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

[Anonymous]

Anonymous wrote:

Anonymous wrote:I want my doctor to be a problem-solver and figure out what’s going on instead of writing a script for a medicine that treats the symptoms and doing nothing more.

What if what’s going on is just you’re getting older? I can’t problem solve my way out of you being 75.

Ok, but what about all the times this happens with kids or problems that aren’t related to aging? I can think of numerous examples in my family where it took visiting numerous doctors to find one willing to dig a little deeper to discover the real issue. Most doctors don’t do this because they’re arrogant or lazy. There are some talented doctors who won’t rest until they find an answer. These doctors are worth their weight in gold!

[Anonymous]

Anonymous wrote:

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Anonymous wrote:

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.

Doctors have zero control over their own schedules. Unless they own their own practice, in which case they are struggling to make ends meet thanks to the insurance industry paying Pennies on the dollar.

It looks a lot more than pennies on the dollar when I get my statements. They get hundreds for a few minutes of face time.

What percentage of what is billed do you think goes just to pay overhead to run the clinic, straight off the top, not even including malpractice insurance, maintaining licensure, etc. -- just the lights on, employees paid, and utilities?

This is true of most businesses with rent, salaries, insurance, material and utility costs. The patient is not paying pennies though. They are paying hundreds and thousands of dollars a year.

Right. So what percentage do you think thatis, for a medical practice?

How can I tell? Are you in Manhatten or Front Royal, which affects rent and salaries. What kind of doctor are you - OB-Gyn or dermatologist or PCP, which will impact insurance premiums. Are you a concierge doctor or part of a hospital system? How many support staff do you employ? How long do you spend with each patient?

I don't know the answer to these operating cost questions for my tree service or local supermarket either. Why don't you provide these figures to us?

So you're judging the cost and assigning salary, without any sense of what the average overhead is for a basic medical practice? Okay.

Sure, if you want to know, I'll pull it for you. I'm still interested in what your guess would be. I think it would be informative. FYI, it's different for medicine than most small businesses, for various reasons of specific responsibilities, liabilities, and constraints.

I'm interested if you diagnose your patients without doing any tests or asking the patient any questions. Yet you want to DCUM users to guess overheads without providing any data about your practice's income and costs. Do you diagnose on averages or is each patient different?

No, it's just a simple question. The average doesn't vary as much as you seem to think, and yet the complaints here are not about single, specific practices -- for the most part, they are about doctors in general.

It's interesting, that's all. I wonder if anyone would have gone with 65-70%?

I’m a dentist (although in public health, not private practice). Dental overheads typically run at about 75%. And people wonder why dental fees are so high.

Yes. As noted earlier in the thread, for primary care, the average is 65-70%. Private equity management can drive it down to 35-45% (more like where it used to be decades ago), or sometimes even a little lower, but that's by doing things nobody but them likes -- target less time per patient, doctors don't return messages (it's a nurse, or a visit), charge for filling out forms, etc. Sound familiar?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Doctors have zero control over their own schedules. Unless they own their own practice, in which case they are struggling to make ends meet thanks to the insurance industry paying Pennies on the dollar.

It looks a lot more than pennies on the dollar when I get my statements. They get hundreds for a few minutes of face time.

What percentage of what is billed do you think goes just to pay overhead to run the clinic, straight off the top, not even including malpractice insurance, maintaining licensure, etc. -- just the lights on, employees paid, and utilities?

This is true of most businesses with rent, salaries, insurance, material and utility costs. The patient is not paying pennies though. They are paying hundreds and thousands of dollars a year.

Right. So what percentage do you think thatis, for a medical practice?

How can I tell? Are you in Manhatten or Front Royal, which affects rent and salaries. What kind of doctor are you - OB-Gyn or dermatologist or PCP, which will impact insurance premiums. Are you a concierge doctor or part of a hospital system? How many support staff do you employ? How long do you spend with each patient?

I don't know the answer to these operating cost questions for my tree service or local supermarket either. Why don't you provide these figures to us?

So you're judging the cost and assigning salary, without any sense of what the average overhead is for a basic medical practice? Okay.

Sure, if you want to know, I'll pull it for you. I'm still interested in what your guess would be. I think it would be informative. FYI, it's different for medicine than most small businesses, for various reasons of specific responsibilities, liabilities, and constraints.

I'm interested if you diagnose your patients without doing any tests or asking the patient any questions. Yet you want to DCUM users to guess overheads without providing any data about your practice's income and costs. Do you diagnose on averages or is each patient different?

