Observations at the doctor's office

[LVSteve]

Tired of waiting for a return phone call after a week, I drove down to the practice my PCP had been moved to. Note, he had been moved by the large health company that bought up a chain of practices here in Vegas. He used to be five minutes away if the lights were against me. So, score negative points to the new owners.

Walked in and stated my issue regarding a referral to the first counter girl. As I did so, two more people came in behind me. I was invited to sit down while she booked in the other patients. OK, she's probably not the referrals person, so fair enough. More people came in, and a common theme began to appear. You now have to present insurance card and ID every time, which apparently was new to these repeat patients. They grumbled, A LOT. Two had to go outside to their cars where they had left their documents. Who the heck leaves important stuff like that in a car they cannot see? Color me baffled.

The other common theme was that patients with appointments bring copays, unlike grumpy old men chasing referrals. I know this because after 25-30 minutes when it was quiet, I went to the counter to ask again about my referral. Seems their record show it was sent, but then I asked, "Did it go to their ________ facility, or one nearer here?" Never got a straight answer to that, but now I have a paper copy of my referral to wave in faces, so I should be good.

 

[444 Magnum]

Dang, Steve...if that was the worst part of your day/week, it sounds pretty good to me. I'm happy to lend an ear...

 

[Rudi]

It is a giant machine. Amazing it works as well as it does.

 

[LVSteve]

Dang, Steve...if that was the worst part of your day/week, it sounds pretty good to me. I'm happy to lend an ear...

It could have gone a lot worse, I agree. I guess what I was trying to show how the average doctor's office is becoming more impersonal as more and more are swallowed up by these "practice corporations".

 

[LVSteve]

It is a giant machine. Amazing it works as well as it does.

Late wife#1 was a medical biller in a doctor's office. "Works as well as it does" would have had her in hysterics.

 

[Tom S.]

A bit off topic here but I have a one hour rule with Dr. appointments. First off, I am never late, arriving usually 15 or 20 minutes early incase there is paperwork to fill out, which often there is. At my appointed time, my one hour rule starts. If I have not seen the Dr. by that time, whether I am sitting in the waiting room or in an examination room, I leave. This has resulted in many conversations and phone calls, and even leaving Doctors for new ones. I should point out that I always schedule early morning appointments, so as to avoid the "stacking lag" that usually occurs later in the day from appointments running over. On the occasions where the staff has offered the excuse that the Dr. got hung up doing rounds or treating an emergency, I always respond that they knew that when I arrived and should have said something then rather than leaving me uninformed. To the "the Dr. is very busy" response they typically say, I reply that so am I and my time is as valuable to me as the Dr.'s time is the him. Admittedly, I live in an area where Dr.s, even specialists are easy to find, so leaving one for another isn't a big deal. In two cases, I know for a fact that the Dr. overbooks his appointments, and I have pointed that out to the staff. It is understandable that a percentage of appointments will be no-shows. I would guess it to be around 10% and I can understand booking at 110% to cover that, but this guy was overbooking at closer to 125%, resulting in delays no matter what time your appointment was, and the latter in the day, the worse the wait became. I asked someone during an afternoon appointment I had how long they had been waiting and they said 3 hours - and I was just getting there! I immediately rescheduled and left.

I have the utmost respect for Dr.s but I expect them to have at least some respect for me.

 

[444 Magnum]

A bit off topic here but I have a one hour rule with Dr. appointments. First off, I am never late, arriving usually 15 or 20 minutes early incase there is paperwork to fill out, which often there is. At my appointed time, my one hour rule starts. If I have not seen the Dr. by that time, whether I am sitting in the waiting room or in an examination room, I leave. This has resulted in many conversations and phone calls, and even leaving Doctors for new ones. I should point out that I always schedule early morning appointments, so as to avoid the "stacking lag" that usually occurs later in the day from appointments running over. On the occasions where the staff has offered the excuse that the Dr. got hung up doing rounds or treating an emergency, I always respond that they knew that when I arrived and should have said something then rather than leaving me uninformed. To the "the Dr. is very busy" response they typically say, I reply that so am I and my time is as valuable to me as the Dr.'s time is the him. Admittedly, I live in an area where Dr.s, even specialists are easy to find, so leaving one for another isn't a big deal. In two cases, I know for a fact that the Dr. overbooks his appointments, and I have pointed that out to the staff. It is understandable that a percentage of appointments will be no-shows. I would guess it to be around 10% and I can understand booking at 110% to cover that, but this guy was overbooking at closer to 125%, resulting in delays no matter what time your appointment was, and the latter in the day, the worse the wait became. I asked someone during an afternoon appointment I had how long they had been waiting and they said 3 hours - and I was just getting there! I immediately rescheduled and left.

I have the utmost respect for Dr.s but I expect them to have at least some respect for me.

I schedule early appointments as well for the same reason and I still find myself waiting. I won't wait an hour, however, before I get up, open the door to my appointment room, and ask the first passerby where the doctor is. This usually invokes an unpleasant reaction but I get my point across.
I've found on occasion that the doctor simply hasn't arrived yet. One time, the excuse was that the doctor was having to answer a complaint to the office manager about a patients wallet being "stolen". It was later found in the parking lot.

 

[Smoke]

I usually talk about this in relation to guns and doctors asking you if you own any but I worked in the medical industry for about 3 years, of the doctors that I worked for I think only one of them had paid off his student loans and the only reason that he had was because he had joined the Army out of medical school and they paid off his student loans for him.

I worked for a physiatrist(AKA high priced specialist) who had been in practice for 15 years and was still paying off student loans.

I said all that to set up this next statement that I've made before, every Medical Practice I ever worked in was like a Sausage Factory.

Every practice I ever worked for double booked every single one of their appointments all day long. As a Medical Assistant I was expected to turn the room every 15 minutes.

