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re: Gotta Love Doctors Offices
Posted on 9/9/22 at 8:44 pm to SmackoverHawg
Posted on 9/9/22 at 8:44 pm to SmackoverHawg
quote:
Ain't nothing in that oath with putting up with dumbshits or staying on schedule. I done read it a thousand times to make sure. I'll still give you quality care, but I don't have to like it!
I posted sort of tongue in cheek, sort of, this is a good place to vent and I know people can be dumbshits, and rude and late, but putting up with that is part of your job, if I caught myself saying that to myself at work irl, I'd strap myself into an arse kicking machine and reboot or reevaluate whether I'm in the right line of work, just me though
0
Posted on 9/9/22 at 8:50 pm to SmackoverHawg
quote:
The only reason I haven't switched to concierge is because I don't want to abandon my patients that can't afford it.
I’ve wanted to be cash only since the day I started. It would solve 99% of the problems with modern medicine.
The one it wouldn’t solve?
How to take care of the vast majority of people that need me, because I work in a poor area without enough folks like me.
I don’t let my office double book new patients. I don’t let them put more than 2 per 15 minutes without asking me first. When someone is actively bleeding, and I’ve got two in that time slot, they’re going to wait. And people walk in bleeding all the time. If someone is more than 20 minutes late without a particularly good reason, I’ll let them back but see the folks who came in on time first. I’ll run up to an hour behind, but I’m usually on-time to 25 behind. I’d love to be on time all the time, but my ER is bad, and my steroid-shot-and-zpack factory which will give you a steroid shot and z pack for whatever your complaint is can, unfortunately, only give steroid shots and z packs or send you to the ED (though not long ago they started seeing people, telling them they didn’t know what was wrong and have them call me to send something out since they were seen at the local urgent care. Somehow, that bothers me less, sadly). If I’m more than 15 minutes late, I apologize for the wait. Almost everyone is happy to wait, because they know if they need something urgently that I’ll get them in too.
I had a patient scold me as I walked in the door about 4 months ago before I could even apologize for getting behind. Turns out the patient one room over decided to have a stroke in my exam room. They were a little upset no one explained that to him before I walked in the door. I had to explain to him that it’s sort of me who’s the only one that is really understanding what’s walking through the door, and I don’t really stop taking care of folks in front of me to explain to the ones behind them what’s going on. Imagine your doctor leaving the room during your heart attack to tell the other patients they would need to wait a little longer. He realized it was a pretty silly statement, but people don’t understand that most colds really are just colds. But some of them are sepsis, pneumonia, or lung cancer. And a lot of chest pain is just heartburn. But some heartburn is a heart attack. Some people get a 30 minute spot to get “skin cancer” cut out that’s just a skin tag (which I could’ve told them from a grainy cell phone picture from the 2000s), while other people come in for a stubbed toe and have a melanoma that needs to come out today.
It’s a tiny arse town, so my schedulers are…at their limits. Just like the little hole in the wall country restaurant doesn’t have skilled wait staff, receptionists that can so much as follow rules are pretty hard to find.
The people who are qualified enough to schedule accurately are, unfortunately, doing significantly higher-level work, because the need for people who understand how things work are so few, and the demand, particularly in my area, is so high.
I’ve got patients I’ve made come in for a cough that’s gone by the time they come in. I’ve seen people who have “just a cough” that are actively dying. Patients are horrible at describing their symptoms over the phone, receptionists aren’t really capable of diagnosing and, unfortunately, mine really suck at triage despite a lot of hand holding and teaching. It’s a complex and nuanced situation. Toss in there a day a week of covering call for the nursery and then cowering the hospital/ICU for myself during all business hours, and sometimes things get slowed down.
There’s also been a whole bunch of talk about Medicaid patients in particular. My days would be a lot easier if I didn’t take it. My profits would be higher (or at least the money I made per hour of work would be). They’re over 40% of my time and under 25% of my pay, but they’re people. And they’re people that most don’t really care about. I have no savior delusions. A lot of them are beyond things I can help them with. They’re the group of patients who piss me off more than any other, too. If practicing medicine were a business, they’d be the first ones gone. And concierge or straight cash would be the next step. But unfortunately, deep down, I feel some sort of duty to help them. Nevermind that they could drive 30 minutes down the road to a doctor who has fancy FQRHC designation and gets 5x what I make to see them. Most of those doctors suck, make enough with a high enough demand that these folks are limited to 1-3 visits a year and can’t get in for acute issues, leading to them showing up in the ED, etc.