NP here but I’m guessing you’re the one who wants this info. And you want the PP, doc, to give it to you for free while you sit there. This sounds all too familiar. If you want to know overhead costs for medical practices, google it. The doctor isn’t your butler.

The doctor is the one demanding that people on DCUM guess their overheads without providing any information. Sure I can Google it, and when I did I came up with the same answer as the doctor did when they googled it earlier in the thread. It was free to learn that. The Google answer doesn't give me the income/cost profile of the OP's practice however.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I want my doctor to be a problem-solver and figure out what’s going on instead of writing a script for a medicine that treats the symptoms and doing nothing more.

What if what’s going on is just you’re getting older? I can’t problem solve my way out of you being 75.

Ok, but what about all the times this happens with kids or problems that aren’t related to aging? I can think of numerous examples in my family where it took visiting numerous doctors to find one willing to dig a little deeper to discover the real issue. Most doctors don’t do this because they’re arrogant or lazy. There are some talented doctors who won’t rest until they find an answer. These doctors are worth their weight in gold!

No, most doctors don’t do this because if they spend more than 10 min with you, they get in trouble.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:21:55, I forgot two more:

I do to want to have pay to park for the privilege of seeing you

I do not want to wait 30 minutes (or more) in your waiting room and another 30 minutes (or more) in the exam room before I am graced with your presence for less than 10 minutes, and then I have to pay even more for parking, for the time I spent waiting for you

You’re going to have to pay for concierge service to get all of this. It’s readily available to you. But…I’m guessing you don’t want to pay.

I'm not paying for concierge services when frankly my PCP is a minor part in my overall health management. The specialists who keep me going don't charge concierge fees.

Just realize then that you won’t get any of those things on your list.

I'm a different poster. That wasn't my list. I have low expectations. My PCP writes one prescription and ticks off I've had my routine cancer screenings once a year.

[Anonymous]

^^The other way out of it is to drive up income while overhead remains a fairly fixed costs. Procedures can do this, as you can bill a lot for procedures. Adding providers without adding more support staff does it, as well.

Procedure-driven practices (e.g., surgical) can buy some leeway with this. They have their own challenges, but procedures mean income, whereas talking with people tends to be a fixed cost.

On the one hand, it's awful to talk about medical care like this. It feels like it reduces people to numbers, and makes their very real and painful issues into monetary problems. On the other hand:

1. We keep getting told that medicine is just a business, it's not special, and doctors are just employees. And yes, this is what that looks like.

2. If medical practices are owned by private equity, the standard of care of patients is, by definition, not the primary concern. Money is.

3. Physicians could run their own practices when on average, overhead was around 35-45%. This was true up to around the early eighties, but it was going up in the 90s, and that has rapidly accelerated since. It's not feasible at 65-70%, so it consumes itself. Or you go concierge, or you join a large hospital-based HMO-type practice, or you go with private equity. For the most part.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Doctors have zero control over their own schedules. Unless they own their own practice, in which case they are struggling to make ends meet thanks to the insurance industry paying Pennies on the dollar.

It looks a lot more than pennies on the dollar when I get my statements. They get hundreds for a few minutes of face time.

What percentage of what is billed do you think goes just to pay overhead to run the clinic, straight off the top, not even including malpractice insurance, maintaining licensure, etc. -- just the lights on, employees paid, and utilities?

This is true of most businesses with rent, salaries, insurance, material and utility costs. The patient is not paying pennies though. They are paying hundreds and thousands of dollars a year.

Right. So what percentage do you think thatis, for a medical practice?

How can I tell? Are you in Manhatten or Front Royal, which affects rent and salaries. What kind of doctor are you - OB-Gyn or dermatologist or PCP, which will impact insurance premiums. Are you a concierge doctor or part of a hospital system? How many support staff do you employ? How long do you spend with each patient?

I don't know the answer to these operating cost questions for my tree service or local supermarket either. Why don't you provide these figures to us?

So you're judging the cost and assigning salary, without any sense of what the average overhead is for a basic medical practice? Okay.

Sure, if you want to know, I'll pull it for you. I'm still interested in what your guess would be. I think it would be informative. FYI, it's different for medicine than most small businesses, for various reasons of specific responsibilities, liabilities, and constraints.

I'm interested if you diagnose your patients without doing any tests or asking the patient any questions. Yet you want to DCUM users to guess overheads without providing any data about your practice's income and costs. Do you diagnose on averages or is each patient different?

