<p>toorich: those appts, when the docs ask lots of history questions, are called initial visits or consultations and are always extended visits. we have been talking about return visits that are routine follow ups. 15 minutes is standard practice for the appointment book. MD’s that have been in practice for many many years, can often afford to close their practice to new patients and limit the patients they see. They made their killling back in the 70’s. In the 80’s, everything changed in California (onset of HMO/PPO/Managed Care). It took several more years for the trend to spread across the country. When we were dealing with it back in '87 and '88, our friend in KC was seeing 100% fee-for-service, private insurance and some medicare (which still paid fairly). The east coast followed California in the late 80’s and early 90’s. MD’s in the mid west and east had a few more good years than the west coast docs. Now, only in the underserved areas of the country, do MD’s have much control over their practices and reimbursement. </p>
<p>toorich: The medical insurance situation in California is horrendous. It is not just the NE; Young MD’s are not making the money that was once the norm in medicine. Trust me, I know. Frequently, you see two MD’s married to each other…they do well with the combined income, but usually don’t have much of a family life! I think it is a myth that medicine is a good place to get rich…the exceptions being the big surgery specialties: neurosurgery, cardiac and ortho. They are still reimbursed well as they are almost exclusively procedure oriented and the insurance companies have a harder time denying brain surgery, bypass, setting broken bones. It’s harder for them to label them as “unnecessary.” That time will come too…sadly.</p>
<p>For all of you who won’t wait for your MD when they “get behind” because of previous patient issues, paperwork, etc…</p>
<p>If your mechanic doesn’t get your car finished when promised because there is an additional problem, or they have to order a part…or maybe the car they were working on before yours was a real problem…do you just tell them, never mind and take your car and drive off…</p>
<p>I get the sense that there is a difference between those of us who have worked in people-service industries…(where human beings and their issues are unpredicable) and those who haven’t.</p>
<p>Bulcroo,
They are not initial visits but yearly annual exam/check up visits. I never like to visit doctors either, prefer alternative medicine like acupuncture, etc… , and I told this to my current doctor( many time to his face), but he won me over, so I don’t dislike doctors as much.:)</p>
<p>annual visits are usually scheduled longer than routine follow ups. A year is a long time in the health of most patients over a certain (choke, cough) age. For the healthy who only go once a year, you need time for full exam, getting new history, ordering labs etc. In my H’s practice, he sees his regular patients every 6 weeks to 3 months. they have chronic issues.</p>
<p>Thank you bluecroo, for listing but just a few of the myriad of problems the providers face. Add to your list the patients who show up 1/2 late (and still expect to be seen), haven’t filled out the forms that were sent to them in advance (or haven’t filled them out correctly), don’t bring their insurance cards or aren’t prepared to pay their copay, refuse to pay when the insurance company doesn’t cover a service, etc etc etc. These sound like small issues but they are not, especially when they mount up over the course of the day. Then there are the patients that want to call in and discuss their symptoms over the phone at length, but don’t want to come in for an appointment. </p>
<p>If you are an attorney, or an architect, or a piano teacher, you set your own fees. Doctors fees are set by the insurance industry. Patients want their doctors to be “in network” providers, so the copay is low, but this means the doctors are taking bigger and bigger cuts in their reimbursement (and no, this does not mean the doctors rate is too high). Then they (the insu cos.) deny claims, process them incorrectly, request more information and stall on payments, etc. This all requires more staff in the office putting in more time to deal with the insurance headaches. The benefits dept of an insurance carrier quotes one thing, but the claims dept. pays it another way, and the patient gets mad at the doctor. We have had insurance companies flat out lie to the patient. They tell the drs office it is not a covered service and then tell the patient to go have the service and then let the claim be processed (knowing full well it isnt covered). We had one insurance co. try to refuse to allow us to do a 3 way call when we tried to get such a situation straightened out. Believe me, I wish I could get off all insurance plans and let the patients file their own insurance. Many doctors are now doing that. But patients are used to paying their small copay, and don’t want to pay a coinsurance (like 20%). I’ve had people demand all sorts of unreasonable things (eg a daughter of a patient that was seen once or twice 4 yrs ago calling the secretary and yelling at her, insisting our office was keeping her mother from being discharged from a facility because we didnt have a copy of the 4 yr old report immeditely available in our office to fax over there immediately-- oh and never mind that we did not have an authorization signed to release the information, and that the dau hadn’t returned calls placed to her. Then, after the record was sent, the same dau called back a few weeks later and wanted the record sent somewhere else (of course she wanted us to drop everything and do in immediately) because she wasn’t happy with the previous Dr. Then she faxed a request to our office 4x wanting us to fill out some forms about her mother (whom we hadn’t seen in 4 years) because the current doctors didnt want to do it… and never mind that they didn’t come back for their last appointment 4 yrs ago to go over the results… now they expect us to do this for them… at no charge for our time. OK, rant over.</p>
