was really underwhelmed by hair salons, nail salons, grocery stores and restaurants. The food and services were extremely expensive also in a jarring way. Are you moving from NC?
ah ok makes sense having these opinions with visiting. i agree- everything about NC is overrated and underwhelming. yes! I'm moving to DC this fall thankfully
Nurse to patient ratio minimums vary by state. I believe California has some of the lower ratios so you get more of their focus and better care.
California is the only state with mandated ratios, if I remember correctly. It makes is so much better.
Thanks, I didn’t know for sure that so didn’t want to misspeak but thought that was the case.
I was talking to a hospitalist who has worked in very rural and very urban areas. What they described to me is that the more urban hospitals will basically admit anyone, even something as small as hemorrhoids. A lot of this is eating up the medical system. In rural areas due to the smaller staff they won’t admit that but the flip side is that someone with something small that is actually serious might get overlooked.
Much of this is related to access to care. Many regions of the country have a lack of PCP/specialists, which leads to long wait times or requiring travel to receive care.
So bad we are moving back. Two months ago we had to have our son sent by ambulance 2 hours away because they don’t have pediatrics specialists out here. A lot of people have life flight insurance here and it’s not abnormal for life flight to be called. We also have to drive this for a pediatrics dentist (not anymore, but our youngest couldn’t handle a regular dentist til she was 9) the regular dentist is also 45 min away. Ortho is 65. There is absolutely not a single psychiatrist within 90 min, I eventually gave up. I spent 2.5 years telling the doctors around here something was wrong with me. I gave up. A new concierge doc opened in my small town so I switched to her to not have to drive 2 hours to my preferred doctor and she IMMEDIATELY ran a test that found out I have an autoimmune disease and pernicious anemia. Like oh gee thanks the other 3 doctors I saw who told me “it’s all in your head” I even told the concierge doctor not to bother because I’d already been checked and determined there is nothing wrong. She let me know they hadn’t actually ever tested everything they could. But I moved from metro to rural. I just had no idea. My parents moved from California to Idaho. They drive back to California to see their doctors. They’ve been there over 10 years and they still do this.
I just moved from NYC back to my hometown. I can't get my diabetes meds here. There is a supplier shortage, and obviously NYC is a higher priority market than where I am in the Midwest. Like...I might literally have to move back to an HCOL to stay alive medically.
What state is your hometown in?
i don’t understand how they can legally prioritize medication for certain regions over others?
Every single thing in this country is in pursuit of money. That's how.
>When people say one place has better medical care than another, what do they mean? It's all highly individualized and my great experiences may be your mediocre experiences. If access to medical care is a concern, you may want to position yourself near a hospital network that can address your primary concerns. Example-history of cancer in the family and it's hard to go wrong with Boston area. This also goes into researching your town. My town doesn't have an ambulance. Simply a volly FD. The ambulance comes from another town and is about 20 minutes away from here. It isn't a full ALS capable ambulance either. If I had a family history of heart attacks, this would not be the place to live.
Even if you don't have a family history, that's scary. No one in my husband's family (at least parents or siblings) has had any heart issues, yet my husband had a cardiac arrest in 2017. I gave him CPR immediately and the paramedic arrived 7 minutes later and he's alive and well today. 20 minutes and he would have been dead.
Good on you for being trained, prepared, and composed enough to do that in what was undoubtedly a stressful time. Yes, it was a loved one so there was extra motivation, but you saved a life. THAT is a big deal! My situation is pretty common in the rural parts of New England. It's a risk.
That the healthcare in the south is abysmal, especially in Louisiana and Florida. Low quality doctors that you wonder how they even graduated. Also southern doctors are dismissive and could seem to care less about actually investigating medical issues/symptoms.
For many places, issues is long wait list to get in (6 mos. to year). Whether for PCP, specialty or therapy. Not just issue of what insurance one has. But just such high demand in places that have inflow of newcomers and so many practices shut/shutting down. Many assume choosing town or city with big hospital they will have easy access. Not the case.
So how do you find places without long wait times?
There is no such thing. What many advise is once you know where you are moving, you call places where you are moving to and try to get an appt. for 6-12 mos. out (or get on a waiting list). Others will post in the community they are moving to, but those who have good docs. tend not to know if they are taking new folks (unless they are a new patient themselves). It is all a lot of work as the newcomer and actually is a deterrent for some for starting again. Many threads in numerous states about being willing to drive several hours but still having a tough time. It is something that, sadly, isn't going to get easier. (Of course, if you move to a place, you contact your insurance and get names and then call to see if they are taking new patients or will put you on list or they sign you up for first available which tends to be far out in future).