So my office runs a little behind on most days. But I think all of my patients know that I’d pretty equally push everyone else’s appointments back for them if they needed what I could help them with.
Posted on 9/9/22 at 9:11 pm to Hopeful Doc
quote:
Hopeful Doc
Well said. That's why I've always liked you. I lack the patience and tact to lay it out there as well as you did. Too many see primary care as nothing but head colds and med refills. They don't see or understand what a good clinic offers it's patients. Those that do are very appreciative and loyal. Those are the ones that keep me from doing the smart thing from a business standpoint. Those people are getting fewer and fewer.
It won't be long until those of us that are in high enough demand will have to drop out of the current system if we want to keep our autonomy and stay financially secure.
Posted on 9/9/22 at 9:37 pm to TDFreak
Exactly why I pay for MDVIP. NFW do I want to ever go back to a regular waiting room full of the unwashed.
Posted on 9/9/22 at 9:48 pm to KLSU
My Dr has a 24 hr policy if you don't cancel 1 day in advance you are paying for the visit.
Posted on 9/9/22 at 10:44 pm to armsdealer
quote:What this thread has taught me:
I am not buying this poor doctor routine.
PCP average is $250k
Specialist $350k
Surgeons $500k
Hell residents complain about making more than the average household income while they are still learning. That's household, not individual.
1. Doctors are awful at time management
2. Doctors are awful at money management
3. Doctors are not at fault for #'s 1 and 2
Posted on 9/9/22 at 10:48 pm to Porter Osborne Jr
Yep, bc that doc isn’t showing up to 8am himself. Worked at an office in HS, saw it all the time
Posted on 9/9/22 at 10:49 pm to Hopeful Doc
quote:I don't think the complaints in this thread are about doctors like you. Few care if things are running a little behind, especially if it's clear that efforts are being made to really care for each individual and keep on schedule.
So my office runs a little behind on most days. But I think all of my patients know that I’d pretty equally push everyone else’s appointments back for them if they needed what I could help them with.
This thread is about the doctors like the one earlier who said "if you don't like it you should have gone to med school".
Posted on 9/9/22 at 11:17 pm to Korkstand
Well hopeful doc represents most doctors.
Most(certainly not all) are conscientious, empathetic, and hard working.
Most are also at the mercy of many other issues.
Most (GP) have little (if any) control over their schedule. Even if they did, they aren’t logistics experts, they are physicians.
Most have no control if a patient shows up and wants to unload on them about a death in the family, or even the fact that their electric bill was stupid high this month (they don’t have a “wrap it up box”).
Most have no control over a patient who shows up on time for their appointment, but takes an hour to fill out paperwork that any reasonable person could fill out in 10 minutes.
Most have no control that (even if the policy says if you show up 15 minutes late, you have to reschedule) people stroll in 14 minutes late for their appt.
Most don’t know, or even care, if you have private insurance or Medicaid. To them, you are a patient, not a private patient or a Medicaid patient.
Most have no control that everything runs through the front of the office. These jobs pay about the same as most restaurant jobs. These jobs are hard to staff and hard to keep staffed with even minimally qualified employees.
Most are just doing the best they can. They are not any happier about being an hour behind than you are.
Most wouldn’t say this, but I will…if you don’t like it, you can go piss on an electric fence. There’s no shortage of patients, but there is (and will continue to be) a shortage of qualified physicians.
Most(certainly not all) are conscientious, empathetic, and hard working.
Most are also at the mercy of many other issues.
Most (GP) have little (if any) control over their schedule. Even if they did, they aren’t logistics experts, they are physicians.
Most have no control if a patient shows up and wants to unload on them about a death in the family, or even the fact that their electric bill was stupid high this month (they don’t have a “wrap it up box”).
Most have no control over a patient who shows up on time for their appointment, but takes an hour to fill out paperwork that any reasonable person could fill out in 10 minutes.
Most have no control that (even if the policy says if you show up 15 minutes late, you have to reschedule) people stroll in 14 minutes late for their appt.
Most don’t know, or even care, if you have private insurance or Medicaid. To them, you are a patient, not a private patient or a Medicaid patient.
