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What is your average wait time? Do you complain if it’s more than one hour?
Yes
Some doctors keep people waiting for no other than to seem busier than they are.
What’s your problem?!? Take the Coffee Room with you!!!
Joseph:
You wrote: “Some doctors keep people waiting for no other than to seem busier than they are.” I also believed that. There are certain realities that suggest this is a myth. Firstly, doctor’s offices are seriously understaffed. Secondly, the use of doctor’s for impromptu visits is commonplace. In this era when payments to doctors are significantly decreased, and insurance premiums for malpractice are skyrocketing, the funds to provide more staff are limited. There is newer technology that makes things quicker and easier, which also costs. There are more non-physicians (nurses, PA’s, etc.) providing services today, and this all comes with its disadvantages.
One of the most respected medical journals carried an article many years ago where the suggestion was that the patient send the doctor a bill for the waiting time, which makes sense if that patient works in a field where charge is levied by units of time.
A down side of waiting in doctors offices, aside from the delay factor is the exposure to other sick people and the microbes they carry. This poses potential risk, especially when there are contagious diseases like flu that have been at epidemic levels.
Very fact specific….too many scheduled visits and overbooking in many cases simply as basic economics for small practices trying to meet “quotas” to cover their costs. Unscheduled emergency visits or patients with more complex issues add to the delays since their is no “free time” built into the schedule.
Ezra Medical Center in Boro park boasts a waiting time average of 5 minutes! Thats the upside!
I’ve found that the doctors I have to wait a long time for are behind schedule because they give more time to each patient than is scheduled. Which is a good thing- they actually do a thorough exam, listen to the patient, take time to explain things, and don’t just shove you out the door because your 10 min is over. The problem stems from the tight scheduling of the appointments, which in the system in E”Y, is beyond the Dr’s control. I once went to a Dr (a specialist who only works 1 morning a week) and several of us realized we were booked for the same time slots- and these were appointments made long in advance, not emergencies that were squeezed in. The dr still gave each patient the time she needed, which meant that not only were patients waiting, but the dr had to work overtime. When i asked her why they schedule an impossible schedule, she said that this way people can get appts within 6 months, and don’t have to wait 1 yr.
After 30 minutes I get up and walk out. I also refuse to give the receptionist the co-pay before I see the doctor. Once they have your money, they don’t care how long you sit and wait.
CT, then you really weren’t sick.
@lesschrumras
There are many occasions for ‘well doctor’ visits: Annual physical, Flu Shots, Eye Exam, every six month teeth cleaning, orthotic adjustment at the podiatrist.Not every doctor visit is because one is sick.
In fact, I went on Monday to update certain vaccinations for travel to travel to southern Africa this month.Frankly , in my office I try to run on time and am fairly good about it. Rarely more then five to 10 min late.
But those days when I’m backed up can almost always be blamed on patients .
Either patients coming late , or new patients not coming early to fill out paperwork and then the alloted appointment time passes while their info gets entered and now they are into someone else’s time.
As for emergencies, it’s nice to say to leave time in the schedule for them but by definition they are impossible to predict. Do I leave two slots a day? What about days with six emergencies? What about days with none? Whose paying for those empty slots ? What about all those annoyed patients who desperately wanted an appointment asap but I told them we were full when we really weren’t?
Get where I’m going with this?
Old business adage . You can’t have all three of the trinity of price, service and skill. But in healthcare everyone wants all three and hates on us providers when we don’t provide it.CT
a beautiful system would allow dr’s to get paid by the hour. Imagine a world where I can charge my pt’s in six minute increments. Let’s say $35 every six minutes even when they are late. Then I could compensate those waiting in the waiting room . Sounds fair right ?
Instead I can’t even begin to imagine the amount of money I’d be worth . Because I don’t get paid for time. I can spend an hour with a patient taking a complex medical history, or giving treatment advice and answering unending questions from patients that come with long sheets of paper filled with imaginary concerns and symptoms. Or the patient who is depressed and just needs someone to listen for a few minutes. That’s my day, I help people. And I don’t get paid for a lot of itit. But that’s why I went into the medical field instead of becoming a lawyer.I could deal with the long wait time if it wasn’t accompanied by rude staff doctors office receptionists are some of the rudest most obnoxious people you will ever have to deal with maybe they think the glass sliding window means that they are the gatekeeper and the patients are the undeserving hordes asking to see the king.
