Doctors and the $25 Rule?

Parent Cafe
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<p>It’s never been an emergency (in which case, I would have been seen immediately); in cases where I’ve done that, it’s just an annual exam. I can wait. I think the last time I did it, I rescheduled for an appt about 6 weeks later. I asked for the very first appt of the day and got it. When I got there, I was seen immediately, and the doctor apologized profusely for how long I’d had to wait before. So, no problem, really. I wasn’t charged anything; I didn’t have to wait; the doctor didn’t lose a patient, and it all worked out.</p>

<p>The turning point for me was when my daughter was really young, and she had this cough that would not go away. It got progressively worse, and each time we went to the pediatrician, he kept saying it was allergies. So the last appt, I made clear on the phone that it was something more, and I wanted him to do a chest x-ray. We waited from 11 am until 1:30 pm. Just waited–no explanation or anything. Finally, at 1:30, I heard some talking outside and realized that the whole time we’d been waiting (and the appt was scheduled), the doctor had actually been out to lunch. So we just got up to leave. The staff stopped us and told me he was back from lunch now and would see us, and we couldn’t leave. So I said, “Okay.” We went back and waited about 10 more minutes; that was it for me. They tried to stop us leaving again, and we just left. I got home, made an appt with Duke Pediatrics (admittedly, a lot better docs than my local pediatrician), got in the very next day, with no waiting. They immediately took an x-ray, and did a TB test. Turns out she had walking pneumonia. So much for allergies. Never went back to the old pediatrician, got our records, and that was that. I vowed never to wait more than 30 minutes for anybody again, and I haven’t. And we’re all still here–alive and healthy. ;)</p>

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<p>Opie, mine generally are young, I rarely pick older doctors, I think this one looks under 30 but could be early 30s.</p>

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<p>I had the first appt of the day once, and waited an hour. No explanation, such as a delay while doing hosp rounds. The doctor and I had a talk, she apologized, wrote a note in the chart and I never had to wait again.</p>

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<p>From the industry itself you’ll find alot of doctors are joining up with hospitals. The label on the door may not say it, but they’ve become employees. Usually the signs are unusual “rules” or changes in long standing office policies. Sort of out of the woodwork. </p>

<p>It will also depend on the area, alot of hopspitals are also selling themselves as networks and creating situations where employees have to go to their network to get the best benefit (lowest cost, not necessarily quality). the number of players are shrinking as costs rise faster than alot of smaller private practices can absorb.</p>

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<p>I guess I look at doctors like I do any other business. If I don’t like one, for whatever reasons, there’s usually another (probably better one) nearby I can just as easily go to instead.</p>

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<p>I guess I live in a smaller community in which doctors’ recommendations are through word of mouth and trusted relationships with doctors are still coveted.Once I was in a waiting room with at least ten patients because the doctor was running late with an emergency. A nurse came out to announce the wait time would be more than an hour and asked those not needing urgent treatment to make another appt on another day…and to my dismay no one budged.</p>

<p>We also have a real shortage of primary care doctors here; many “good” doctors have closed their practice to new patients and very often, the next open appointment may be 3 weeks away. Yes, I know, it’s ridiculous.</p>

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<p>For those of you who complain about being billed for missed appointments or having to wait for your appointment, here is a first hand perspective from the other side:</p>

<p>When it comes to office practices (most Internists, Family Practioners, etc.), MD’s only have their time and expertise to “sell”. If you cancel or no-show the time is just lost. </p>

<p>Here is California, Medicare pays very little for a standard office visit. State Medi-caid (MediCal here) pays about $8 for a visit. Most private insurance use the Medicare guidelines to set rates which barely cover costs. Payment can take as long as 90 days once billed. MD’s are prohibited from claiming unpaid bills as a loss against their income. Every year it gets worse and worse, which is why so many MD’s have left private practice. New MD’s starting out can’t make it as a solo practioner and many have big college debt to pay off. The cost of setting up a medical office, paying malpractice insurance is extremely high. My brother, a neurosurgeon, paid $300,000 a year for malpractice insurance in California. He left the state. When he did, he had to buy “tail insurance” to protect him for up to 10 years against late claims.</p>

<p>When we were first starting out, H was in private practice for 7 years before joining a large group practice. He is a Rheumatologist so he deals with chronic diseases and many disabled and elderly individuals. </p>

<p>We could not go on vacation, pay into retirement, buy a house. Patients wanted/expected/deserved as much time as needed to deal with their medical issues and questions. Problem was, H wasn’t paid for much more than 15 minutes…Some came for a standard visit and took 30-45 minutes with questions and concerns. Some did not speak English and had to use an interpreter, which doubled the amount of time needed. Many/most could not tell H what meds they were taking, etc. </p>

<p>When he left private practice he had OVER 70 contracts with different PPO’s, HMO’s and other insurance companies. My job allowed us to have health insurance, thankfully.</p>

<p>I recently took my mother to a Gerontologist. What was a routine visit (15 minutes scheduled) turned out to be almost an hour as mom let known (for the first time) that she was having “a little shortness of breath”. Well, a few months later, she is recovering from her bypass surgery. Thankfully, the MD did not rush her out of the office to make sure she kept those in the waiting room happy. Mom had already had one silent MI and would probably be dead.</p>