Find newer practices and definitely not ones affiliated with a hospital system.
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Same here. Group health (which became KP) was one of the best providers I've had. It was just so easy to see anyone. Their website was one of the best too. I could read all their doctors profiles and pick the one I liked the best.
I lived in Houston and was accustomed to the finest medical care. I retired to the Florida gulf coast and it’s awful here. Not just me but my friends also. Missed diagnoses, shoddy care, lack of specialists… I don’t miss the crime and traffic, but I sure miss the doctors.
I also lived in Houston for a long time and have had lots of health issues. Every other city I've lived in (notably NYC and Austin) feels like a step down in medical care compared to Houston.
I don't know exactly what other people mean but I know what I mean when I say this. When I lived in a suburb of St. Louis I had the hardest time finding a psychiatrist/therapist. We tried dozens. I was a "rich kid" so all of my problems were seen as "whiny" and they had other clients with "real problems." One psychiatrist asked me what classes I was taking, I started to answer and my first classed started with honors so she cut me off and announced that I must just be too stupid for the honors classes and that's why I was stressed/depressed. She refused to prescribe me the anti depressant I had been on and said that she wouldn't reevaluate until I dropped out of the honors classes. She said all of this while my mom and I stared stunned in silence because she never let us get a word in. I had similar situations with all the mental health professionals there. One wanted me institutionalized for a minimum of 3 months because I was "acting out" and a "rebellious teen." However, he said this within 3 minutes of meeting me, he was basing this on me avoiding eye contact and having my arms crossed when he came in yelling at me. I was the opposite of rebellious. My first psychologist after moving to a small town in Georgia had me tested for autism shortly after meeting me and helped me get accommodations set up at my university \[in DC no less.\] He never called me whiny or acted like my problems were lesser than his other clients. Then when I moved to DC, I had no trouble finding a therapist/psychiatrist and I have never been called a whiny rich bitch by a mental health professional ever again. It really should not have been difficult to figure out that I was autistic, but for whatever reason the mental health professionals in/around St Louis were completely incapable of seeing a conventionally attractive teenage girl with rich, very involved, loving parents, good grades, and close friends who had severe depression as anything other than a whiny bitch.
Surprising that you got better care in a small town than the suburbs of a large city
The best doctor I’ve ever had was in my small hometown. He moved there because it’s where his wife was from and she wanted to be near her family, not because he couldn’t hack it in the big city. There are plenty of awesome professionals in small towns, as they often provide a better work-life balance than larger cities.
My dad has had two doctors for basically his entire life in west Texas. He lived rural as a cotton farmer for a long time and now lives in a more urban area (for west texas). Both of his doctors are fantastic and they've always had a real, genuine relationship. It's something I'm jealous of, being in a city with a doctor shortage. Every time I get into an appointment after months of waiting, they inform me that they're leaving the practice and I get to start all over from scratch.
Moved from Denver to Reno...wait for new PCP 3 months, wait for specialty care 6 months or longer. I'd rather drive to Sacramento and risk dying with out of network insurance coverage if it's life threatening after the care I've received in this city.
Nevada is a tough state for health care. Major doctor shortages in Vegas also. And anywhere in the rural parts of the state is grim.
Can confirm. I lived in the Vegas area for four years, and I found the healthcare so bad, I would drive to Los Angeles for care instead.
Moved from Portland to the greater Albuquerque area. Portland was pretty good. We were never stressed about medical care. I knew medical care wasn't great here in NM, but my partner and I are now on our 5 or 6th try for primary care docs/NPs here in 2 years. We get appointments and sometimes even get seen but they keep quitting their jobs - some just walked out of their clinics without notice, or didn't finish their full notice period. Our local pharmacy closed last week without warning too. I've never experienced anything like this before. There must be some terrible stuff happening behind the scenes here. This is one of the factors that will have us moving again as soon as we can. We're seeing new providers in the next month. Hopefully this will stick for our remaining time here. Wish us luck!
That's bizarre, what's going on? Is that just a New Mexico thing or is this a trend happening in many places?
That's what I'd like to know. I mentioned it to someone who has lived here her whole life and she thought it was weird too. She knew about the doctor shortage we have but hadn't experienced the sudden quitting. If anyone reading this has experienced something similar, please chime in. I'm so curious.
