My Moms medication would be 1500 per month if my Dad had not been a 100% disabled veteran.I think she pays a little over 300 because of the VA benefits.Very happy about that.For me it seems like my Dr. wants to draw blood too often.Each time my blood is drawn the Dr. office charges my insurance 500 dollars for the lab work.
What exactly did you DO in the doctor's office, can you tell me? Because I can guarantee you... the physician doesn't WANT to have to schedule 30 patients a day. I guarantee you that. Why do you think they do so? Do you have ANY idea at all?
Enlighten me.
Do you know how much the utilities cost? The insurance? The equipment? How about staffing costs? Paying insurance for your employees? How about even FINDING employees who are willing to work, and don't want to just sit on their phones surfing Facebook? Overhead is incredible in a doctor's office, how much do you know about that? How about how long it takes for insurance companies to remit checks? Or what percentage of what is billable (as determined by the .gov) actually gets paid? So... you see... they say, "This is how much you can bill." Specifically... and then... they don't pay that. And when they DO pay it, how much of that is written off, how much is 30, 60, 90 or even 180 days behind? Yet... the staff still needs to be paid. The bills have to be paid, or the lights will be turned off. The insurance and licensure fees... must be paid. And paid on time. Not 30 days behind. Certainly not 60, 90 or 180 days behind. Not at all.
So then... tell me what happens when the physician goes in to see the patient? Tell me How exactly the doctor can keep the patient on track, where they can talk for 10 minutes with the doctor in the room. And counsel them (again) about keeping their BP logs, watching their diet to keep their diabetes under control, the complications that come when they don't take their medicines appropriately, or exercise or a million other things. And then the patient wants to additionally talk about their gout, their sore back, complain they can't sleep, talk about what they read on Google about their condition, talk about how they don't want to take medicine, they just want to be fixed. And the doctor asks again and again for them to bring logs of their medicines, logs of what they eat, what medicines they actually are taking ("Oh, that little green pill, I don't know what it's called"), meds from other doctors, what happened at their Cardiologist's office visit, at their Neurologist's or Rheumatologist's office? But they don't really remember that.
Seriously... do this 20, 25, even 30 times EVERY. SINGLE. DAY. Then spend an hour or two after the office is closed doing all the charting required by the .gov - on the EMR system that cost you hundreds of thousands of dollars, that cost you hundreds of thousands in equipment to be able to run, that is slower than hell and is dependent upon your network and internet service, that is slower and less efficient than using old paper charts - but that you don't get any extra money from the government or insurers to implement - you just get reimbursed LESS if you don't do it.
And tell me how it's just a matter of respect, trying to make sure everyone gets seen within.... what? How long should it take? To walk in the door, to check in with the front desk, fill out your paperwork (which most people DO NO DO), sit down, be called back to the exam room, have a nurse check your vitals, go over your history and medications (again, on another cantankerous computer) - because you didn't bring your medicines OR a list of them, to go over what is being discussed today, and then the nurse goes back out and you wait for the doctor to come in. How long should that take? Seriously. 10 minutes? 20? 30? And when new patients come in, have ZERO records, don't bring their meds, want all their meds refilled, want several referrals and all these things done, when the doctor (and staff) is just trying to write in who they are, learn about their long, complicated, convoluted, confusing, poorly-recalled in scattered, sometimes conflicting history and reports... how easy is that?
Oh, and let's make some medicine and testing choices in there that are life-threatening, hmm? How about being terrified you might miss ONE, just ONE TINY, CRITICAL element that could cause a drug reaction, a complication, and potentially the DEATH of someone - all while you're stuggling to read through reams of papers that come in DAILY from Home Health agencies, from other providers' offices, take care of patients appropriately, document everything appropriately so you will be able to review it all when they come back - oh, and evaluating all the refill requests from people who don't want to come back in to discuss things, Home Health agencies that want to change people's medicines or dosages with little to no explanation - agents of Home Health agencies YOU DON'T KNOW. I know my nurses in the office. I don't know the nurses out there seeing people in their homes. Or at the nursing home.