<p>So, complain away about having to wait, but it could be you needing the extra time. You better hope that you haven’t walked out too many times in a huff, when it’s you causing the delay. Find a MD who always “runs on time” and you found one that doesn’t provide individualized care. I have worked too long in the health profession to think otherwise.</p>

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<p>As I said earlier, I don’t think it’s uncommon around here to charge for missed appointments. Paperwork may have been begun, charts have been pulled. As far as the “slot” needing to be filled, though, the doc is usually over-booked enough that an extra 10 or 15 minutes suddenly freed up would only help.</p>

<p>My dentist says appointments cancelled within 24 hours will have a fee. However, my D ended up with a sinus infection the morning of her apt. I called the dentist, and they said they would prefer not to see her while she is sick. I wasn’t charged.</p>

<p>I think a cancellation charge that is open ended is silly. Surely if it is cancelled more than a day or two in advance, another patient will call needing an appointment, and the slot will be filled. When I call my kids’ doc, I usually can’t get through the first hour or so of the morning, with people calling in needing urgent appts. </p>

<p>I am a piano teacher, and I get frustrated with missed lessons. I keep a slot available for a single student, and if that student doesn’t show, I lose the money and the time. My rational is that they should pay for me to keep that slot available. But for a doctor or dentist, who can fill that slot with anyone, given enough lead time, I don’t think charging for a cancellation is right.</p>

<p>An OT issue concerning wait time: I used to get frustrated that my kids’ pediatrician assigned me an appointment time, but took patients on a first-come basis. So if I showed up for my 3:00 appt at 2:55, but the 3:15 appt. came in ahead of me, he/she was seen first. My D’s senior photo photographer did the same thing, and we had squeezed her photo appointment into a very tight spot, and had been assured we’d be seen on time. We ended up being late for a following appointment. I don’t understand the rationale on this.</p>

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<p>I beg to differ. The best (and most thorough) doctors I have ever had, bar none, were the ones who provided me with great “individualized” care. And I don’t think anyone else was waiting (past 30 minutes) in the waiting room while I had my appts, either. </p>

<p>I think some doctors know how to manage their time, and they can control the number of patients they see daily. Plenty stop taking new patients if they’re well- established, too.</p>

<p>I do not see the need to make specific timed appointments, if–in fact–what a doctor’s office is actually doing, is scheduling a certain number of patients at that exact same hour. If I make an appt at 11:00, well, I understand that to be my scheduled appointment. I do not understand this to mean that I am one of 20 scheduled for this same hour. I’ve certainly been to doctors who do this. So that’s not really an appointment; rather, it’s a time that is the start of a “first come, first served” policy. </p>

<p>Again, barring any unforeseen emergencies, I give any doctor 30 minutes within that scheduled appointment. If the doctor can’t manage that, then he/she is scheduling too many patients.</p>

<p>I note that your mother’s bypass surgery was not immediately following that appointment she had (not the day after?); consequently, unless she was in danger of having a heart attack right then (and that would fall in the category of “unforeseen emergency”), I think her doctor could have scheduled her in the very next day for more tests, or referred her to a cardiologist (and insured that she got an appt right away), or immediately put her in the hospital for tests. If her appt went on for 45 extra minutes, he was either doing tests, or the question and answer period was really slow. Either way, she could have been taken care of, but not at the expense of keeping other patients waiting at that hour. Again, this is assuming she wasn’t on the threshold of having a heart attack in the office.</p>

<p>Edit: Just cross-posted with Binx; I agree.</p>

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<p>Say all what you will, but my award-winning, universally considered to be exceptional pediatrician H, first got out of private practice, then medicine all together, because of trying to be the doc you all want. (like bluecroo said–the one that gives you all the private attention you could want, while dealing with 70 different HMOs/PPO/other insurance plans, and somehow still having a life–oh, never mind the last, he didn’t.)</p>

<p>He’s a very happy HS teacher now, still working 12 hour days, but sleeping better.</p>

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<p>jack, you misunderstood. Mom was in surgery within 2 days of the appointment. She was admitted to the hospital that afternoon. When I said “a few months later” I am referring to now. Her surgery was a few months ago and she is still recovering. </p>

<p>Also, Doctors typically schedule 4 routine visits per hour as that is what the insurance guidelines pay for. If a patient comes in with a significant new problem, or brings family with issues and questions, the appointment will likely run more than 15 minutes. I don’t know if you have ever been at an appointment with an elderly person, but nothing happens quickly! Also, these days, most MD must fill out tons of paperwork to get labs, xrays, perscriptions, or referrals. Patients expect to leave the office with the paperwork in hand. Once the first patient runs over, the results can snowball. It just takes one or two. Other interruptions, such as the hospital nurse calling about an inpatient with an urgent issue, just add to the back up. Of course, patients show up 5 or 10 minutes late for appointments and think nothing of how that impacts the schedule. It is easy to criticize from the outside.</p>

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<p>To those of you who can’t wait, I suggest you all fight for and schedule appointments for first thing in the morning. If no hospital-based emergency interferes, you should be seen on time.</p>

