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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

How much of the shortage is due to young doctors filling med school spots then working part time soon after? I get that many of them face the fertility ticking clock soon after qualification.

Many professionals and non professionals can tell stories of long hours. Then there are all the military families facing absent spouses and parents for months on end.

What would put me off medicine personally is seeing so many different people all the time and all of them complaining about something. My father in law who was a doctor pushed his kids towards engineering.

[Anonymous]

Anonymous wrote:They should not charge extra for services that were always expected before (such as returning a phone call).

They should not tack on a new, annual administrative fee when they neither participate with any insurance, nor will they submit any forms on your behalf.

If your practice is being run by a corporation who wants to charge for your time (e.g., private equity, but not just them), then what do you do if these are the rules for your workplace -- that all time gets billed? You do it, or you get let go. Or you get severely penalized and have to leave anyway.

They can work five days a week if they want to earn an upper middle class income.

No full time doctor doing standard patient care is working only 40 hours a week, even in the federal system, where working more is not compensated and therefore actually illegal.

They should listen to the patient’s concerns and ideas, being open to a two-way conversation about the best plan for moving forward.

None is that is unreasonable , so stop exaggerating.

Your last one is not unreasonable at all, agreed.

(If you want/need higher reimbursement levels, work through your professional organization to lobby for system change that resumes all boats. Don’t just kick out your old patients who are living on a fixed income, which is what happens when you go concierge, because you want to work less but make more.)

It's nice to get your opinion, but you are not entitled to anyone else's attention and care, unless it is at the Emergency Department. Docs are not slaves or indentured servants.

[Anonymous]

cry me a river...docs have not increased their fees for at least a decade all while the insurance premiums have increased. ding ding ding, wake up, docs are responding to what is given to them. go complain to the insurance company, your lawmakers to force a chance. it will continue getting worst thanks to the politicians including OBAMA who did this to dentistry and medicine. since then, all docs are stuck where they are with no growth so what do you expect? perfect service when we are being pushed to turn over patients faster than ever?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

How much of the shortage is due to young doctors filling med school spots then working part time soon after? I get that many of them face the fertility ticking clock soon after qualification.

Many professionals and non professionals can tell stories of long hours. Then there are all the military families facing absent spouses and parents for months on end.

What would put me off medicine personally is seeing so many different people all the time and all of them complaining about something. My father in law who was a doctor pushed his kids towards engineering.

Part time work is a means of survival. For every hour with a patient there is another hour of paper work. So working 20 hours of patient care equals about 40 hours of work a week. Full time is not sustainable if you have a family.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Agree. People here need to think outside the US box.

Sure, go on navel gazing and "think outside of the US box." You are suggesting blowing up the entire US healthcare system. While that may very well be the best outcome, it isn't going to happen. So waste your time if you want, while the rest of us deal with the practicalities.

[Anonymous]

Anonymous wrote:cry me a river...docs have not increased their fees for at least a decade all while the insurance premiums have increased. ding ding ding, wake up, docs are responding to what is given to them. go complain to the insurance company, your lawmakers to force a chance. it will continue getting worst thanks to the politicians including OBAMA who did this to dentistry and medicine. since then, all docs are stuck where they are with no growth so what do you expect? perfect service when we are being pushed to turn over patients faster than ever?

I don't understand your anger directed at patients here. I personally vote for candidates who are progressive on healthcare, I am all for Medicare for all. Regular patients have almost no say in the big picture of medicine in this country. My insurance company doesn't care what I think either.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Agree. People here need to think outside the US box.

Sure, go on navel gazing and "think outside of the US box." You are suggesting blowing up the entire US healthcare system. While that may very well be the best outcome, it isn't going to happen. So waste your time if you want, while the rest of us deal with the practicalities.

What are the practicalities? And the question was a navel-gazing question, asking people their personal opinions. Don't ask for an opinion and then get mad people are giving an opinion...

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

How much of the shortage is due to young doctors filling med school spots then working part time soon after? I get that many of them face the fertility ticking clock soon after qualification.

Many professionals and non professionals can tell stories of long hours. Then there are all the military families facing absent spouses and parents for months on end.

What would put me off medicine personally is seeing so many different people all the time and all of them complaining about something. My father in law who was a doctor pushed his kids towards engineering.

Part time work is a means of survival. For every hour with a patient there is another hour of paper work. So working 20 hours of patient care equals about 40 hours of work a week. Full time is not sustainable if you have a family.