<p>My point is, it goes both ways. I do have a 24 hr cancellation policy, because my appts are 45-50’ appts and I cannot fill them at the last minute. For testing, I require 48 hrs cancellation notice, as I have set aside most of the day for it, and have to pay my assistant no matter what. I don’t have a waiting room full of patients I can stick in an exam room. I try to be on time and am respectful of peoples time, but I think I deserve the same in return.</p>
<p>thanks jym626: Most non-medical people have no clue what the health care world is like. My H has had families come into his office and have a full blown war over what to do with mom or dad…the fight really being about who was getting control of the money. My H has had to call adult protective services and then was sued because he reported that one of his patients was found wandering around town with no lower clothes on, confused and disoriented. the patient’s D sued my husband because she lost control over her mom’s estate!!! The day to day work life for an MD is nothing like what the public thinks it is. That is why many leave private practice and opt for big groups that handle the hassles for them or go to Universities, or leave practice all together.</p>
<p>blucroo: I don’t think the mechanic analogy is a good one. When my car needs work, I call and arrange a suitable time (convenient for both of us) to drop it off. I can leave it all day–no problem. I can even leave it overnight–again, no problem. Fortunately, I live in town and can bike or walk to work, or wherever I need to go, and I have a second car. The point is, my entire day isn’t lost, because <em>I</em> am not the one sitting up there with the mechanic all day. The car is–and between you and me, I don’t think my car has a life, so it’s not a problem. </p>
<p>Additionally, I have never cancelled a doctor or dentist appt in less than a 48 hours notice. </p>
<p>Shrinkrap: I’m not really too worried about how much money my doctors are making. I think they’re actually doing okay (well, better than okay) for themselves. Seriously, they are. I suspect the ones I have frequented don’t really make all their money from the patients they see, anyway.</p>
<p>jack…if you have never cx’d an appointment with less than 48 hours, you are a prince and doctors are lucky to have you!</p>
<p>as for the car analogy…sorry, it was lame, but my point was…stuff happens and life is not as predictable and to the clock as you would like it to be…especially when it comes to diagnosis and treatment (kinda like the car.) If everything was so predictable and all patients were model citizens like you, and the health insurance industry would leave MD’s to practice medicine, then life would be just peachy… But, sorry to say…it aint so in the real world (at least the one I live in.)</p>
<p>Blucroo (answering post several spots up) - I agree, but I also think people in general have no idea about what ANYbody else does.</p>
<p>I don’t remember - did the OP mention that it was a 24 or 48 hour cancellation? For some reason, I thought it was a blanket cancellation fee, which still doesn’t make sense to me. I have no problem with last minute cancellation fees. In my experience, I think doctors use them for their “forgetful” patients, and don’t always enforce them across the board, when people really do have good reasons. </p>
<p>And Jym, I think a situation like yours (Psychologist? Psychiatrist?) where the appointments are long, and a missed appt is a big deal, then the ramifications are different as well. I doubt anybody in your office ever sits for several hours waiting for their appointment, either.</p>
<p>I agree wholeheartedly with the insurance garbage. In fact, that is why I put off going to the doctor as long as possible. I know that once I go, it will be followed up by several months of phone calls and letters, straightening out insurance! But that is another thread entirely!</p>
<p>blucroo: While I fully understand that “life is not predictable,” and “to the clock,” especially where [sick] people are concerned, doctors offices are notorious for keeping people sitting in waiting rooms–sometimes for hours. Since excellent doctors are out there who do not do this, this kind of waiting (and scheduling 20 people into one time slot) certainly can be avoided, if not completely eliminated. Again, I have no problem with unforeseen emergencies that can’t be helped.</p>
<p>I’ll just add that for any patient that arrives 30 minutes after their scheduled appt time (if it really is an individual appt time for that one person), I have no problem with a doctor cancelling that appt for the person and moving on to the next patient. Seems fair enough to me.</p>