Perhaps if ….doctors could charge for every minute that they speak on the phone with patients, and charge extra for the time they spend with pts who say, “oh by the way doc, while I’m here can you look at….” when the visit was really over, and charge a retainer for those pts who refuse to pay their copay when they come and have to be chased, and to cover insurance denials….then they wouldn’t have to book so heavily.
And if only patients would have the common courtesy of calling to cancel if they’re not going to come in (my average no show rate is 25-35%)In America, I walked out of the office after waiting an hour. I spoke to the practice manager and told her why I was leaving. She threatened to send me a bill for the missed appointment. I told her I would send her a bill for my missed work time. I never heard from her, and switched doctors shortly afterwards.
funnybone, many doctors like to force patients to come to the office unnecessarily when they could have easily answered the question quickly by phone, without a visit, or just have related basic information because by coming to the office they can bill the insurance and copay.
There are many choices in the medical field, make them! If your time is important to you , don’t stick around in those type of offices!
The pediatricians in my neighborhood that are the best doctors are basically the ones with the longest wait times. And yes, they overbook because it’s almost impossible to say no to a sick child. That holds even more true when the flu or some other virus is out there infecting many kids.
But if you end up waiting a while at a medical center even when there are almost no patients, it’s most likely that the bureaucratic system and staff are at fault.
It’s always good to check what’s going on after half an hour or so, perhaps the receptionist simply didn’t check you in properly. And for them to know you don’t appreciate waiting…
If it’s an emergency speak up loudly, and if staff doesn’t listen, walk in straight to the doctor. (Years ago, my then toddler needed nebulizer treatment and perhaps medication for breathing difficulties that I couldn’t safely handle myself. When I told the receptionist that my child was breathing rapidly her response was an empathetic “Yes, I see that.” but continued to let me wait… So I walked in to the pediatrician who B”H had the sense to treat right away.)
@mentsch1
Contrary to your belief, lawyers also help people.
Unlike doctors, the first consultation is generally free. My firm spends 20% of its time on pro bono cases…work done free for the public good.
I can’t tell you how to run your practice and schedule your time. That’s your business. I know that you can charge different amounts for a brief office visit and a long one. The problem is that you are constricted by insurance payments, I am not.
My internist has a concierge practice. I pay an annual fee that grants access and short wait times. Not every doctor offers that nor can every patient afford it.
My dentist is in the same building as my office. I have his staff trained to phone me when the previous patient gets up from the chair in the procedure room. I am able to be in the room by the time the dentist is ready to see me.
I dropped my eye doctor when I found he was making 6 ‘first’ appointments, sticking patients in exam rooms and wasting hours of me time.I went to my internist for vaccinations this week. He schedules a vaccine clinic each week for three hours. Patients are in and out. No other issues are discussed or treated. He only sees adults as patients. This leads to a much more orderly flow to the workday.
CT
all very nice
but as i said in a business paradigm you cant have all three
we all assume the doctors to be skilled
that means that either you need to choose between price or service. Since you can afford it you chose service. the other 99% want healthcare for free AND concierge service. That’s not a fair expectation. But its what we healthcare providers hear all day long.
In your concierge service, if you didn’t show for an appointment you would be charged for it.
Yesterday, my colleague had a full day when she walked in to the office. By the end of the day she had 30% cancellations. Time is money, that cost her tons and if she dares charge for it people leave.
Im sorry but from my POV, patients are far more inconsiderate then the health care providers they complain about.When doctors have to compete with personal robots that cost the same as refrigerators, they’ll find ways to make their office visits more convenient.
DovidBT
ridiculous statement obviously made by someone who doesn’t run a business
All those conveniences cost
lets do math
whats a fair salary for a doctor?
I think $200K is low but lets go with it
how much does the doctor need to generate/bill to make that money? Besides for basic overhead, rent etc which is a large percentage of gross, there is the biggest fixed cost, payroll. Each staff member is costing 40-50 k per year minimum. So to make your experience at the doctor more convenient, you need more staff and less patients taking up your time. The price of employment is going up while the reimbursement is going down, how can a doctor who takes insurance afford to cut the amount of patients he sees?! just the opposite, he needs more volume
In your scenario, doctors will be out of business bc they need to have a salary that justifies being in school till they are 30+. Otherwise, no one is going to med school.@mentsch1
Here in the country things are different.
No shows and cancellations with less than 24 hour notice are billed a fee (there are exceptions, such as being admitted to the hospital). Don’t pay the fee and chances are the doctor will drop you as a patient.Unlike, some of the Frum enclaves often mentioned in the CR, the doctors here are not seeing a large number of Medicaid patients.
