"All that is necessary for the triumph of evil is that good men do nothing."
“If you want to know what a man's like, take a good look at how he treats his inferiors, not his equals.”
Doctors, whether a sole practice, a group practice, or a corporation, are all "for profit". Some of the specialities make a lot of money. Radiologists used to be the most highly compensated (over $500K/year per doctor average) with orthopaedic surgeons a very close second. This is their take home, not the amount they charge and then have to pay their staff and rent from.
Some dermatologists and plastic surgeons can make very big bucks, but not all of them do.
Primary care used to be one of the worse compensated.
Doctors in a successful group practice in a large city do quite well, in general, no matter what their speciality. The problem they all face is that they're selling time and many get tired of working the long hours.
Mike
[But don't cry for the primary care doctors - they've figured out how to increase their income. It's called a "Concierge practice". The doctor limits his/her practice to a relatively small group of people - let's say 400. Those people pay the doctor a flat fee each year for the privilege of being able to see the doctor. That could be $2,000 per person per year. That gives the doctor $800,000 in additional income over and above the insurance and Medicare payment s/he receives for providing service.
For this fee, the patient is guaranteed to be able to see the doctor either the same day or the next day when they call for an appointment. And no waiting in the waiting room. The doctor can spend more time with the patient and does not have to work the number of hours to make the same amount of money as in a non-concierge practice.
Of course, this only works in fairly wealthy urban environments.]
Last edited by Mike Henderson; 05-23-2019 at 7:44 PM.
Go into the world and do well. But more importantly, go into the world and do good.
Thank God for my doctors.....
I don't want to say to much, but you all should also consider the doctors side of things. They have Hospital Admin breathing down their neck to see more and more patients, have a more and more difficult time getting things approved by insurance, and have to deal with multiple NO SHOWS on a daily basis. I emphasize no shows because doctors need to double book appointments because so many people don’t show up for their appointment - that means a gap in their productivity or sometimes getting delayed. They have to roll the dice every day with their schedule. Not to mention the lack of respect for the profession by some patients.
But yes, of course, front office staff should be keeping patients up to speed. And don’t hesitate to ask if the doctor is running behind, instead of sit there and fume about it.
The system isn’t easy for anyone these days.
Maybe this is different in various states. In both California and in Washington doctors routinely bill "NO SHOWS" for their appointment if it isn't canceled 24 hours in advance. It is made clear on the appointment slip they give every patient and is usually posted in the office in plain sight.have to deal with multiple NO SHOWS on a daily basis. I emphasize no shows because doctors need to double book appointments because so many people don’t show up for their appointment
It must be effective. A few times my doctor or dentist's office has called saying there has been a cancelation and wanted to see if an earlier appointment would be to my liking.
jtk
"A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty."
- Sir Winston Churchill (1874-1965)
Once upon a time I was taken to the emergency room at Erlanger Hospital in Chattanooga due to crushing my ankle in a motorcycle wreck. They gave me morphine on the ride over, which did next to nothing for the pain. When I got there, they gave me Fentanyl, which is an extremely effective but short lived pain reliever. They got my ankle stabilized but said I couldn't have any more pain killer until I was transferred to a room on one of the upper floors. I lay there in the emergency room for a couple of hours while they claimed to be "finding" a room for me. The pain got really serious but nobody did anything. Finally, I started yelling and demanded my cell phone. A nurse walked in, handed me my phone, and asked who I needed to call. I told her I was calling 911 to get an ambulance to come in and take me to some place where I could get treatment. As I started dialing, they somehow managed to break the log jam and get me quickly transferred to a room so I could get some kind of pain killer. My point is that emergency rooms and hospitals in general can be just as sloppy and inconsiderate as doctors when it comes to medical care.
'No Show' notices and charges are pretty routine around here, particularly with specialists. Primary care is often capitated by insurance plans, so "no show" fees seem to be less evident there. The practice gets paid a set fee simply because you chose them to be your primary care practice and they are only "out" the co-pay when you don't arrive for your appointment. I'm in no way saying that being a no-show is appropriate behavior...it's not..of course.
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The most expensive tool is the one you buy "cheaply" and often...
There's a physician in rural Kansas that had an office visit charge that was keyed to the first class stamp. 100 times the price of the stamp. He didn't accept insurance.
The only time I can remember having to wait well over an hour for my family doctor was a time when a patient should have gone to ER and the doctor had to call 911 and have them taken out on a stretcher. It put the doctor way behind on his schedule. I had a late afternoon appointment and needed lab work. They kept the lab open just for me. The entire place was empty by the time I was done.
I needed the care and wasn't about to reschedule as long as the doctor could still see me.
"A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty."
- Sir Winston Churchill (1874-1965)
I once waited an hour and a half for the ortho guy to cut the cast off my young son's arm. Finally I went to the desk and told them to forget it, I was going to take him home and cut it off myself. They got him back immediately and the cast was off in about 2 minutes.
My longest wait was maybe 3 hours. I occupied the time by computing the square root of 15 in my head, one digit at a time. I got to 3.872983346. Decades later I can't get it out of my head. So far it hasn't been useful for anything except to get people to quit bragging about their mental capabilities. I can barely compute the square root of 16 these days!
Also, these days I take a Kindle and don't really care how long I have to wait.
JKJ
Sometimes, no shows aren't the patient's fault. Case in example. Last week had a follow up with urologist for my ultrasound on kidneys. I get there in plenty of time, but not only isn't doctor there, but neither is the building. It had been demolished and was being loaded on dump trucks. Seems doctor's office forgot to tell several patients, myself included, that they would be relocating. Called and found new location, and made my appointment on time, but still had to wait almost an hour. Oh yeah, ultrasound showed I had two LARGE stones, one in each kidney, which neither CAT scan nor xrays had shown two weeks earlier. Surgeon didn't find them when I had surgery two months ago either, cause they aren't there. Ultrasound reader got it wrong, but I still get to pay for ultrasound test.
Dr Tranh, a Vietnamese refugee was one of the nicest people you could meet. His office was right along Rt 50 in Falls Church VA. Right in the middle of the hectic Northern VA suburbs of Washington DC. His wife was his secretary and nurse. The basement of his office was all shelves with files. (before computerized records.) The Washington Post did write up about him once. I figure he saw perhaps 8 to 12 patients per hour. and probably averaged 9 or 10 hours a day. He did not do any procedures like stitches he normally avoided vaccines except for the flu shots, etc. I figured he had a good little operation going there and served a niche of folks who other wise would not have care. In the newspaper article about him, he said it was in part, his way of giving back to his new country. I know he was still there in 1999.
We wouldn't put up with an employee who is always 10 or 15 minutes late or a dinner companion who is always that late. Why do we put up with doctors who don't see us at the appointed time ? That's rude and selfish. On the other hand, if I'm 10 minutes late, either they want to reschedule or it's still another 10 or 15 minutes.