Small Private Practice vs. Large healthcare system — The Bump
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Small Private Practice vs. Large healthcare system

I'm 6 wks along with my first and didn't realize how many choices there were out there for OB's, midwives, and hospitals! I've spent the past week doing endless online searches and am really struggling to decide on which direction to go (and need to decide soon so I can book my first prenatal appt). I thought it would be fairly simple and that my PCP would just recommend someone in network (Healtheast). She actually recommended I find a small private practice/clinic instead.

So, my main questions are: 
1) Does anyone have experience or opinions on the private clinic/large practice question? I guess it makes sense that a private clinic would give more personalized care, but I also noticed that these smaller clinics don't utilize midwives as much (which I am interested in if I am not considered too high risk for-- I will be 39 at delivery). 

2) Should I choose the hospital first and then a provider or vice versa? I was somewhat interested in the new Mother Baby Centers at United or ANW (United is probably a bit closer to me). Most OBs with privileges there seem to be with Allina. 

3) I'm not set on MBC so would consider other options if people have recommendations. 

Thanks for any thoughts/help! 

Re: Small Private Practice vs. Large healthcare system

  • I would fully, 110%, without a doubt recommend a private clinic.  I've had pregnancies at both and they have been vastly different.  I'll babble a bit about my experience to elaborate (and trigger-warning, I mention a loss and the terrible way that the old clinic handled it).

    Years ago, when I first moved to the Cities, I had terrible insurance.  Pretty much the only clinics that were covered were HealthPartners.  But I was young-ish, and healthy-ish, an really just needed someone to see for my annual exam and bc prescription.  So I asked a coworker for a recommendation and went with it... And then stayed with the clinic because I was too lazy to move. 

    Over the years, I started to have issues.  I was pretty sure that I had PCOS (I do), but they refused to do any testing or treatment about it.  Their answer was "we'll deal with it when it causes an issue, like you can't get pregnant."  I also had an ex- report that they had been diagnosed with something.  I requested to be tested for the whole gamut - the clinic refused to test for anything other than the one sti.  I asked to have my thyroid tested, they claimed I didn't have enough symptoms to justify the test...

    I finally got pregnant this spring.  They confirmed it with a urine test, (plus, now they ran every sti test in the book).  My normal NP "didn't do pregnancy," so I carefully selected from their midwives.  She was nice enough the first time we met, but clearly didn't even take a second to glance at my history and was almost an hour late for my appt.  Over the next few weeks, I called the nurse line with a few concerns, but felt shushed and dismissed each time. 

    Finally was time for my first ultrasound...  And we found out that I had had a missed miscarriage.  The sonographer wasn't allowed to break the news, so I had to sit awkwardly, half-naked, waiting for a doc I'd never met to come into the room, whisper to the sonographer like I couldn't hear, and then coldly tell me that my baby died.  And then I had to wait another 45minutes to meet with the midwife, who walked in and introduced herself like we had never met.  And then basically bullied me into scheduling a d&c. 

    Luckily(?) my body figured it out over the weekend and I was able to pass it on my own, in the ER.  So two weeks later I went back to the doctor's office like the ER advised.  Of course, I couldn't see my original NP, because this was still "baby related" and the new one was unavailable, so new doc it is.  And guess what... he was an hour late for my appt, too.  Know what's not awesome?  Sitting in a combo ob/ped's waiting room bawling your eyes out.  I asked, and it turns out that reception was not allowed to call to tell me that the doc was running late and they overbook rooms, so they couldn't let me sit in an exam room to wait.

    After all that, I became incredibly convinced that this clinic was doing all that they could save themselves money.  Once I looked at bills, I realized that they were also adding on billing "add-on codes" left and right.  The ten second conversation that we had about my weight ended up costing us $50, because I was now a "high risk" pregnancy.

    (I should add that I had this issue at HealthPartners, but have heard similar horror stories from friends who transferred from Fairview, HealthEast, and Allina clinics as well.)