NP here but I’m guessing you’re the one who wants this info. And you want the PP, doc, to give it to you for free while you sit there. This sounds all too familiar. If you want to know overhead costs for medical practices, google it. The doctor isn’t your butler.

The doctor is the one demanding that people on DCUM guess their overheads without providing any information. Sure I can Google it, and when I did I came up with the same answer as the doctor did when they googled it earlier in the thread. It was free to learn that. The Google answer doesn't give me the income/cost profile of the OP's practice however.

Well, it was provided, but I think you dind't read it.

I asked what the assumption was, since multiple posters seemed to be claiming doctors make far too much. It seems people are comfortable with guessing about that but have no opinions about the other. That's interesting, given it's a zero sum game, but sure. People get to be who they are and make the judgements they choose to.

[Anonymous]

^^didn't

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I want my doctor to be a problem-solver and figure out what’s going on instead of writing a script for a medicine that treats the symptoms and doing nothing more.

What if what’s going on is just you’re getting older? I can’t problem solve my way out of you being 75.

Ok, but what about all the times this happens with kids or problems that aren’t related to aging? I can think of numerous examples in my family where it took visiting numerous doctors to find one willing to dig a little deeper to discover the real issue. Most doctors don’t do this because they’re arrogant or lazy. There are some talented doctors who won’t rest until they find an answer. These doctors are worth their weight in gold!

No, most doctors don’t do this because if they spend more than 10 min with you, they get in trouble.

What a stupid system. Everything becomes more expensive because not enough time is spent understanding the problem.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Doctors have zero control over their own schedules. Unless they own their own practice, in which case they are struggling to make ends meet thanks to the insurance industry paying Pennies on the dollar.

It looks a lot more than pennies on the dollar when I get my statements. They get hundreds for a few minutes of face time.

What percentage of what is billed do you think goes just to pay overhead to run the clinic, straight off the top, not even including malpractice insurance, maintaining licensure, etc. -- just the lights on, employees paid, and utilities?

This is true of most businesses with rent, salaries, insurance, material and utility costs. The patient is not paying pennies though. They are paying hundreds and thousands of dollars a year.

Right. So what percentage do you think thatis, for a medical practice?

How can I tell? Are you in Manhatten or Front Royal, which affects rent and salaries. What kind of doctor are you - OB-Gyn or dermatologist or PCP, which will impact insurance premiums. Are you a concierge doctor or part of a hospital system? How many support staff do you employ? How long do you spend with each patient?

I don't know the answer to these operating cost questions for my tree service or local supermarket either. Why don't you provide these figures to us?

So you're judging the cost and assigning salary, without any sense of what the average overhead is for a basic medical practice? Okay.

Sure, if you want to know, I'll pull it for you. I'm still interested in what your guess would be. I think it would be informative. FYI, it's different for medicine than most small businesses, for various reasons of specific responsibilities, liabilities, and constraints.

I'm interested if you diagnose your patients without doing any tests or asking the patient any questions. Yet you want to DCUM users to guess overheads without providing any data about your practice's income and costs. Do you diagnose on averages or is each patient different?

NP here but I’m guessing you’re the one who wants this info. And you want the PP, doc, to give it to you for free while you sit there. This sounds all too familiar. If you want to know overhead costs for medical practices, google it. The doctor isn’t your butler.

The doctor is the one demanding that people on DCUM guess their overheads without providing any information. Sure I can Google it, and when I did I came up with the same answer as the doctor did when they googled it earlier in the thread. It was free to learn that. The Google answer doesn't give me the income/cost profile of the OP's practice however.

Well, it was provided, but I think you dind't read it.

I asked what the assumption was, since multiple posters seemed to be claiming doctors make far too much. It seems people are comfortable with guessing about that but have no opinions about the other. That's interesting, given it's a zero sum game, but sure. People get to be who they are and make the judgements they choose to.

Quoi?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I want my doctor to be a problem-solver and figure out what’s going on instead of writing a script for a medicine that treats the symptoms and doing nothing more.

What if what’s going on is just you’re getting older? I can’t problem solve my way out of you being 75.

Ok, but what about all the times this happens with kids or problems that aren’t related to aging? I can think of numerous examples in my family where it took visiting numerous doctors to find one willing to dig a little deeper to discover the real issue. Most doctors don’t do this because they’re arrogant or lazy. There are some talented doctors who won’t rest until they find an answer. These doctors are worth their weight in gold!