I wish my husband restricted his hours to forty.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Not all of the patient's turn up every year e.g. my 20 something kids. If they have something urgent outside of the PCP's limited hours or can't get an urgent appointment, they end up at urgent care. I'm on my OB GYN's roster but don't have to go every year anymore.

And some patients come every 3 months. Look you can argue all day that doctors stink and have this attitude but all it does is cause more burn out and will lead to more doctors leaving. Blaming the doctors won’t really get you anywhere- it’s a systems issue.

I know personally for me, I went to med school seriously a bleeding heart and wanting to take care of patients. I’m in primary care and I do try to listen to patients and take my time but then other patients are waiting and I get backed up. Then I have to return labs which takes time later in the day and I want to be thorough. All of this with my family life is making it so I probably have at most 5 years in this field and I also work part time. So there goes another one and we keep on leaving.

Is being a doctor boring when you spend years working on horses day in and day out, and the zebra cases go off to specialists? I used to look at the pediatrician treating my kids for check ups, strep and ear infections over and over and wondered how they did it.

I wonder the same. It really seems like a difficult job in the sense that you’re dealing with sick/unhappy people most of the time and the work doesn’t seem very interesting.

The specialists I see (particularly the pediatric ones) seem much happier. Is it because they make more money? Have fewer hours/patient demands? Do more interesting work?

[Anonymous]

I didn't read the whole thread, but personally I wish more PCP offices offered "concierge light" models. I don't want to spend $250 per month to retain the services of a doctor I see once or twice a year but I would spend $250 per year or an extra $50 per visit over two visits per year if it meant I could see the same 1-2 providers on a regular visit and didn't get rushed out of there. Same thing goes for our pediatric practice.

[Anonymous]

Anonymous wrote:I didn't read the whole thread, but personally I wish more PCP offices offered "concierge light" models. I don't want to spend $250 per month to retain the services of a doctor I see once or twice a year but I would spend $250 per year or an extra $50 per visit over two visits per year if it meant I could see the same 1-2 providers on a regular visit and didn't get rushed out of there. Same thing goes for our pediatric practice.

I feel like Teledoc fills that role in my life now. For little sick visits, we just use that: it's immediate care at home. And the doctors we have had were always great.

[Anonymous]

Anonymous wrote:I didn't read the whole thread, but personally I wish more PCP offices offered "concierge light" models. I don't want to spend $250 per month to retain the services of a doctor I see once or twice a year but I would spend $250 per year or an extra $50 per visit over two visits per year if it meant I could see the same 1-2 providers on a regular visit and didn't get rushed out of there. Same thing goes for our pediatric practice.

Yes, almost like if you could cut out insurance and just pay a reasonable price to see a doctor when you need to.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I didn't read the whole thread, but personally I wish more PCP offices offered "concierge light" models. I don't want to spend $250 per month to retain the services of a doctor I see once or twice a year but I would spend $250 per year or an extra $50 per visit over two visits per year if it meant I could see the same 1-2 providers on a regular visit and didn't get rushed out of there. Same thing goes for our pediatric practice.

I feel like Teledoc fills that role in my life now. For little sick visits, we just use that: it's immediate care at home. And the doctors we have had were always great.

I used Teledoc recently and it was so easy for a minor dermatology thing. I had a response within an hour.
I work in nutrition though, and dietitians complain about Teledoc because BCBS hires dietitians at low pay for Teledoc services, and then tries to get patients to use that instead of paying out for a private practice dietitian. Basically it saves costs but at the expense of the providers.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I didn't read the whole thread, but personally I wish more PCP offices offered "concierge light" models. I don't want to spend $250 per month to retain the services of a doctor I see once or twice a year but I would spend $250 per year or an extra $50 per visit over two visits per year if it meant I could see the same 1-2 providers on a regular visit and didn't get rushed out of there. Same thing goes for our pediatric practice.

I feel like Teledoc fills that role in my life now. For little sick visits, we just use that: it's immediate care at home. And the doctors we have had were always great.

I used Teledoc recently and it was so easy for a minor dermatology thing. I had a response within an hour.
I work in nutrition though, and dietitians complain about Teledoc because BCBS hires dietitians at low pay for Teledoc services, and then tries to get patients to use that instead of paying out for a private practice dietitian. Basically it saves costs but at the expense of the providers.

I can see that. At the same time are these dieticians very busy? If so it might unclog practices. I'm sure Teledoc has unclogged urgent care a bit.