My time is money…that’s what attorney’s do, they bill time. I respect the doctor’s time as well. When booking an appointment I let the receptionist know if I need a brief or extended visit. The internist who is my primary care doctor does not see children. That speeds things up. Also, people who call and say they’ve just come down with a kronk are referred to the walk-in facility in the building, not told to come in and be squeezed in.
As far as your statement about costs, in this areas almost 50% of MDs have sold their practices to the area hospitals and are employees, not business owners. Excluding my dentist. all of my doctors are in practices now owned by two hospitals. This includes the concierge practice owned by Yale.
Funny
Like any other business a doctor office needs to generate a certain amount per hour to pay expenses and salaries. That’s the starting point in this equation. Of course doctors may be greedy and trying to milk every available dollar. But let’s assume a practice were the doctor is making an average salary for his field.
In order for things to run smoothly the following needs to happen
1) the doctor doesn’t overbook, rather he leaves enough time per patient . This is difficult to guess but doable.
2) every patient shows up on time (or early to fill out paperwork)
3) if a patient doesn’t show on time then the doctor needs to make a decision, reschedule the patient or allow the schedule to start to get backed up . Ideally the patient would be rescheduled but the patient would…
4) ability to charge patients for missed or late shows. With dedicated appointment slots comes the need for definite revenue . Otherwise several missed appointments and the dollar per hour is in the negative range.
It all comes down to insurance. Low reimbursement means a need for high volume in general. The worst Is a Medicaid practice, besides for low reimbursement,doctors can’t charge for missed appointments . And when patients have no skin in the game they have no incentive to not show so multiple cancellations is the norm and thus overbooking by doctors is the norm.
I’m not saying doctors can’t do a better job. I’ve left doctors for being bad about wait times. I’m saying that a lot of this rests on pt insurance and pt irresponsibility.
Like in all other areas of life , those that are on time end up having to wait for those that have no concept of time.It’s interesting that we’re talking about costs and finance in a thread about doctors. Has anyone ever asked a doctor or dentist office how much something simple cost? Sometimes I can’t even get a quote. They bill a third party payer, who has the rates set, normally based off of Medicare set rates. Then if you are lucky enough to have worked in health insurance, you can discuss things with the rude and snobby receptionist who billed wrong, although she can do no wrong, although you were the professional who denies her bills for doing them clearly wrong.
If time = money, and no one knows the value of their services or money as it just gets typed into a computer with a code (that’s usually wrong), then who knows the value of time?
We might want to take along a sefer to learn not to waste the time.
jd
when Ben Shapiro talks about this he comments that for all intents and purposes doctors are indentured servants. What other field allows the government to insist on a person (doctor) to provide services and doesn’t allow the provider to set his own fees.
At fault is the system, a doctor would love to tell you a set fee and get paid for his time.
Medicaid is a huge part of the problem.
Why is this the doctors fault?funny
of course not
but if you actually read my posts, you would see the problem is more with patients then the doctors. Doctors need to overbook bc insurances (read:patients) don’t pay well and are lax about showing up on time
This may not be you, but it’s many of your fellow patients@mentsch1
“What other field allows the government to insist on a person (doctor) to provide services and doesn’t allow the provider to set his own fees.”Unfortunately your representation is flawed.
You only have to treat this group of patients and accept the fixed fees if you CHOOSE to accept Medicaid, Medicare and/or specific insurance company covered patients.
Many of my doctors have signs at their windows stating they do not accept Medicaid, do not take Medicare assignment (patient is responsible for difference between Medicare reimbursement and full fee) or Insurance company X.BTW, I’m a family law attorney. If I take cases in Probate Court (Surrogate’s Court in NY) The percentage of the estate that I can charge for being executor is set for me. If I represent youth in Juvenile Court who are DCF (CPS elsewhere) wards, my hourly rate is set by the court (about 1/3 of what I charge on the open market). I can make the decision whether to do this work or not, I’m not a slave.
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At any moment that I am in the courthouse, a judge can snag me and order me to represent an indigent criminal defendant at NO CHARGE (pro bono) where I not only don’t get paid for my time, but must bear the cost of many expenses from my own pocket. Attorneys are expected to take on X number of pro bono case hours per year. Here in CT we don’t have a Government Legal Aid department, so we become indentured servants at times.Funny
I don’t know what CTL is going to say but he has already said that if you want good service you can pay for it. It’s called concierge practices. You won’t wait.
