What Happened when We Went from Family Doctor to Family Practice?

Our family doctor had his office in the basement of his house in 1960's Arkport, N.Y. I remember going down the narrow stairs to where his receptionist, who was also his nurse, sat. The doctor, in his fifties, did all sorts of things there. He had an x-ray machine. He had a big lab, or so it seemed to a child, with a microscope. He also made house calls.

I never liked going. It always seemed to mean a shot when I was young. My doctor experience in 2011, and her office, is vastly different.

He's a she, that's one change. If there were women doctors around the small upstate New York town where I grew up, I never heard about them. Women were nurses.

My present doctor is part of a practice affiliated with Rochester, N.Y.'s largest employer, the University of Rochester and its Medical Center. The woman at the desk when you go in is not a nurse, and you pay your co-pay before you sit down. They have at least three staff just to keep the records.

In the 1960's, I don't remember if Mom paid every time. We were poor, and I think a few times the doctor just let our payment slide. When she paid, the office visit cost about $20, my current co-pay.

My doctor's practice does not have an x-ray machine. If you need one, they hand you an order and suggest some places to go. Back in Arkport, New York, I cannot recall if the doctor or the nurse took the x-ray. I know it wasn't an x-ray technician. There were none.

Either the doctor or the nurse drew blood, took specimens and the doc did his own lab work. Here in Rochester, if I need lab work, I receive an order and get sent next door where there is a collection station operated by that same Medical Center. They're not nurses there, but phlebotomists, specialists trained to draw blood.

I really am unable to tell what the titles of most of the people I see once I get past the receptionist at my doctor's practice. Some are LPN's. A few might be RN's. Some are doctors. I saw a medical student there once. There are clerical staff to check you out, schedule your next appointment or refer you to a specialist. They all wear these new, friendly scrubs, that are multiple colors and if you don't catch their U of R ID tag, you don't know who or what they are.

I know that medical care is better now than it was in the 1960's. But I wonder if the changes from Arkport to Rochester as mirrored by how my doctor does business improved the care as much as it increased the costs? My present doctor has fewer diagnostic resources at her immediate disposal and more non-medical staff. If I am any example, I am going to her with the same problems that Mom and Dad saw our family doctor for in Arkport. And it clearly costs a great deal more.

More from this contributor:
Prognosis: Inflation
Advice for a High School Senior: Money
What is a Small Business?