<p>Binx: I agree that a blanket cancellation policy makes no sense. I have never heard of such a thing in a medical practice. But, there nothing surprises me much anymore…Especially in medicine, patients have all sorts of reasons why they need to cancel and reschedule or not. Many of those reasons are medical ones!!! Some earlier post mentioned cancelling an appointment when they were down with a cold or flu. I think that is an excellent reason to cancel and even MD’s with a 48 hour cancellation policy would prefer a patient cancel if they are contagious and don’t need to be seen. I have cx’d dental visits when I had a cold…no one needs to be in my mouth when I am sniffling. </p>
<p>Your last statement is so true and is another reason why visits often take longer than predicted. Patients wait until they absolutely have to see the MD and so sometimes problems are made worse by waiting.</p>
<p>jack: if a doctor has a “several hour” back up in his or her waiting room, it is unlikely they get to have lunch or leave at the end of their day as scheduled. Few MD’s get to leave the office at 5 pm when the schedule says they are done… So unless they are gluttens for punishment, getting behind is not done intentionally. I don’t know any doctors that book 20 people into one time slot. Some MD’s have a few exam rooms and may see one patient while the nurse is prepping another, but 20…no. Me thinks you exaggerate. Typical scheduling is 4 per hour for routine follow up; 2 per hour for complicated follow up; 1 or 2 for new consultation depending on the referral issue. </p>
<p>as for “I have no problem with a doctor cancelling that appt for the person and moving on to the next patient. Seems fair enough to me.”<br>
MD’s usually see patients even when they are late because the consequences of turning them away can end up with a ranting and raving patient (I know you wouldn’t do this, but it happens); a screaming family member or worse yet, a medical-legal problem if the patient has a serious medical issue and they are turned away. MD’s practice defensive medicine. Its the sad state of our litigation frenzied society.</p>
<p>I guess I should mention that I have a degree in nursing. While I am sadly out of date, I am probably better than the average patient at self-diagnosis, and knowing when I can afford to put something off.</p>
<p>blucroo: A lot of professions don’t end at 5 pm daily, and a lot of professions don’t allow for a regularly scheduled lunch. If they were going after a profession that ended precisely at 5 pm, and one that offered a regularly scheduled lunch hour, then maybe they should have gone to pharmacy school instead. I have to admit, my heart is not breaking, nor am I losing any sleep, for all the MDs out there. Like any other profession, there are certainly some excellent and dedicated ones, and some that I really have to wonder how they ever got through med school.</p>
<p>As far as scheduling a bunch of patients at the same hour, 20 may be an exaggeration, but not by much. The point, really, is that each person should be scheduled with an individual appt time. To deliberately schedule more than 1 person at one time is simply a bad policy. Period.</p>
<p>Agree with the above post. I don’t get lunch sometimes because of meeting, some meeting starts at 6:00 A.M and end at 8:00 P.M for weeks. </p>
<p>As for missing appointment, if a patient consistently misses apointment then charging that person makes sense but the one I missed yesterday was a visit for consultation but they did not call to remind me, so that is why they did not charge me. I think if they want to charge me, they should call a day ahead about the appointment. I consider that wise patient management practice. </p>
<p>I do think some doctors overbook, same practice as to what airline would to, maybe not blucroo’s husband, and not all doctors do this but some do.</p>
<p>jack-
As bluecroo said, it isnt that simple. Many Drs use nurses and PA’s to assist with seeing the patients (asking preliminary q’s,taking vital signs, blood draws, etc) and they have several exam rooms to put the patients in. They do the best they can to see as many pts as they can. Patients gripe if they have to wait weeks for an appointment, and they gripe if there are too many patients scheduled in a day. Can’t win. </p>
<p>Also, as bluecroo said, turning away a patient who may be ill is bad news, regardless of how late they are to their appt. In the example given with the sx that turned out to be heart related, if that person had been told to schedule another appt and had then had a cardiac crisis, you can imagine that the next call would be to the patients lawyer. Again, can’t win.</p>
<p>In my case, I do a lot of testing, and patients are seen over a few appointments. If they mess up the first appointment (which is scheduled for several hours) it messes up the next appointment (which takes most of the day) , yet people don’t seem to mind doing a tapdance on my schedule. My favorite reason for a last minute cancellation was that the person was having company coming into town (she knew this whe she made the appts) but she wanted to tidy up the house. (She had INSISTED that she get in to see me during the xmas break- didn’t care about my vacation schedule-- she HAD to be seen! Then she cancelled because of her housekeeping issues). Another needed to schedule a manicure! As for me, I can’t remember the last time I had a real lunch. When I do eat, it is usually one of those Breakstones cottage cheese and fruit things. If I am really lucky and have time, I also have a yoplait chocolate yogurt. It takes about 2 minutes to eat these. In between, I try to do paperwork or return phonecalls. Sigh…</p>
Seriously, they are. I suspect the ones I have frequented don’t really make all their money from the patients they see, anyway.</p>