Postcards from the Imagination

I know you are frustrated, but I am really sick to death of people complaining about waiting for doctors and a presumed arrogance. If the world ran orderly, no one would wait to see a doctor. But guess what, people are more sick than you or your daughter, and if they call in and have to be seen, they have to be seen. Hence you wait. Are you telling me if your daughter were in an emergency setting you would let the doctor say to you: "Well, we have an appointment tomorrow afternoon. Sorry, I have to stay on schedule so no one waits." You would hit the roof, but that is what you are asking. Seeing a doctor is not like seeing a banker.

And let me guarantee you, your for-profit insurance company makes a profit because they DON'T pay doctors. It is rare for a doctor to see even 30% of what they bill actually paid for by the insurance companies. Too often, patients confuse doctor's bills with hospital bills. Well, we aren't the same! I am sorry I am ranting at you, but considering the crap I have spent half my day dealing with, this just set me off.

Sometimes you get what you wait for: I try not to fume when my physician is running late, because I remember all the times she's spent extra hours with me going over everything I needed to know to stay healthy with SLE. I try to be the last appointment of the day for just that reason. I used to transcribe part-time for her and help with insurance appeals, and I know she didn't have a return on half of what was billed. The 30% return C. Dale mentions sounds about right. A great doctor will spend time with you when you need it; a great patient sometimes needs to be just that--patient. (I do agree about the frustrations of waiting in a long checkout line, but then I get ticked at Target for the same reasons).

Yeah, it's totally not worth it to be a doctor. That's why so few people are doing it and making excellent money at it, shitty insurance payments and all...

Actually, Steve, less people are going into Medicine. And you can make significant more money in the world of Business than you can in Medicine. Consider the fact that for 8-10 years you make nothing as a physician (well 4 of them you rack up debt, the others you get paid less than minimum wage) and add in interest for the loans and the lost years of income, and Medicine is not nearly as "profitable" as you might think.

C. Dale, my dad was a doctor. I sympathize with that stuff, from insurance companies to PIA clients. I also know how much money he made, so I'm not inclined to be overly sympathetic.

At least we agree about the menace of for-profit health insurance, C. Dale. :-P

"Are you telling me if your daughter were in an emergency setting you would let the doctor say to you: 'Well, we have an appointment tomorrow afternoon. Sorry, I have to stay on schedule so no one waits.'"

In fact, the first thing I did was call my daughter's PCP, and I was told exactly that: we're booked, take her to the ER. I didn't hit the roof. We waited patiently at the hospital to have her injury examined and treated. (I've also been turned away on two occasions for being 15 minutes late for my appointments.)

Where I'm impatient, however, it's with non-emergency practices that are not public service entities, but businesses. To the extent that a healthcare provider can choose not to treat patients who can't afford to pay (either through insurance or out-of-pocket), that right is predicated on the fact that they are private for-profit enterprises. [Full disclosure: I have no health insurance and no money, so if I got sick tomorrow I'd be totally screwed.] And that's the crux of the issue for most people, I think. If a practice is going to operate according to a business model on the financial side, it ought to do so on the service side as well. Most businesses learn how to predict and plan for fluctuations in demand--and where they fail do so effectively, people get grumpy. In medicine, however, the problem is so pervasive that one suspects a lack of reasonable effort--e.g. hiring more doctors, leaving enough time slots open to accommodate patients who need to be seen immediately, referring some of the overflow to other practices.

In this case, the doc's appointments were booked in 10-minute increments and he was already running more than 45 minutes behind schedule by 9:10am. In anything other than medicine that would be considered gross mismanagement.

If the treatment demand of a given population can't be reasonably met by private practitioners operating on a capitalist model, then one has to wonder whether or not that's an appropriate model for healthcare. I'm not absolutely asserting that it isn't, but I'm not convinced it is.

And I have to say, comparing the financial health of doctors to business's privileged elite does not make a compelling case, to me at least, for maintaining the status quo in healthcare--particularly not when there are people who work hard every day and still can't afford to see a physician or buy medicines.

Ginger,

I am by no means asking for a maintenance of the status quo. I am just pointing out that things aren't always what they seem (as in when you first posted the rant). The models you imply work well for other types of business, but not for Medicine.

Steve,

Reimbursement rates for physicians have fallen 4-6% a year for the past 15 years. No one in your Dad's specialty makes what your Dad made, and add in inflation and it is even less. I am not crying poor, just pointing out that being a physician isn't all money and joy.