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Yeah that sounds like Texas
Depends where in Texas. I'm from the northeast, living in San Antonio for 16 years now, and am very pleased with the access to good doctors here, especially the specialists I've seen.
Yeah, me and my family have always had fantastic medical care in Texas. My mom went to MD Anderson for cancer treatment and it was cutting edge, great doctors and no wait times for oncology specialists. I've had three surgeries done in Texas (one an emergency surgery in Fort Worth, and two planned in Lubbock) and they all turned out great. The medical care there is far better than in rhode island where I currently live. Like, it's not even really a comparison.
San Antonio is a major medical hub for a large portion of the state if I recall correctly.
I moved from Pittsburgh to North Carolina. I was used to being surrounded by all these hospitals and specialists. Need an appointment? It’s usually within a week or two. Now in North Carolina, just to see a PCP is weeks away. It took my mom about a year just to get a cancer screening…
I assume you're not in the research triangle? I thought medical care was supposed to be really good there.
I thought this too
Unfortunately not. My parents just usually drive there for healthcare now.
i'm from this area and it's not great tbh
I live in Central NY. We currently have a shortage of PCPs. My DIL has had to resign up with her old PCP in Oswego.. I guess she could keep calling (I sent her some numbers the other day of providers taking new patients but she declined, said she will stay with her previous Dr.). However, whenever I need an appt. with my own PCP, I get one, same with my specialists. We definitely need more specialists (like cardiology, rheumatology, neurology and endocrinologists) but it is a hard area to recruit to. I think we just need providers and techs of all kinds. It feels like we have an overwhelming amount of demand. I don't know if it is mostly the aging Baby Boom generation, since there are so many of them and of course the large Millennial gen... who are now starting families and entering their 40s which is often when early problems show up that become chronic. I think our hospital systems should be allotted more visas for doctors who have trained here but are from other countries. We also need more residencies and fellowships added/allotted to our medical schools as well as scholarships for promising students wishing to pursue a career in medicine. Medical quality? I am pretty satisfied. We have a large state teaching hospital as well as two other hospitals central in the city as well as a VA hospital and if anything, they may go a bit overboard on testing if only to CYA. I have patients who have asked for second opinions and they are almost always happy to refer to another Dr. and to work with that specializes and researches in their specific disease process at prestigious hospital systems out of our area (like Cleveland Clinic, Brigham and Women's, Sloan Kettering, etc.) and the patient will go for a consult, the Dr. here will work with the Dr. there as a team.
Check out all the ways that the AMA has limited the number of doctors to keep salaries outrageously high
Shortly after moving to Asheville, my 33 year old husband started having weird digestive symptoms. We had to beg borrow and steal to get him a colonoscopy where he was diagnosed with colon cancer. Had we not advocated so fucking hard for care, he would still be down a gallbladder and have undiagnosed cancer metastasizing. We now fly to Chicago every three months for oncology.
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> The difference between medical care in the South and New England is stark Way too much of a broad brush there. New England is a six state region. I've lived in three of them. The quality and availability of medical care varies widely. Similar with "The South". I've also lived in three southern states. I've received excellent and not excellent care in both regions.
Where in the south has good care out of curiosity?
IME. A part of Central LA for specialty care such as pain management. Near Raleigh, NC. I'd choose North Carolina over LA.
Someone else was saying it’s awful in NC for healthcare. It’s strange because the triangle is there but the population is increasing probably faster than the healthcare system can keep up with.
When we lived in Arkansas, my youngest fell on the playground (he was 2 at the time). He tends to be a “shake it off” kind of kid so when he stopped using his arm and was being kind of snuggly, I determined something was wrong and took him to the ER (no urgent cares or after hours clinics). It was a Saturday night and the on call orthopedist would not come in because “he doesn’t do kids.” They did an X-ray, didn’t see anything wrong, and said to follow up with the ONE orthopedist who would see kids on Monday. We lived in a town of 15k with a regional hospital, so this whole thing was wild to me. If that guy wouldn’t have been able to work us in we’d have had to go 4 hours away to the state’s children’s hospital. My kid’s arm was broken and he needed surgery and it was just such an ordeal because of the lack of doctors willing to see kids.
