Hi June. I'm not sure I understand it all because I don't know what a case manager is. Is this a person who oversees your medical care? I have several doctors who I work with for my health care (e.g. PCP, dermatologist, ob/gyn, therapist, etc.), but don't have a case manager. I just manage all my doctors myself. Could you hire a case manager and continue to work with your current pdoc? It would be hard to throw away an important and working relationship of 14 years. Maybe just search hard to find a case manager who is willing to work with your current pdoc? Why would a case manager want you to change pdocs? Sorry I have more questions than answers!