Why can't I get a hold of my doctor?

 

 

I remember when just starting residency in '91, clinic days were limited to 6-8 patients daily.  The model was to make sure the new guys weren't overwhelmed with learning the process as they developed interview and exam skills.  Most important was to give enough time to take the patient case (all written down on paper) and present it to the overseeing doc/teacher.  By the time 3 years passes, most of us in Family Medicine can see patients every 10-15 minutes.  It seems this was the perfect balance of getting the biggest concern diagnosed (impossible to only have 1 medical concern especially medicare aged patients!) and being able to bill medical insurance and break even.  Most family medicine clinics don't break even with seeing patients.  In fact, over the last 20 years, when a bill goes to insurance, I usually see 3/4 of a reimbursement.  Inflation is about 3% annually and yet medical reimbursement decreases every year.  You see it on TV/Internet....spending cuts across the board for reimbursable medical expense by the government for medicare.   What medicare pays for and denies usually is followed by all the medical insurance companies.  Ultimately, medical office have to be really good with cutting corners and saving money. 

So how do primary care medical clinics survive?  They are usually large groups of several hundred doctors consolidated to save on administration and staff fees....."safety in numbers".  Another popular option for young graduates is to join a hospital group.  Hospitals have deep pockets and can help the neophyte doctor float for 1-3 years with base salary/malpractice coverage while s/he builds up a following.  Hospitals know that if the doc orders tests/therapy or suggests surgery, BINGO.....lottery payment!!!!!  Medical insurance reimbursement is procedure oriented so if you order a procedure it pays much better than keeping a person healthy with health education, lifestyle change and community/family bonding.  It is very rare to see a primary care doc in a solo practice.  There is no time to see patients in clinic, review and make decisions on test results, visit patients in the hospital, maintain a business (gotta pay for the multitude of staff necessary to maintain medical records, phone calls and scheduling/billing).....or answer phone calls personally 6 phone calls daily =1 extra non reimbursed hour in the clinic.  More economical to have the phone staff return the call with a preprinted answer.   Then there is the poison of malpractice insurance increasing every year regardless of excellence of practice......I have been in practice for 20 years with no cases of suit but have to pay the same amount as a high risk-new graduate that has a fraction of my experience.  (Maybe I should practice with abandonment!!!)  Na....its not in my nature.

So now I have a private practice (solo) but it consists of tedious evaluation to identify weakness in the plans my patients have to get old and stay healthy.  My "booked up" day is equal to 6 -8 patients.  I have to laugh......its like watching 6 TV shows or 3 movies regarding comparative time spent-not the entertainment.  The medical decision making is easy, with the training I have been privy to, diagnosis and planning is a breeze!!!  (thanks Andy Weil)  The challenge is making sure the teeny weeny reimbursement I get from medical insurance (remember I get 3/4 of what I charge) pays for the roof/staff/utilities/malpractice and my paycheck.   (yes....my paycheck is exactly the same as what a new graduate gets fresh ....out....of ...residency!)   No ....medical insurance says all docs are the same.

The only way I have found to maintain the balance between giving excellence of care and not going bankrupt.  Working a second job.  Here is the irony I was contemplating on the way to an interview 2 days ago.....I give excellent care with a knowledge base I have painfully paid for out of my own pocket to make people successful with healthy lifestyle change.   I also am outstanding in time management when I run the immediate care centers I work for to supplement a "just barely getting by" private practice.   (patting myself on the back) - I can run circles around the younger guys that are complaining "why are the patients in the waiting room and not in the exam rooms" (yet the neophytes are just sitting there not helping the front desk/triage folks!!!)  Primadona pansy-grab a chart and do some work!!!

 Yes....this means to be efficient at my second job.....I have to see patients for one diagnosis and get them out of the room in 10 minutes!!!!   I have to be the doctor (in immediate care clinic) adding to the burden of society illness that I (in private practice) am trying to fix.  What a polar opposite life I lead!!!   I feel it is going in one direction though.  You would think if I healed the world and made everyone successful at lifestyle change.....no one would be sick and the immediate care clinics would go out of business.  Ain't gonna happen.....not everyone is ready for change and too many millions that are leading an unhealthy life.

Like scooping water out of the hole you dug at the seashore......the ocean is too large to bail out of your little hole.   I will be "scooping out" for a long time so who can answer phone calls?!?!