No, most doctors don’t do this because if they spend more than 10 min with you, they get in trouble.

What a stupid system. Everything becomes more expensive because not enough time is spent understanding the problem.

You are not wrong. It is not tenable. You can't provide even reasonable care like this. The doctors who find a way to do it within this broken system are getting burned out nonetheless, and pretty fast. It needs to change.

[Anonymous]

Doctors need to admit that they no nothing about nutrition, due to their education. And that nutrition is the key to prevent most disease. Ask anyone with diabetes about a typical doctor’s recommendations. If you followed their advice your A1C would go up.

[Anonymous]

Anonymous wrote:^^The other way out of it is to drive up income while overhead remains a fairly fixed costs. Procedures can do this, as you can bill a lot for procedures. Adding providers without adding more support staff does it, as well.

Procedure-driven practices (e.g., surgical) can buy some leeway with this. They have their own challenges, but procedures mean income, whereas talking with people tends to be a fixed cost.

On the one hand, it's awful to talk about medical care like this. It feels like it reduces people to numbers, and makes their very real and painful issues into monetary problems. On the other hand:

1. We keep getting told that medicine is just a business, it's not special, and doctors are just employees. And yes, this is what that looks like.

2. If medical practices are owned by private equity, the standard of care of patients is, by definition, not the primary concern. Money is.

3. Physicians could run their own practices when on average, overhead was around 35-45%. This was true up to around the early eighties, but it was going up in the 90s, and that has rapidly accelerated since. It's not feasible at 65-70%, so it consumes itself. Or you go concierge, or you join a large hospital-based HMO-type practice, or you go with private equity. For the most part.

Re point 1, how would you describe medicine in the US? Do you consider it a calling or vocation like the priesthood? Doctors who work for others are employees, just like engineers, economists and financial analysts working for private equity. Given the amounts of money being moved around, it certainly seems like a business from my perspective as a patient. This ain't the NHS.

[Anonymous]

Anonymous wrote:

Anonymous wrote:^^The other way out of it is to drive up income while overhead remains a fairly fixed costs. Procedures can do this, as you can bill a lot for procedures. Adding providers without adding more support staff does it, as well.

Procedure-driven practices (e.g., surgical) can buy some leeway with this. They have their own challenges, but procedures mean income, whereas talking with people tends to be a fixed cost.

On the one hand, it's awful to talk about medical care like this. It feels like it reduces people to numbers, and makes their very real and painful issues into monetary problems. On the other hand:

1. We keep getting told that medicine is just a business, it's not special, and doctors are just employees. And yes, this is what that looks like.

2. If medical practices are owned by private equity, the standard of care of patients is, by definition, not the primary concern. Money is.

3. Physicians could run their own practices when on average, overhead was around 35-45%. This was true up to around the early eighties, but it was going up in the 90s, and that has rapidly accelerated since. It's not feasible at 65-70%, so it consumes itself. Or you go concierge, or you join a large hospital-based HMO-type practice, or you go with private equity. For the most part.

Re point 1, how would you describe medicine in the US? Do you consider it a calling or vocation like the priesthood? Doctors who work for others are employees, just like engineers, economists and financial analysts working for private equity. Given the amounts of money being moved around, it certainly seems like a business from my perspective as a patient. This ain't the NHS.

US medical care in 2024? I'd say it's a fairly on point description.

[Anonymous]

Anonymous wrote:^^The other way out of it is to drive up income while overhead remains a fairly fixed costs. Procedures can do this, as you can bill a lot for procedures. Adding providers without adding more support staff does it, as well.

Procedure-driven practices (e.g., surgical) can buy some leeway with this. They have their own challenges, but procedures mean income, whereas talking with people tends to be a fixed cost.

On the one hand, it's awful to talk about medical care like this. It feels like it reduces people to numbers, and makes their very real and painful issues into monetary problems. On the other hand:

1. We keep getting told that medicine is just a business, it's not special, and doctors are just employees. And yes, this is what that looks like.

2. If medical practices are owned by private equity, the standard of care of patients is, by definition, not the primary concern. Money is.

3. Physicians could run their own practices when on average, overhead was around 35-45%. This was true up to around the early eighties, but it was going up in the 90s, and that has rapidly accelerated since. It's not feasible at 65-70%, so it consumes itself. Or you go concierge, or you join a large hospital-based HMO-type practice, or you go with private equity. For the most part.

Do you think doctors are special? Isn't this the origin of some doctors' god complex that causes such dissatisfaction for patients.