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<p>If she was admitted to the hospital that afternoon, then I’d put that in the category of “unforeseen emergency.” To be fair, though, when she made the appt, she should have mentioned these “new” issues, so they could have scheduled some extra time with her, and made the next appt later, so things would not “snowball.” In fact, when scheduling an appt, a doctor’s office should ask, “any new problems you want to discuss?” Depending on the answer, he/she can schedule accordingly.</p>

<p>Also, I have never been to a doctor, including a dentist (or for just a routine cleaning), in my lifetime, where my appt was as short as 15 minutes. I’m not even sure what the point would be for 15 minutes. At least 2 of the best (and most thorough) doctors I’ve ever seen were part of major university teaching hospitals, not in private practice.</p>

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<p>I am not talking about dentists or MD’s that do “procedures” in their offices. That is another breed and they get paid per procedure. Very, very different from an MD who uses only their knowledge and analytical skills to care for their patients (internists , FP’s, pediatricians…those paid the least for using their brains :(</p>

<p>Jack, you must live in another world than I do and I have been in healthcare for over 20 years and am married to an Internist. I would say 75% of our friends are in health care. 15 minutes is standard visit. New consultations are longer; "complicated visits are longer. </p>

<p>As for </p>

<p>“To be fair, though, when she made the appt, she should have mentioned these “new” issues, so they could have scheduled some extra time with her.” You make my point exactly! Patients don’t know that they need to ask for extra time when they make appointments. Unless they call in with a specific complaint, they are scheduled for routine follow up. If they schedule for a “problem” then they would be allotted extra time. Clearly, you have not had the pleasure of escorting your aging parents to and from their doctors appointments. They usually start off with “Oh, by the way Doctor…”</p>

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<p>blucroo: No, I never had the pleasure of escorting my aging parents to and from doctor appointments; sadly, they both died relatively young.</p>

<p>I guess I do live in a different world; no one in my family has ever had a doctor’s appt that was as short as 15 minutes. That includes family practioners, pediatricians, and internists (many of whom decidedly do <em>not</em> use their brains-- or their brains are sorely lacking).</p>

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<p>Jack, you’re right that a patient is usually in the office for more than 15 mintues, but think about it. Is the doctor with you that whole time? It seems to me that when I go to a doctor, I see the doctor for maybe 2 mintues. They do a quick exam, write a prescription, and are on their way. Nurses take the histories, explain procedures, write prescriptions that the doc signs…</p>

<p>Specialists take a bit longer.</p>

<p>I have several friends who are doctors. One of them complains regularly about all the business aspects of medicine she has to deal with, and how hard it is to make a living. Both her and her H are docs, but she works part time. They are both general practitioners. They live in a house probably twice as big as mine (mine is close to 3000 sq ft.) and own another piece of property outside of town for hunting on. They apparently have figured out how to make it work, but she complains a lot about how poor they are.</p>

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<p>I would also like to know where primary care docs routinely spend 15 minutes or more with a patient, and if they get reimbursed for it. It sure isn’t in California! University settings are often different as they are sometimes paid by sources that went a function of insurance payments.And depending on the specialty, it is not always appropriate to swap one patient for another without some time to make arrangements.</p>

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<p>I’m in California and the good doctors that I know spent more time asking questions to get an overall picture of your health. My doctor was that thorough. The doctors that rush you in and out usually are not good at diagnosing problem anyway, I think they cause me more problem then they fix. I’ve been to enough doctors to know that doctors vary in their practice, not all doctors are equal.</p>

<p>When I mean the wait time I mean from the time you arrive at the doctor’s office to the time they call you in. Usually you deal with the nurse first before the doctor see you.</p>

<p>I believe the insurance problem is mostly NorthEast/New England problem, I know I read about them. I too have known lots of young doctors in CA/Nevada and they made so much money here that our income is laughable.</p>

<p>My dentist rarely charges me money if I have to cancel my appointment, even the last minute one, for example, yesterday I did cancel within 10 minutes of the appointment because I did not log in to my computer and that is where my calendar reminder is.</p>

<p>But everybody experience is different, I’m glad that I do have excellent doctor and dentist and they don’t make me wait that long. My only worry is that the dentist will retire and that is why I only pick young doctor if I have to change again.</p>

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<p>I’m thinking back to the last appts I’ve had, excluding the dentist. And, yep, the doctor was with me more than 15 minutes. One was a general practioner; the other was a specialist.</p>

<p>Just saw TooRichForAid’s comment above, and I completely agree with his/her first paragraph–my experience as well. I also have excellent doctors and dentist, though it took some time to finally get to the right ones.</p>

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<p>Good for you and your doctors who get to spend move than 15 minutes together. I mean this sincerely. Be aware that you doctor is not likely to be reimbursed for this time if you are using insurance. Doctors ARE generally paid for time spent, but unlike lawyers, NOT by the people they are spending the time with. They are generally paid by on insurance company. Hopefully your doctors are not also called upon to go without being reimbursed because of unused time in their schedule as well. If yor value them, keep this in mind. It will be hard for doctors like this to pay their overhead and stay in business .</p>