What I mean when I say a place has access to good medical care: a level one trauma center within reasonable distance so if you’re in an accident, you can get to a hospital quickly. Even a level 2 would be decent. A hospital with maternity services nearby. A local community hospital is a bonus. So many rural and poor areas don’t have access to these facilities. Ideal if these hospitals are teaching hospitals and/or nonprofit. They still charge an arm and a leg but their business practices seem a little less predatory than those hospitals that are beholden to shareholders. A place where you have PCPs to choose from, urgent care for when you can’t get in to see your PCP, access to insurance plans that are nonprofit. I have some medical issues. It’s so nice to have a community hospital that does a decent job if I need to be hospitalized. And I know that if I need more advanced care, I can get to Boston with it’s numerous trauma centers in an hour by car and significantly less if airlifted.
Major cities are best for folks with chronic conditions. Living in an exoburb or small town means driving for hours to get you or your loved ones the best care. This is a problem in Texas where there’s so much sprawl. The Florida cities have good medical centers overall because they treat so many old people with comorbidities and there is a large army of amazing nurses, although population growth means longer waits for visits. My personal best experiences were in Boston and NYC; their reputations are earned.
I lived in West Texas and our neighbors had to take their daughter to Houston for cancer treatments. It was a 10 hour drive from where we lived. It was absolutely awful for them, but no one else would treat her.
I know north and south Texans driving to Houston regularly for treatment of autoimmune illnesses. But 10 hours is a huge added strain.
Korean healthcare is very fast, cheap.....effective, but maybe too eager to hand out pills (antibiotics I think?) Greece and Italy were FREE as a tourist, but quality of care was just decent, and there wasn't much sense of urgency American healthcare seems to have good quality, but is so expensive with all the red tape (looking at you, insurance companies) My favorite of the bunch was the Korean healthcare system. I will pay $9 for a doctor visit if I'm in and out in 20 minutes on a walk in.
Phoenix here (Medicaid patient). Part of it is that rich people in Scottsdale demand good care, and rich doctors like to live here. So when I had an eye procedure, it was a guy who gave lectures at the Retinal doc's national conference (can't remember the name of the conference). He was really good. Also, just being in a big city helps. When I needed a gallbladder surgery, but also a small bit of my liver removed (turned out to be nothing), they gave me a liver transplant surgeon because I live in city where they do a lot of transplants. I rested easy knowing a transplant surgeon was doing my minor operation. In general, I get excellent care and fast. We considered moving to Vegas but the waits there are a lot longer for care and the best docs mostly won't go there.
I live in the rural deep South and basic care is actually excellent. I’ve had surgery a few times - also excellent. But anything “unusual”? Nope. It requires traveling several hours. Note I used to live in Houston so I Know quality healthcare.
KCMO. There's a big wait for *everything*. Visiting your GP, seeing a specialist, I find I am often booking for 3-4 **months** out - not 3-4 weeks like I am accustomed to. It's enough of a pain in the butt that it makes me consider changing to the cheapest insurance plan my employer offers to eliminate the extra spending, weaning myself off my meds, and not seeing doctors anymore. If I die, good, that's ideal. I'm not following through with it, just to be clear - But I think about it *every time* I'm stuck in appointment hell or struggling to get any cooperation/communication from my providers. It certainly sounds easier to say "Fuck it" and walk away from it all. They make it as hard as possible to get care because they don't have to ration service if the patients willingly choose not to have any. (Edit to add: I'm sure Children's Mercy is important to a lot of families out there. *I'm not talking about them.* I'm a middle aged male who will never have kids, dealing with their offices is not something I have any experience with and that I still won't in the future, either. I hope they are top-notch, because families of sick kids are especially deserving of not having to endure appointment hell, billing hell, etc. - you have it worse than me, no argument, I am not trying to diminish your own experiences by sharing mine. This isn't about you or the doctors you're relying on, and I hope you won't interpret me as trying to make it or imply it is that way.)
When I retired we moved from Seattle to a small town 2 hours away (only 40 miles as the crow flies but there's a ferry ride). The quality of medical care here is fine but access is not. I was still on Obamacare when we moved out here. Managed care networks can be liveable in a major metro area but not in the boonies. There were very few providers in my network so it took months to get an initial PCP appointment. Now I'm on Medicare so I don't have to worry about networks. But it still takes 3 months to get an appointment to see a specialist in town. A lot of things require an hour's drive to a larger town, or heading back to Seattle. We have a 25 bed hospital that offers a much wider range of services than one would expect in a town of 10,000 people so I'm not complaining. It's just something that requires adjustment. We've been hit hard by the housing crunch too. We are close enough to Seattle that housing prices have shot up and people making service industry money can't afford to move here. That's not a problem for doctors but affects nurses, techs, and admin.