But
If you are looking to bargain a doctor down and not pay a fair wage, then you are part of the problem. You certainly don’t have a right to complain.
To an extent, everyone using any insurance plan is part of the problem(and yes I have insurance, but you don’t hear me complaining) this is bc the whole reason insurance exists is to remove dollars from doctors pockets and shift them elsewhere. With private insurance the money gets shifted to corporate America. Medicaid is a different animal, but in the end it creates the need for a high volume practice.
A colleague of mine who takes Medicaid has a wall in his waiting room that he calls the hall of shame . He tried to illustrate to patients the insanity of dealing with insurances. He posts reimbursement checks that he gets from insurance company’s that are less then a dollar. That means he lost money. Between the time paid to his biller and the postage it wasn’t worth the effort.
I’m not saying that the system isn’t broken in many ways
I’m saying that patients who use insurance and who come late , shouldn’t complain.
Instead . Try paying out of pocket for doctor visits and use a concierge practice. Only take out catastrophic medical insurance. After all , (acc to consumer reports) the whole point of insurance is to protect against catastrophic loss not day to day expenses.@Mentsch1
Just a quick mention of what happened to me today (apropos of my last post).
Today I had jury duty at the local Superior Court. In CT, attorneys are not exempt and I am called every three years for the obligatory one day service, then if not chosen for a jury and free for the next 3 years.
I was sent as part of a group of 40 to be interviewed for selection to serve on a murder trial.
After discussing the case, the judge called us into the courtroom one by one for questioning (Voir Dire). Most prospective jurors were questioned for about 3 minutes. I was on the stand for over half an hour. The judge wanted me to serve, the prosecutor wanted me to serve, the defense attorney was forced to use a peremptory challenge to get rid of me.
As the judge thanked me for my time and dismissed me from jury service, he informed me that I could not leaver the courthouse, but had been assigned to represent an indigent minor child whose parents were in the family division in the final stages of a divorce.
So, I spent the entire afternoon providing free legal counsel…with the state determining I should work at a rate of ZERO dollars per hour.CTL: Could you refuse, saying that you need spend the time with fee-paying clients so that you can feed your family?
DovidBT: Would you like to help me in starting a GoFundMe campaign to keep CTLawyer’s family afloat while he does he indentured servitude?
CTL
Mea Culpa
I herby recognize you as a fellow indentured servant to the government.@DovidBT
I could not refuse in this case. I was obligated to be in the court for the entire day for Jury Duty (and longer if empaneled on a jury). One does not have to be let go by the judge. but can be sent back to the prospective juror waiting room to be on call for other cases.
I am not a dues paying member of our county Bar Association (but am of the State association), however they set their standard as every member shall provide a minimum of 2 days pro bono work per year. That can cost anywhere from $1500 to $9000 depending on billing rates of the attorney.
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A non-solo practice attorney, such as myself can ask the judge to allow a different attorney from the firm to serve if there is a scheduling conflict, but as owner of the firm I’d still bear the cost.
In general, one does not refuse the legal requests made by a judge.
The good thing is that we don’t elect trial court judges in CT and never are on the hook for political contributions, etc.@Joseph
B”H I am not in need of assistance. My posts were merely there to illustrate to Mentsch1 that doctors are not the only professionals to be forced to accept reimbursement rates set by government.@Mentsch1
Thank you.
This discussion was important so that readers can see that we are operating businesses, even though we are deemed to be ‘professionals’ and that it is not a free market. Government can and does set rates.@funnybone
It is highly unusual for a client to have to wait for me. Unlike a physician, most of my client contact is by phone, email, fax, etc.
Should a client have a short wait before being shown into my office (generally caused by my doing something to facilitate the meeting) the client would be offered coffee, cake, a cold drink or snack. I can’t remember the last time a client was made to wait more than 10 minutes for an office appointment with me.
BUT, unlike Mentsch1, I see less clients in the office in a week than he does in a typical afternoon. I’m far more likely to meet with associates, paralegals, investigators, accountants or other attorneys on my clients’ behalf than with the client during representation. There are many clients who I never see from retainer to resolution.funny
If you have understood anything I have written then you should understand the fundamental difference between practices. A concierge doctor is essentially getting paid by the hour and therefore has much more control over income, and thus can schedule accordingly (to keep the income rate at the desired level)
A standard insurance accepting medical office has no control over income other than volume. In fact the same procedure billed to 10 different insurances is unlikely to ever be reimbursed at the same rate.
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