And then the drug reps who all just want a MINUTE of your time - and you have to try to be nice and give them some time. You know why? Any idea? Not because you get a free lunch, not because you get a pen or a pack of sticky notes here and there, but because they leave SAMPLES of medicines. Expensive medicines. Things you can give to your patients to help them, because a lot of them are unable to afford the most effective medicines they really need. Like insulin. Blood pressure meds. Bladder control meds. How much does your 80 y/o woman want to talk about her blood pressure when she is leaking urine all the time, and you can't help her at all? Yeah, without samples, some of those folks would be screwed. Especially the diabetics.
And again, then people want to come in once every 3 months, or every 6, or fight about even coming in once a YEAR - but they need you do fill their meds, they don't want to do labs, they forget to fast, they skip appointments. How valuable is MY time? When people book appointments and just don't show, don't call, don't care?
So come now... tell me how simple, how easy it is to get in to see people in a reasonable timeframe? How it shouldn't be that hard, how it's just simply a matter of "respect". That's all, right?
Keep in mind, every 10 minutes I spend with a patient - I might have to spend another 10 or 20 minutes documenting what we talking about, putting in lab orders, sending in medications, even more time ordering tests or doing Prior Authorizations - you know, that time I have to physically get on the phone and sit waiting for some insurance schmuck to get on the phone (usually 10-20 minutes of menus and hold just to get them on the phone) so I can tell them why a patient needs a certain test. And you have to have patients scheduled pretty much every 10 minutes, 15 at the most.
How many hours of my evening and weekend time is it reasonable to expect I give up to do all the charting and paperwork? Just curious. 1 hour? 2? 3 hours a night, outside of the normal 7:30-5:00PM just to try to make ends meet.
Tell me how easy it is. Tell me why it shouldn't be so damned hard to see people in a "reasonable" timeframe. When they want to make a 3 month follow up to talk about their blood pressure, diabetes and heart disease. Then they want to add in their sore back, their bladder, their sleep, and all the other little aches and pains and irritations, and then get mad when you want them to come back for a different visit to talk about those things.
Tell me. Enlighten me.
I've scratched the surface of the things I have to worry about EVERY. SINGLE. DAY. And I glossed over the life-and-death stuff. Tell me how much sleep you lose over if you made the right decisions that day. When there IS no good answer, but you have to come up with SOMETHING to tell your patients. You can't just say, "Tough luck, you're old. Live with it." That doesn't work.
But the formula, boy it sure sounds simple, doesn't it? Make an appointment, show up, get your 10-15 minutes, and get everything you need done - DONE. IN TEN MINUTES.
Sounds simple.
I think Doctor's offices should operate like McDonalds and have drive through windows. If anyone, Doctor or otherwise doesn't like their job then they need to go find another. Life is too short to work in a job that is despised. After all, the patients aren't worth the paperwork and if one hires sluggards...well, find another person that actually needs a job. Don't keep them on the clock because give them a stethoscope and in a few months they start thinking they know as much as a Doctor-I've seen that too. And when a patient knows they have a problem and the Doctor says, "Next time" and next time never comes and the patient has to refer themselves to a Nephrologist or Oncologist-I've done that myself and changed Doctors.
I gotcha, man. You think you got it all figured out. Still waiting to hear what capacity you worked for all those patients. But that's ok. Anytime you wanna debate about those spoiled, lazy, good for nothing, arrogant, know it all physicians just let me know.
Oh and who said anything about not liking their job? I'll have you know, I DID despise my last job - and it was mostly the patients who made it that way, combined with the corporate overlords.