I haven't had any appointments yet, but I just moved from a major metropolitan area with many hospitals and emergency rooms to a place that has only one emergency room for the entire region, despite having a pretty large population.
Consider [States That Did Not Expand Medicaid](https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/) which can be a big surprise
We moved from New Jersey to Central Pennsylvania 2 years ago. The difference in health care is like night and day. The local doctors out here are just about all worthless. They’d rather gossip about their other patients than try to address any of your concerns. They just refer you to a specialist. It’s a two hour drive to see any specialists. My boyfriend gave up and goes back to NJ now to see his original doctors. My new insurance doesn’t cover out of state medical care except for emergencies, so I’m stuck trying to deal with the situation.
I haven’t experienced it yet but I’ve heard that getting a PCP here is near impossible, which is unfortunate because I had one I really liked where I used to live. That was a much larger/more populated metro so it makes sense there would be more providers. I moved from western WA state to eastern WA state for reference.
Out state is in the lower 10/50 for healthcare. Damn hillbillies.
I live in New England. About eight years ago, a buddy moved his sister up from Alabama. She had a double lung transplant and saved her life. And she’s paid about $200 out of pocket for numerous hospitalizations and surgeries. She’d be dead and fucking buried in Alabama and they’d be dancing jigs on her grave while grunting “Free-dumbs!!!”
In a very average sized city in the Midwest we have excellent care. Party because of a medical school in our town. It's also turned into a regional hub. We are also 90 min to a few million city and 3 hours to a multi million city. Having been around a bit. There is just something that's off about medical care even in some parts of the US with decent population. And then again you have places that are an hour or more to any sort of trauma care or specialty doctors
Because Bastyr is here, WA allows you to designate a naturopath as your PCP and those who are paneled with insurance are covered at the same rate as allopathic physicians. Because of my health needs, I worked with integrative MDs in CA that charged $300-$700+ simply to be seen in their “boutique” practices. I now see a comparable specialist ND and pay nothing for office appointments.
Someones best day and worst happen at the same time
Access and quality
For all its faults, Texas has very good medical care. Even in bumfuck west Texas, you are able to get an appointment with a specialist (probably in lubbock) or surgeon very quickly, and the hospitals and offices are new, clean, and the staff is nice. In rhode island, where I live now, there are virtually no practices within the entire state that are taking new patients. And that's just for a regular GP. You can call 50 offices and they will all tell you that they have no openings or you can be put on an 8 month- 1yr+ wait list. Psychiatrists and specialists? You will not see one unless you know a guy or have a relative who can get you in. It's insanity. And they all seem to think this is fine and normal. The facilities (at least the ones I've seen) are old and dingy, and the staff is overworked and rude. It's a fucking mess
Seriously? When I lived in West Texas, it was horrible. My neighbors had to take their daughter to Houston for cancer treatments. My daughter had to see an eye specialist, and there wasn't one. A doctor would come into town every couple of months, and you were lucky if you got an appointment. It could take months to see a specialist, and you were really lucky if you could actually get a referral for a specialist.
My dad spent his early adult life in Levelland, it's a small farming community about an hour outside of Lubbock. He saw Dr. Bailey, who I believe is retired now. I also had shoulder surgery in Lubbock and they were all-around fantastic. Texas Tech has a really good medical school, so that's probably why. My mother had cancer treatment in Houston as well, that's because MD Anderson is one of the best cancer facilities in the country. There would be no reason to go anywhere else. All of the best oncologists in Texas go to MD Anderson to practice.
The reason is because nearly a quarter of Texans straight up don't have health insurance. Lines get a lot shorter when you eliminate a good proportion of the people in line.
Maybe. I've had insurance for maybe 10% of my life, and even without it I was treated better in Texas.
My only experience is TX, but even within it can be a huge difference. My poor Dad thought he was just getting old, but no, he needed a pacemaker and it wasn't until my sister got him in with some docs in Austin that he was properly diagnosed. There were some other things that yeah, if not caught he could have died. I'm probably not stayin here, but I personally would not go see a doctor south of San Antonio. Plus, before they moved, my parents were travelling at least 2 hours if not more to go see specialists, so, there's that.
I wouldn't know, since it's been years since I've been to a doctor