Most have no control that everything runs through the front of the office. These jobs pay about the same as most restaurant jobs. These jobs are hard to staff and hard to keep staffed with even minimally qualified employees.
Most are just doing the best they can. They are not any happier about being an hour behind than you are.
Most wouldn’t say this, but I will…if you don’t like it, you can go piss on an electric fence. There’s no shortage of patients, but there is (and will continue to be) a shortage of qualified physicians.
Posted on 9/9/22 at 11:18 pm to Chipand2Putts
quote:
if you don’t like it, you can go piss on an electric fence.
Posted on 9/9/22 at 11:31 pm to Chipand2Putts
quote:
Most (GP) have little (if any) control over their schedule.
quote:
Most have no control that everything runs through the front of the office.
quote:I may have identified the problem.
These jobs pay about the same as most restaurant jobs.
quote:Well yeah if they pay the same as a restaurant job. Do doctors understand anything at all about money and running a business?
These jobs are hard to staff and hard to keep staffed with even minimally qualified employees.
quote:Can you recommend a good doctor to treat a fried dick?
if you don’t like it, you can go piss on an electric fence.
Posted on 9/9/22 at 11:35 pm to Korkstand
Sure, but you might have a problem getting an appt. Urologist appts are months out. But most don’t take Medicaid.
Posted on 9/9/22 at 11:37 pm to Korkstand
quote:
Do doctors understand anything at all about money and running a business?
seems like very few do
Posted on 9/9/22 at 11:42 pm to Korkstand
quote:
Well yeah if they pay the same as a restaurant job. Do doctors understand anything at all about money and running a business?
Even if they are running their own office (most work for a larger entity) they understand razor thin margins the same as any restaurant manager. You can only pay what you can pay. Certain positions demand more pay than others. But it’s a crap shoot if you can find someone who takes any pride in what they do.
Sure, you could cut your own pay to pay these people, but that would be prohibitive, as NO ONE wants to do their job, so why pay a premium?
Posted on 9/9/22 at 11:44 pm to Chipand2Putts
quote:
so why pay a premium?
that's what you're asking your customer to do isn't it?
Posted on 9/9/22 at 11:48 pm to Chipand2Putts
You’re right…
Most doctors don’t know shite about business.
Most doctors don’t know shite about billing, or staffing, or reimbursement.
Who do you want taking care of you or your loved ones? A business person who runs a tight ship? Or a caring doctor who only wants what’s best for all their patients?
Most doctors don’t know shite about business.
Most doctors don’t know shite about billing, or staffing, or reimbursement.
Who do you want taking care of you or your loved ones? A business person who runs a tight ship? Or a caring doctor who only wants what’s best for all their patients?
Posted on 9/9/22 at 11:51 pm to Chipand2Putts
quote:
A business person who runs a tight ship?
thought there were classes in med school for this?
is that so hard?
quote:
Most doctors don’t know shite about billing, or staffing, or reimbursement.
maybe they should look into this?
quote:
a caring doctor who only wants what’s best for all their patients?
oh, so we're playing the humanitarian card now are we?
Posted on 9/9/22 at 11:57 pm to Chipand2Putts
777…
There’s been much written that the medical industry (hospitals in particular) should run much more like the airline industry, as far as safety is concerned…schedules, checklists, hard stops.
A 777 is the same in Charlotte as it is in Atlanta or Chicago? No?
Will you at least concede that humans are more highly varied and imperfect than machines? And if so, wouldn’t the outcomes be less predictable?
There’s been much written that the medical industry (hospitals in particular) should run much more like the airline industry, as far as safety is concerned…schedules, checklists, hard stops.
A 777 is the same in Charlotte as it is in Atlanta or Chicago? No?
Will you at least concede that humans are more highly varied and imperfect than machines? And if so, wouldn’t the outcomes be less predictable?
Posted on 9/9/22 at 11:59 pm to TDFreak
First thing in the morning or first Appt after lunch, especially if they close for lunch. Pediatricians are the worst, but you can’t blame the sick kids they’re seeing. You don’t plan to be sick, so it’s tough to scheduled appts for it
Posted on 9/10/22 at 12:00 am to 777Tiger
quote:
thought there were classes in med school for this?
I’m not sure what med schools teach business management.
Did flight school include scheduling and baggage service?
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