But I left that one nearly a year ago - took a huge pay cut in order to do so. Let's see, as a general rule, I've made about 60% less money (except for last week, when my paycheck was approximately 20% of what I used to make). Sorry, I left out the financial part up there about being a doctor... you know, paying back all those school loans? After training for over a decade - my check last week was just over half of my student loan payments. That's right... my entire check for 2 weeks wouldn't even cover what I have to pay to Navient (Sallie Mae) this month. Gotta love those collection problems with insurance and Medicare, right? I was there in the office... every. single. day. It was the patients who made a ton of appointments and didn't show up. Phone call reminders apparently aren't enough. A no-show rate of 20-30% means your doctor has to overbook even MORE just to make the bills. So then on an odd day when everyone actually DOES show up, it means everyone's stuck running behind. But that's my fault, too. And believe me, I know it, my family is so far in debt, I have mortgaged their future for ever. My son will be in college and I will probably be 50 years old before my net worth gets up to $0. Yeah, you read that right. All those rich, spoiled doctors. lol
See... if your doctor does what they'd really LIKE to do, that is, book only enough patients to be able to spend plenty of time with them, address all the problems they need in one visit, the time to counsel them on all the things that will help them be healthier, dig deep DEEP DEEP and try find the underlying mental issues that may be contributing to them sabotaging their own health, etc. - you'll end up looking for a new doctor. Because they will go bankrupt. It's just how it is. You CANNOT spend that kind of time in today's healthcare system (even though you may WANT to), or you will lose your business and not be able to provide ANY care for ANYONE. Just a fact. If you don't like it, well... lobby your
In the meantime, there're plenty of apps you can log into, pay your $40 and let the provider on the other end of the chat app take care of you. Have fun with that, you can do it in your PJs while you shop for a mortgage from the comfort of your own home. Lenders compete for you, right? lol It's not a drive through, it's even better! Sounds like that would be perfect, right??
TRidiot, I think you are an exceptional Family Physician and I meant no disparaging comments directed toward you. What I indicated is that sometimes things don't go as planned and I think you'll admit not all physicians were A students in med school and some shouldn't even have been there. And you often have to deal with idiots and jerks for patients who are demanding, won't follow your directives to better their health and when you issue a regimen of antibiotics they'll take a few until they feel better and then put the bottle in their medicine cabinet for future use. I worked at the VA Hospital and the drug reps did create problems with 137 patients per day and four MD's. You mentioned that people doing clerical or other work spend too much time on their own activities, surfing the web, checking personal email and using their iPhones. I don't like that, there has to be someone who won't do that on company time-especially if you're paying their salary. A good office manager could fix the problem, read the rules to them when they're hired and have them sign that they have a copy and if they are found not in compliance they have so many chances and they're terminated. Surely everyone isn't like those hirelings? You see, I've worked hard in a clinical environment covering many bases and finished my job/s and there were incompetent people there also who were slow and guess what? I was asked to assist the lazy ones do their jobs also and that irritated me because we were all hired to do our jobs. I worked in Ophthalmology and did all kinds of duties from refractions to fitting glasses. I still remember a third-year resident using a laser on a patient's eye and the click-click-click of the foot pedal and "Whoops, I told you to sit still." And I haven't even scratched the surface of the cost of medical equipment you have to buy which is outdated in six months. So I understand where you are coming from and understand at least partially the situations you are encountering in your office. And when you call to find out the cost of certain things like car repair etc, don't tell them you are. physician-sometimes they'll charge you more Thant he average guy on the street because they think you have great wealth. It isn't the Docs that make the money, it's the hospitals and ancillary work-lab, biopsies, government etc. And with all the paperwork required and generated by the government it is a wonder that more physicians don't go into other vocations. Let's be friends and at least agree on some things, you may even be my physician! I know better than to go in and see you for an oil change and then ask you to check the tires and get the windshield- I think you know what that means!
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One thing you are for sure wrong about... I'm not exceptional in any way. I'm just a dude, doing a job. Trying to survive in this .gov-regulated world, trying to provide for my family, trying to save for retirement (if I live that long) and not doing a very good job of it. Not at all.
Anyways, back to your regularly-scheduled programming.
I shaved my beard off today. I'm back to resembling my avatar more and Duck Dynasty less. Never seen that show, but oh well. It's what I was told.
Anyways, back to your regularly-scheduled programming.
I shaved my beard off today. I'm back to resembling my avatar more and Duck Dynasty less. Never seen that show, but oh well. It's what I was told.
WHAT?!?!?! You're kidding!?!?!? Witness protection??? ... AGAIN?!?!?!
Great discussion. I think we all learned a few things in this one. I certainly did.
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