When I worked at a Mountain View Medical Group urgent care facility as a temp we were expected to have the patient ready to see the doctor in 3 minutes. That included getting thier height, weight, vitals and a brief history of their Chief complaint.

I've also said this before but even though I never really had a lot of connection with the business side of the medical practice it seems like every Clinic I ever worked in ran on a very thin profit margin. The HMO was making bank but the doctors weren't.

So, I said all that to say in my experience that's why the doctors are usually about half hour to an hour behind 2 hours into their day.

I've also said this before but if the doctor sees 28 patients in an 8-hour day, and you take your business elsewhere he's not even going to notice. And wherever you go is it going to be just as overbooked.

Again, said it before. When I worked for Colorado Springs Health Partners the orthopedist double booked every single appointment all day long. He stayed double booked 6 weeks out.

A lady called the clinic one day wanting an appointment within the next week or so and I told her we were completely booked 6 weeks out. I offered to put her on the waiting list and call if we got an opening.

She told me that wasn't good enough and if the doctor couldn't get her in that week she'd take her business elsewhere.

I had just told her that we were booked solid for 6 weeks, it's not like we needed her business. I politely informed her that I was unable to grant her request and wished her good day.

 

[Tom S.]

I usually talk about this in relation to guns and doctors asking you if you own any but I worked in the medical industry for about 3 years, of the doctors that I worked for I think only one of them had paid off his student loans and the only reason that he had was because he had joined the Army out of medical school and they paid off his student loans for him.

I worked for a physiatrist(AKA high priced specialist) who had been in practice for 15 years and was still paying off student loans.

I said all that to set up this next statement that I've made before, every Medical Practice I ever worked in was like a Sausage Factory.

Every practice I ever worked for double booked every single one of their appointments all day long. As a Medical Assistant I was expected to turn the room every 15 minutes.

When I worked at a Mountain View Medical Group urgent care facility as a temp we were expected to have the patient ready to see the doctor in 3 minutes. That included getting thier height, weight, vitals and a brief history of their Chief complaint.

I've also said this before but even though I never really had a lot of connection with the business side of the medical practice it seems like every Clinic I ever worked in ran on a very thin profit margin. The HMO was making bank but the doctors weren't.

So, I said all that to say in my experience that's why the doctors are usually about half hour to an hour behind 2 hours into their day.

I've also said this before but if the doctor sees 28 patients in an 8-hour day, and you take your business elsewhere he's not even going to notice. And wherever you go is it going to be just as overbooked.

Again, said it before. When I worked for Colorado Springs Health Partners the orthopedist double booked every single appointment all day long. He stayed double booked 6 weeks out.

A lady called the clinic one day wanting an appointment within the next week or so and I told her we were completely booked 6 weeks out. I offered to put her on the waiting list and call if we got an opening.

She told me that wasn't good enough and if the doctor couldn't get her in that week she'd take her business elsewhere.

I had just told her that we were booked solid for 6 weeks, it's not like we needed her business. I politely informed her that I was unable to grant her request and wished her good day.

Well, as in most things, I also have opinions about student loans - especially in the medical profession. In the area of medical doctors, the whole system needs to be revised, starting with the med schools. Doctors do not need the level of training they receive, nor all the classes colleges require them to take. The first two years should be centered on general medical care and knowledge. At the end of that time, each student would determine what they wish to become, a general practitioner, or a specialist. The next three years would be based on that decision, followed by one year working in that particular area, for a total of 6 years. All courses would be centered on medicine relative to the person's choice. No standard college remedial fluff like English and the like. Ask any doctor today, especially a specialist how much of there college classes pertained directly to their profession. I would guess 70% to be the maximum.

Tuition would be regulated at a set rate determined by standard national average tuition rates, not the inflated rates of med schools. Cost would be handled in the following manner: A student could pay out of pocket or with grants, or they could take government backed loans. The loans would be based on prime rates and could be renegotiated if the prime rate drops. Upon graduation, loan repayment would begin automatically at the rate of 5% of the loan per year, until paid in full. Of course the person would be allowed to pay additional interest free payments if desired. The loans and applicable interest would be tax deductible so long as the person remains in practice. Grades averages of "B" or better would be required or the student would be dropped from the program. Graduates working in the medical profession would be required to pass a 'refresher' course every four years to update them on new techniques and discoveries within their field. Such a course could be online or in person, the participant's choice.

By my unscientific estimation, this would reduce the cost of becoming a doctor by approximately 50%. In the case of foreign students, there would be no government backed loans. Default on the loans would result in revocation of the degree until the loan was repaid. I am not naive enough to believe I have all the answers, but I do believe this would result in far lower costs for those seeking to be doctors while retaining a high degree of knowledge and appropriate training. Academia in our country has continued to raise to cost of becoming a doctor based not on the true need of the person, but rather on increasing the content of the school's coffers. In return, the newly minted doctors are forced to become intensely focused return on investment businessmen and women in order to pay off staggering loans. In the end, we, the patient pays the price in both higher insurance costs and out of pocket non-covered expenses.

 

[Smoke]

In return, the newly minted doctors are forced to become intensely focused on return on investment businessmen and women in order to pay off staggering loans.

IDK I never went to medical school and I've been intensely focused on women since the day I realized there was such a thing

 

[Nevada Ed]

I start out with the answering service, which take down info and past it to my Doctors office.
If I do reach the "Front Desk" the info is taken down and passed down to the Doctorst secretary, when possible.
She will pass the info to the Doctor when he finishes with his present patrients and hopefully his first free time.
I have had to wait 30 hours for a reply from my Doctor, several times, when he is booked solid.

On one call about my pills, it took four days to get a answer from him.
The VA is some times not much better, with a 24 hr wait, for a reply.