Agglomeration Economies

Yesterday afternoon, startsandfits.com went to see a dermatologist for a very serious health problem: acne. Because of my new medical insurance, I am required to get a referral from my primary care physician before seeing a specialist. This is a new concept to me as I was not subject to such a requirement under my previous health insurance. More paperwork? Fine. As long as I don’t actually have to pay for health care, I’m happy.

Upon leaving for my appointment, I had a sinking feeling that I was forgetting something. Some part of my mind, buried deep within my subconscious, knew what it was, but up at the forefront of my stream-of-consciousness, I couldn’t quite figure out what it was, so I left for the appointment, trying to forget that vaguely unpleasant, “I know I’m forgetting something” feeling.

Upon arriving at the doctor’s office, I filled out the paperwork and took it back to the receptionist. That’s when I spotted the sign that told me what I had forgotten. It said something like, “Patients must show medical insurance card and referral or they will not be seen.” Yikes. I had come all the way across town and had forgotten my referral form. This appointment had been scheduled for months, and I knew that if I had to make a new one, it wouldn’t be for months. So I prepared to schmooze my way past the receptionist with a promise that, yes, I really had a referral and that I would bring it by the office later, but soon. When she asked me for my card and referral, I said, in the sweetest, most plaintive voice I could muster, “You know what, I’m really sorry, but I forgot my referral.” That didn’t really work out, because she said that, therefore, I couldn’t be seen by the doctor. Just as I was about to go into a panic, she said something that suggested a resolution was possible: “Can you get it from your doctor?”

Here’s where this story changes. It happens that the doctor’s office was on the 11th floor of a tower at 1090 Amsterdam Avenue at 114th Street that is filled up to the top floor with doctors’ offices (and with Strokos Pizza & Deli at the ground floor). As it happens, my primary care physician’s office is on the fourth floor of the same building. Because of this extraordinary luck, I told the receptionist that I would just be right back. I hopped on the elevator, went down to the fourth floor, asked the friendly receptionist there if she could check my file and give me a copy of the referral in question. She did. I took the elevator back up to the 11th floor and proudly presented my referral to the receptionist who needed it. The whole thing took maybe 10 minutes. Then the doctor saw me and everything went smoothly. File this tale as a disaster narrowly averted.

From a land use and transportation perspective, which is what this blog is all about, I couldn’t help but think how much easier the situation had been made by the fact that these two doctors had their offices in the same building. If I had lived in the suburbs, a similar trip would more likely have involved a 20-minute drive somewhere, parking, getting out of the car, getting the form, walking back to the car, and driving back to the first office. By that time, the first receptionist would say, “I’m sorry, you missed your slot.” Or I could have tried to call the second doctor and asking the staff there to fax me the form. But such an impersonal approach would be more likely to be met with, “I’m so sorry, but we’re really busy right now. Can you call back another time?” It would also require me to remember my primary care physician’s phone number, which I don’t, or to look it up, which would complicate already complicated matters. The moral of this story is that in health care, as in so many other areas of life, density is better.