    So I began the search for a new doc.  Read all the "best doctor's" lists, searched the boards, asked friends and family, and finally scheduled an appt.  Making sure to find a clinic that would "allow" me a natural birth in the hospital was important, so I was nervous to go away from a midwife.  But this clinic assured me that they would support the plan.

    Surprise, surprise, my old clinic delayed in sending records, and the new clinic almost rescheduled because they felt it important to read my history.  When the new doc entered the exam room the first day, it was clear that she had reviewed my records and had a list of questions and some choice words about the old clinic.  Before I left, we had a 6-week game plan to finally clarify my PCOS diagnosis, look at my thyroid, and test for a few things that she thought might have contributed to the miscarriage and the length of time that it took us to get pregnant.  I ended up back for 3 other appts for diagnostics and each time a nurse practitioner called me the next day with results.  I had a question about one of them and my actual doctor called back with the answer.

    Two months later, we found out we were pregnant again.  This office has taken my health, the baby's health, and my understood anxiety very seriously.  I had blood draws to confirm the pregnancy and to make sure that hormones were going up.  I've had early ultrasounds to check growth.  They are advocating with my insurance to make sure that the NT test is covered.  Hubby needed to see a doctor about something they found in his testing and they made sure to recommend a specific one that they knew.  I've now met two of the docs, 3 NPs, 2 sonographers, a handful of nurses, and of course the front desk ladies.  All have been very professional, kind, encouraging, and reassuring.  It's incredible.  I've also always been able to get appointments on my schedule without much of a problem (except, I had to wait for the first appt, because they only do one new patient per day and my work schedule was crazy). 

    Literally, my only complaint is that I have to pay for parking.  But the office is much closer to my house and work, so I save driving in traffic.  It's also attached to the hospital that I'll be delivering in, so if I go into labor on a weekday, my doc will visit between appts and possibly even deliver me, even if she's not on duty.

    Very long story short --  I am sooooooo glad that I switched to a private clinic. (OGI in Edina or Maple Grove, if you are curious)
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  • Very interesting that your Healtheast PCP would recommend a private practice.  Before I got pregnant my PCP recommended that I see Dr. Maggi Johnson at HealthEast Roseville when I got pregnant.  She is a family practice MD and I ended up seeing her and really liking her!  I was a high risk pregnancy--high blood pressure and then pre-eclampsia and Dr. Johnson did a great job handling my pregnancy.  She consulted with OBs at Partners Obstetrics in Maplewood too.  I delivered at St. John's in Maplewood--  St. John's also has an OB on staff too, so I was able to talk with them and Dr. Johnson when they were deciding to induce me, etc. (again, high risk). 

    A few friends have also used the midwives at HealthEast and have had great experiences if you want to go that route too.

    From my understanding, some of the private practices don't guarantee a certain doctor to be with you at delivery, they will just send whoever is on call, in my case my doctor was 100% available and was there to deliver my daughter.  

    I would recommend St. John's in Maplewood-- easy parking, hospital rooms are large, nurses are great!  
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  • I go to Health Foundations Birth Center on Grand Ave in St Paul. I love them - it feels like I'm in a B&B, not a doctor's office, they are caring and go above and beyond (had a very kind OB there tell me about my missed miscarriage - you could tell that he hated to give that news, it made a huge difference), and I like them for my regular annual exams as well. 
    me 30; DH 35
    TTC since May 2014.
    Aug 2014 BFP, EDD April 22, 2015. Low progesterone, started suppositories. Loss at 5w6d.
    Nov 19, 2015 BFP at 13 dpo, EDD July 29, 2016. MMC discovered 12/29 (9+4). Natural miscarriage 1/16 (12+1).
    AMH results 0.42, 1.2; FSH 12.1, AFC 10, dx DOR. 
    RPL testing results normal. Nurse recommended progesterone suppositories in TWW.
    Clomid + trigger + TI cycle August 2016 - failed. Thin lining.
    Femara + trigger + TI cycle December 2016 - failed. Thin lining.
    Short LP (8 days).
    Acupuncture & Chinese herbs starting January 2017, lengthened LP to 10 days 

    Summer 2016 LFAF awards: 

    Winter 2016/2017 LFAF awards:

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