Re: Doctor's fees -- Thanks Dr. Hill
From: AMD (anonymous@obgyn.net)
Mon, 16 Nov 1998 17:48:17 -0600 (CST)
Dr. Hill,
If 20 minutes is the latest you've ever run on your appointments -- I'm
impressed!!!
Do you have any suggestions for patients to improve this situation? I
have heard of offices being very strict and refusing to see a patient
that is five minutes late for their appointment. Does this work well in
practice? I know it infuriates me when the person with the 8:45 appt
shows up at 9:05 and my 9:00 appt has to wait for them.
I have tried calling an hour or so before my appointment and asking if
they are running on time. I am always told yes even if they are an hour
behind. I think they are afraid that they doctor might catch up and I
won't be there on time and screw up the rest of the day. I have tried
the first appointment of the day and still seem to end up behind other
people.
This problem is particularly awful at pediatricians' offices and I am
open to suggestions to reduce the time waiting. It really stinks to
spend 30 minutes in an exam room with an antsy preschooler after
spending 45 minutes in the waiting room. Plus I really don't want me or
my son to spend any more time than necessary in such a "germy" place.
But I hate to leave a good dr over inconvenience -- plus there is no
guarantee that another office will be any better.
Again, thanks for your insight and educational comments!
Andrea
At Mon, 16 Nov 1998, D. Ashley Hill, M.D. wrote:
>
>I wanted to thank both AMD and Ann for their comments. It *is* a very
>complex and often frustrating situation for all parties. My partners
>and I do a lot of surgical procedures (we are academic and private
>physicians and tend to get a lot of "high risk" cases). If it were not
>for the surgical volume of our practice, I think we would need to see
>more patients during the day to pay the bills. We see 3-4 patients per
>hour, which is the maximum I am comfortable seeing. That includes
>ultrasound, cryotherapy of the cervix, "quickie" repeat Pap smears, and
>longer appointments like well-woman exams and infertility evaluations.
>In many cases the problems are so complex (ie a patient with 6 prior
>endometriosis surgeries) that we will take the history the first visit,
>and add another appointment a few weeks later to do the physical exam.
>
>There are doctors in our area who mostly do low-risk office visits, and
>routinely see 6-8 patients per hour! Think about it for a moment. They
>schedule 11 minutes for a well-woman exam, which is basically a cursory
>breast exam, a super quick Pap smear, and a "see you next year" without
>discussing anything. How is this good medical care? Yet, when I talk
>with their office managers, they tell me that HMO reimbursement is so
>low for office visits that they must see that many patients to cover
>expenses, pay wages, pay malpractice ($ 85,000 per year in our area),
>etc.
>
>As to the long waits, the above reflects part of that. I agree with AMD
>who commented that waiting times are frustratingly long. I would be
>steaming mad if I had to wait an hour to two to see my doctor. Part of
>the problem is poor scheduling (schedulers may be experts, but they may
>also be only entry-level workers). It's hard to "massage" a schedule to
>get it just right for the patients and doctors. Some patients will take
>any available appt., while others demand a 4:15, or 2:30. Others show
>up late but expect to be rushed right in. Sometimes (well, probably
>many times) doctors show up late. It's doubtful they are on the golf
>course. In reality, they are finishing up the morning patients (I may
>get 5 minutes for lunch on a good day), making rounds, checking on a
>patient in labor, finishing up a surgical case, or, sometimes,
>unfortunately, running to their kid's school or some other personal
>errand that could not be rescheduled. I remember one time I was running
>20 minutes behind because the two previous patients had problems (1 had
>a stillbirth at 22 weeks, and the other had cervical cancer), and the
>patient's husband wass all over me about being late. I have not yet
>figured out how to tell a patient "your baby is dead, but I have to go
>do a Pap smear, so I'll see you later." Some things just take more time.
>I of course apologized for being late, but the husband was livid.
>Fortunately, his wife had had multiple problems and knew that I was
>probably busy with someone else's major problem, so she let him have
>hit. It was a bad, day, however.
>
>Running late is a bad deal for everyone involved. The doctor gets to
>have a massive heart attack by age 40, and the patients are
>inconvenienced and angry! The optimum solution will likely never happen:
>the doctor sees a couple of patients an hour, but they or their
>insurance company pay enough to make it worthwhile for the doctor and to
>cover his or her office expenses.
>
>I think that although this is not a true illness thread, it helps to
>talk about the non-medical side of medical care. There are a lot of
>things that need to be fixed.
>
>Take care,
>
>--
>Ashley Hill
>David Ashley Hill, M.D.
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>Orlando, FL
>http://home.mpinet.net/dahmd
>
>The above is intended for general medical education,
>and is not for specific medical advice.
>I apologize, but I am unable to answer personal e-mail
>due to time constraints.
>
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