S/o What the f do you all want from doctors?

[Anonymous]

Currently primary care doctors make 250-300 k and no one wants to do it. They try to get doctors to work out in rural areas for 600k and no one wants it. If anyone would be dumb enough to become a surgeon with 300k student loans and the hell they go through, I wouldn’t want them as my surgeon. This is America- most smart ppl want to make good money.

[Anonymous]

^become a surgeon for only 2500k

[Anonymous]

Medical care is not going to be better, and nor is PP going to be satisfied, just with 1-3 more minutes. That's barely time for her to get the full question out.

That doesn't mean any of this is okay, frustrated PP. It's not. We all need more time. The problem is that we need a lot more time than we have, and we can't lay claim that a couple more minutes will do it and then hold forth that a doctor could squeeze in 3 more minutes per patient and fix it.

I work salaried in a federal position, which is the only way I could keep working and feel like I still give good care. I took 2 phone calls during my admin hours yesterday in which both told the front desk they hardly needed any time -- "just two minutes" and "just a quick second, I won't be but a minute." I log the actual time by a timer, because that's the way the job works.

One mom wanted lab results, because she was sure her child was jaundiced. (I am not in DC area -- this is not identifying.) Labs were normal, and getting her verified by two identifiers and relaying the results took about 2 minutes total. However, then she wanted to know *why* his eyes were yellow (they were not -- I checked the last physical exam in the chart, and I know that doc), and what she should do next, and she wanted to make sure I knew the backstory, so -- 20 minutes.

I don't begrudge those twenty minutes at all. I was able to answer all of her questions and help her with a plan. But that wasn't two minutes, although I am absolutely certain she'd never recall it as 20 minutes. It was a brief call to her.

The other call took 31 minutes, but there is no point going into the details. Also not just a minute, though.

I don't begrudge this! I stayed behind on my paperwork for other visits, but it was good care. It's just pervasive. I used to run my own practice and track the time, though, to try to stay on time for my patients. Even when we would squeeze someone in "just to check his ears," and we would be very clear they only had me in the room for 5 minutes, just to check (no "by the way," no "I've been wanting to ask you," no follow-up questions), it never was 5 minutes. Never.

The literally only time in some 40 years of doing this that I've ever had someone be accurate about estimating time (in advance, or judging it after) was if it was another doctor or nurse. Literally no other time.

That just seems to be how we work as humans in the moment. But if we don't understand what we are dealing with, we cannot fix it.

[Anonymous]

PS: A lot more time is taken up by just being human than we realize. People want you to say hello, and take turns talking. That's normal. That's civil! But if you ever listen to two docs on the phone about a patient transfer, it is really weird to the normal ear. There's no chitchat. It feels extremely brusque until you get used to it, but that's the only way to keep it down to a couple of minutes.

[Anonymous]

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Anonymous wrote:Hit reply too fast. Do you see how this makes zero sense? You want them to know better than you but you don’t want to do what they tell you to do.

Also if they take all those phone calls they’ll never have time to actually see patients in person and also they won’t get paid. Sucks but true. Your quick phone call, multiplied by 15, plus the documentation required for it, would take up hours.

There's A LOT of real estate between
"makes $50k a year" and "makes $600k a year". Doctors could stop over-scheduling, spend more time with patients, take phone calls, work on bedside manner and still make what any American would consider a lavish sum. Nobody is asking them to impoverish themselves, just maybe make a couple thou less a day.

If a doctor actually can control his own patient schedule- and let’s say he sees 3 patients per hour at 20min per patient and then has an hour at the end of the day to answer calls. And a lunch 30min. That’s 21 patients a day. Billed at primary care sick visit rates to insurance. Now he has to pay his receptionist and his two medical assistants. He has to pay his billing lady and his office manager (unless he manages his own office in which case give him an additional patient free hour per day to do administrative work , so, that’s down to 18 patients a day). Now he doesn’t double book patients either. So imagine 3 patients a day no show. You’re down to 15 a day. Now he also has to pay rent , and malpractice insurance. Can you guess how much he’d take home at the end of the day? I’ll clue you in. Not enough to stay in business.

All my doctors are driving much nicer cars than I do—apparently there's some fat to cut in the system. Sorry, not sympathetic.

Of course you’re not sympathetic. You’re an idiot.

Just imagine the types of doctors you’d have if you offered people 50k salaries! the best of the best!

Is $50k the only alternative to $225k that you can think of?

How about, like with any other job, a part of a doctor's pay be tied to customer satisfaction? The contempt most MDs show for their patients would go away in a hurry!

How much do you propose doctors make? NP and PA already make six figures. If doctors made the same why would anyone put themselves through the process of exams and residency? Tell me who would be dumb enough to do that? And then who would do all the free labor that residents provide hospitals? Someone help me understand.

250-300k would be a good level. But many doctors in procedurally-driven specialties make several times that amount.

You won’t be able to get component surgeons if you pay this. They’ll go into tech right out of college for this.

Yet the experiences of other western countries demonstrates otherwise.

They also have a very different debt structure for university and medical, different social support network, and different leave structure. Taxes are also different. It's great to sign up for all of that.

Yes, doctors need to make $600k a year because we don't have decent social welfare programs in the US. That makes complete sense.

Why are you fixated like this on something that is not common?

Then $300k doc salaries shouldn't be so much of a threat to the supply of physicians.

This would be an upgrade to the average pediatrician. For the average OB-Gyn, once you subtract the average medical malpractice insurance premium ($100,000-200,000 per year), that would drop them to $100,000-$200,000 annually. Sure, you could do that, if you think it's a good idea.

I don't think you've really thought through this, but okay.

