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Re: Doctor's fees -- Thanks Dr. HillFrom: D. Ashley Hill, M.D. (anonymous@obgyn.net)Mon, 16 Nov 1998 15:50:16 -0600 (CST)
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
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