This winter, Dr. Eric Larson of Seattle saw a surge in patients seeking medical care. On some days, half of his patients came in wanting to be seen "urgently" before Dec. 31.
"In one case it was a guy in early middle age who had been advised to make certain he saw his doctor in 2008 because the business -- a car dealership selling only one to two cars per month since September -- might not be in business (soon)," said Larson.
Larson later heard that the car dealership sent his patient a letter saying it was staying in business for now, but cutting health care coverage on Jan. 31.
"I'm going to care for this guy on e-mail," said Larson, who is also a researcher/epidemiologist at the Group Health Center for Health Studies in Seattle. "I wouldn't be surprised if I don't see him in person unless he ends up in the ER."
Family care doctors across the country have shared similar stories of a winter rush to the doctor's office. Reasons range from economic worries, insurance deadlines and last ditch efforts to make good on 2008 promises.
In Cleveland, Miss., Dr. Scott Nelson has seen his busiest December on record.
"I had noticed earlier in the year a drop in patient volume, as many people would come to the office and leave when they could not afford to pay their deductible," said Nelson. "I assumed it was a local problem here in the impoverished Mississippi Delta."
But come December, the number of office visits in Nelson's practice shot up by 15 to 20 percent.
"Many patients have frankly told me they are here to get checkups before their new deductible starts," said Nelson.
Insurance deductibles are the maximum out-of-pocket costs patients are expected to pay each year before their health insurance starts to pay for procedures.
According to a survey by the private consultant group Mercer, the average U.S. patient has a $1,000 deductible for procedures and tests each year. That's up from an average of $500 in 2007.
"Clearly, more companies are choosing plans with higher deductibles to save on spiraling health insurance costs," said Nelson.
Doctors find that once people hit their deductibles, they want to get their money's worth in insurance coverage at the end of the year.
"The main driver is cost," said Dr. Randy Wexler, an assistant professor of family medicine at Ohio Sate University in Columbus. "If somebody has a high deductible ... then planning is not the issue -- where they are in their deductible is."
According to Wexler, many patients with health savings accounts, or who have flex savings accounts, are also fighting to get non-deductible coverage at the year's end.
"Since many plans have very high deductibles in the thousands of dollars, it is sometimes not possible to hit the annual max until near the end of the year,"said Wexler.
However, other doctors have seen the opposite effect from insurance premiums and economic turmoil this December. In some practices, patients who haven't hit their deductible are delaying treatment until January to hedge their bets on hitting their deductible in 2009.
"We have actually been seeing less patients in the past few weeks," said Dr. Gil Holland of Phoenix, Ariz.
Holland said many of his elderly patients who winter in Arizona may have stayed home this year to cut costs in the bad economy.
"Many of our patients are wanting to wait until after the first of the year to be seen, or to fill their prescriptions, so that these charges can go towards deductible obligations in 2009," he said.
Not all of the December rush, or lull, revolves around money. Doctors also attribute the December boom to patients taking advantage of holiday vacation time to see a doctor without missing work, or college kids holding out for appointments with their family doctors back home.
Dr. Arvind Goyal, chairman of the Family Medicine Department at Northwest Community Hospital in Arlington Heights, Ill., has seen more requests from small business owners and people who work in retail this December.
"People who are in business for themselves, who don't normally have time," said Goyal. But with the shrinking economy, they have less business and more free time.
Yet, Goyal said at least some of the December rush for office visits comes from good intentions.
"I myself have had in my practice more requests for surgery, for colonoscopies, for other types of services," said Goyal
"They say, 'Hey doc, I know you've been wanting me to get this done, I can do it if you schedule me at the end of the year,'" said Goyal, who added patients like to get an early start on healthy New Year's resolutions.
"The end of the year does put some additional (healthy) targets in people's minds," he said.