Employers should be covering malpractice insurance. Physicians covering their own is an archaic practice from when most doctors were self-employed.

lol, you want the hedgefunds buying up all the practices, setting limits and targets and protocols just so they can also cover malpractice? No thanks, I'll take a small private practice any day of the week!

[Anonymous]

To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

[Anonymous]

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

[Anonymous]

Anonymous wrote:

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

The average primary care doctor has about 2500-3000 patients on their roster, and that's only possible if they are turning people away. People get angry when you decline to take on new patients, because "what am I supposed to do? I need a doctor!" But so do thousands of other people.

Let's say 2500 patients. One hour a year each is a total of 150,000 minutes a year. 2885 minutes a week, which is 577 minutes a workday (with 5 workdays a week). So if your doctor has a smaller than normal number of patients and spends no vacation ever, and takes no lunch break, he or she can open clinic at 8am and will close after working straight through at 6pm every day -- and there's 23 minutes available left over for using the bathroom and drinking water.

None of that includes phone calls, portal messages, or emails. And given that the average percentage of time spent on paperwork for a US physician is at least 40%, that doc will then work from 6pm until midnight on the paperwork, unless they were doing it at the computer while you were talking.

And none of that includes sick visits, or helping the family who was adamant that they are all healthy and won't take up much time because they are never sick -- until they are, and the 39 year old father has brain cancer, and the children are in trauma from it, and the 38 year old mother has clinical depression, and and and. Because those things don't happen often to one family, but spread out over 2500-3000 people, it's common enough.

What you want isn't possible under the current system, PP. It's just math. Can we design another system? Sure. That would be a great discussion. But being mad at the people trying to hold things together right now, just because they cannot make the impossible happen, is what is breaking them. They are leaving. The numbers just get harder, or you just turn more people away.

This. End thread.

[Anonymous]

We are all constrained by math.

My modest proposal is that we don't consider medical care "just a business," but as a human need as fundamental as a need for clean water, food that is safe to eat, and functioning sewer system, and the like. (Of course that can now all be gutted for capitalism, but hey, 2024 is on fire.)

That means a very different system, and one in which third parties having control along with fiduciary responsibilities to their stockholders -- pharmacy companies, private equity, middleman for-profit insurance -- should not be happening.

I don't know what the right answer looks like. It isn't this.

[Anonymous]

Anonymous wrote:To be honest, I don't understand why the healthcare system cannot be reformed such that primary care doctors can spend AT LEAST ONE HOUR with a patient per year.

Lawyers make lots of money and manage to spend an hour here and there with a client, c'mon.

Of course our system is broken and our population is chronically ill and too many dying unnecessarily has something to do with the standard of care being 20 minutes/year with one's primary care physician.

Any idiot can see that there is a strong relationship between those things.

It can be explained to you 1000 times and you still won’t get it. It is IMPOSSIBLE to design a healthcare system - available to all - like this. Literally impossible. It will never ever happen. If you want this, it is available to you in the form of concierge medicine.

[Anonymous]

I don't think we can achieve great medical care for all in this country without removing the profit to insurance and pharma companies. It taints everything from doctor recommendations to access to various tests due to coverage, cost, and just even being able to take the best medications possible. That being said, on a personal level, the doctors I have loved all had the same qualities: truly listened (not necessarily for long, but focused), took into consideration personal patient experience and history, made individualized recommendations after careful thought, were not afraid of answering questions, were not condescending and dismissive.

[Anonymous]

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Anonymous wrote:On dcurbanmoms it seems that:

People want doctors to make pennies and do work for free….

But they get mad when primary care doctors who make little money are quitting and leaving them without care.

People want doctors who pass and excel on their training exams and have tons of knowledge but then get mad at doctors who “think they know more than them” or the think NP/ PAs are better even though they don’t have to take these exams or do any training.

So seriously what do you want from doctors? Should they even exist anymore?

How about not being rude and condescending to women? Take our pain seriously? Stop telling us it is in our heads ( unless it is) How about when you cancel than you find another appointment sooner than 6 months!

Whose appointment do we cancel to get you in sooner, though?

If I cancel, make me wait sure. But why am I being punished when you cancel? And I've already waitrd six months!

You didn't answer the question.

[Anonymous]

Anonymous wrote:I don't think we can achieve great medical care for all in this country without removing the profit to insurance and pharma companies. It taints everything from doctor recommendations to access to various tests due to coverage, cost, and just even being able to take the best medications possible. That being said, on a personal level, the doctors I have loved all had the same qualities: truly listened (not necessarily for long, but focused), took into consideration personal patient experience and history, made individualized recommendations after careful thought, were not afraid of answering questions, were not condescending and dismissive.

Super. Who will pay for your health care, and who will make the drugs you need?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I don't think we can achieve great medical care for all in this country without removing the profit to insurance and pharma companies. It taints everything from doctor recommendations to access to various tests due to coverage, cost, and just even being able to take the best medications possible. That being said, on a personal level, the doctors I have loved all had the same qualities: truly listened (not necessarily for long, but focused), took into consideration personal patient experience and history, made individualized recommendations after careful thought, were not afraid of answering questions, were not condescending and dismissive.

Super. Who will pay for your health care, and who will make the drugs you need?

I am not a policy expert. I do know people in some countries have all those things without the same deep profit entanglement.

[Anonymous]

Anonymous wrote:Currently primary care doctors make 250-300 k and no one wants to do it. They try to get doctors to work out in rural areas for 600k and no one wants it. If anyone would be dumb enough to become a surgeon with 300k student loans and the hell they go through, I wouldn’t want them as my surgeon. This is America- most smart ppl want to make good money.

$300k is good money. And the issue isn't that people don't want to be PCPs- it's that specialists make so much more money.

Basically, PCPs, in some cases, are slightly underpaid, while some specialists are grossly overpaid. So people are attracted to the grossly overpaid positions if they can get into them.