Anonymous wrote:

Anonymous wrote:I had an orthopedic give me his personal phone number and take my phone call midday, and let me text X-rays to him to get a 2nd opinion within 1 hour.

I don’t even really expect that but dang that was amazing.

+1. My breast cancer surgeon did this. Being able to ask Qs by text opened up important opportunities in my care.

It would be nearly impossible for an employed primary care doctor to do this work upwards of 3000 patients. Many are going concierge to bring that down to 200-400 and they do give out their numbers. So based on this thread I anticipate more and more concierge doctors. It seems that’s more the care that both doctors and patients want.

Anonymous wrote:I had an orthopedic give me his personal phone number and take my phone call midday, and let me text X-rays to him to get a 2nd opinion within 1 hour.

I don’t even really expect that but dang that was amazing.

+1. My breast cancer surgeon did this. Being able to ask Qs by text opened up important opportunities in my care.

Anonymous wrote:Everyone is mad at doctors. We should be mad at insurance companies and health systems. We should be mad at the broken free market system and republicans in general.

EMRs, while good in theory and intention, were a disaster to roll out. I’m curious how much time and money is spent implementing, maintaining and using these systems instead of focusing on the patient - a recurring complaint on this thread.

Medicine has become like everything else. Ruined by private equity and other bored, rich AHs who are looking for a new “tech disruption”

We have the winner - this IS the problem

Everyone is mad at doctors. We should be mad at insurance companies and health systems. We should be mad at the broken free market system and republicans in general.

EMRs, while good in theory and intention, were a disaster to roll out. I’m curious how much time and money is spent implementing, maintaining and using these systems instead of focusing on the patient - a recurring complaint on this thread.

Medicine has become like everything else. Ruined by private equity and other bored, rich AHs who are looking for a new “tech disruption”

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I want them and their staff to be polite and helpful. I want them to listen and talk through concerns to find a solution. I don’t want to feel like I’m being rushed out the door. I don’t want them to argue with me if I say no to a treatment option. I want them to explain multiple options and why each are good or bad and let me make the best decision. And I want them to be smarter than me and have experience and not try to fix everything with meds without at least providing me with information on other options first. If I have a concern that can be answered with a minute phone call I don’t want to be asked to come to the office. I don’t want to talk to someone else about the issue either, just call me back in 24 hours. Oh and I don’t want to be charged insurance rates if I’m paying out of pocket. That’s really it, I’d pay big bucks if you know where to find them. House calls would be a plus too.

ND (New Doctor).

Very, very gently -- and please don't misread me here -- I would invite anyone engaging in a one minute phone call to additionally just eyeball the clock and note how long it actually takes.

Maybe 1 minute, maybe not. I'm someone who logs telehealth exact times for billing, and it's interesting. But just take a peek, eh? No pressure.

Enough with the very gently crap-snarky and condescending.

Sure thing. There's no way to phrase it that doesn't evoke anger, probably because it is an uncomfortable criticism.

In follow-up, typical overhead for a small business in America is 10-30%. Medical practices used to be around 35% on average, but the overhead costs have skyrocketed in the last few decades. There is just more that is both required and expected, and that weight is just continuing to press down harder and faster.

How can a business stay afloat under that sort of overhead pressure? Sell out to private equity and let them drive the cost back down by treating it solely as a revenue source, or go concierge and supplement whatever insurance you take with fees (and this also allows you to select the clientele that are not going to drive that overhead back up with excessive demands that require more infrastructure to address, and that bleed away time).

If you make the claim that medicine is just a business and doctors are just employees, then this is what you voted for. That's just the way it is.

Anonymous wrote:

Anonymous wrote:I want them and their staff to be polite and helpful. I want them to listen and talk through concerns to find a solution. I don’t want to feel like I’m being rushed out the door. I don’t want them to argue with me if I say no to a treatment option. I want them to explain multiple options and why each are good or bad and let me make the best decision. And I want them to be smarter than me and have experience and not try to fix everything with meds without at least providing me with information on other options first. If I have a concern that can be answered with a minute phone call I don’t want to be asked to come to the office. I don’t want to talk to someone else about the issue either, just call me back in 24 hours. Oh and I don’t want to be charged insurance rates if I’m paying out of pocket. That’s really it, I’d pay big bucks if you know where to find them. House calls would be a plus too.

ND (New Doctor).

Very, very gently -- and please don't misread me here -- I would invite anyone engaging in a one minute phone call to additionally just eyeball the clock and note how long it actually takes.

Maybe 1 minute, maybe not. I'm someone who logs telehealth exact times for billing, and it's interesting. But just take a peek, eh? No pressure.

Enough with the very gently crap-snarky and condescending.

I went to a doctor a couple years ago because I was just not feeling right. She took a bunch of blood and did a bunch of tests. It didn't turn up anything. I still don't feel better and don't have any answers but I really appreciated her at least listening to me and trying. That's at least something. Maybe one of these days I'll have a symptom that will actually point to something and we'll figure it out.

My daughter had a well visit today. She's been going to the same doctor since she was a baby. We LOVE her doctor. She always remembers us and she is just nice and has a lovely bedside manner. That's what I want from a doctor.

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?

Are you a doctor's kid?

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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.

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 assuming that overhead is different at every office. Is your office the average? Are your overheads the same as the practice two floors up? How do you even know what a competitor's overheads are?

Rents can be different within the same building, let alone between suburbs, cities and states. A practice manager with 20 years experience is getting paid more than a younger one. Same with nurses, doctors, lab staff and cleaners. Some practices employ more support staff than others. Some specialities require more expensive equipment than others. Some doctors like to provide high end facilities while others go for a more spartan environment.

There's actually research on this, across more than 15,000 practices affiliated with the Medical Group Management Association (among other research). There are some outliers, but there is a clustering around the mean. The average is around 60-70% overhead off the top, and that does not include all expenses.

Private equity is of course interested in driving that down. They can get it to 35-40%, or even 33%. Any non-billable time is cut. Interaction times are cut. You charge for everything you can, sort of like the current airline experience model. Bill for seat choice, nickel and dime for bags, all that.

Anonymous wrote:

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 assuming that overhead is different at every office. Is your office the average? Are your overheads the same as the practice two floors up? How do you even know what a competitor's overheads are?

Rents can be different within the same building, let alone between suburbs, cities and states. A practice manager with 20 years experience is getting paid more than a younger one. Same with nurses, doctors, lab staff and cleaners. Some practices employ more support staff than others. Some specialities require more expensive equipment than others. Some doctors like to provide high end facilities while others go for a more spartan environment.

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

I want doctors to have appointments available within one week, not months away (endocrinologist, dermatologists, neurologists and I'm sure more).

I want more generalists less specialists (don't want to be passed along for every little thing, wait months for that appt, and then be passed along again).

Want doctors, not insurance companies, to decide a) their schedule and b) what's best for patients

Don't want ANYONE to end up in bankruptcy due to medical treatment

Anonymous wrote:

Anonymous wrote:Doctors are the only professions treated this way. See e.g., professors, lawyers, law enforcement, teachers, etc. etc.

What way? Have you just graduated?

I don't think you know much about the professions you listed.

DP. I think PP’s point is that many professions are treated this way. You can take the OP’s post and replace “doctor” with “teacher” and it still works.

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.