Is this a nationwide trend, or just here?

[Talk Host]

I find it to be so maddening that in order to make an appointment with a doctor, you have to leave your name and number on an answering machine and they will call you back at their convenience. That means you now have to sit around and wait for the call. If you miss it you are out of luck. What's next, "Hello, you have reached 911, please listen to our options, as they have changed recently. If you are having chest pains, push 1. If you have been cut by a chain saw, push 2. If you are trapped under a bulldozer, you'll have to call back during regular office hours of 9 to 5.....Good bye."

[graciegirl]

Jan

:dontknow:

Don't have that problem here in West Chester, Ohio.

[chelsea24]

:agree: Jan. I took care of my dad for many years in Illinois. If I called a doctor and his receptionist put me on hold, without asking me if I COULD hold, I would never go back. Consequently, in my husbands clinic (veterinarian) if I heard a receptionist answer that way, they were fired on the spot. They had been warned about this when they were hired.

These menu's, especially at doctor's offices are one of my pet peeves. Many times when people call, they are at their most vulnerable, feeling sick or confused. I did find a great doctor here in the Villages. Even on her day off, she calls you back within minutes. And all of her staff, except one, could work for me easily. A very caring, efficient group.

Customer service in all types of businesses comes first with me. It's a nationwide trend I fear.

[Talk Host]

Don't you just know it.......I stepped outside to pull a weed out of the flower bed and the doctors office called back and I missed the call. they left a message for me to call back and when I called, I got that ****ing answering machine again.

[graciegirl]

Call Chelsea and see if Vetman can fix it. ;D

Oh I am sorry. The devil made me say that. :dontknow:

Oh Jan, don't throw me out. :cop:

I know this is serious. I would switch Doctors. :redface:

[islandgal]

The one irritating thing I have encountered since moving here, is when you call a doctor after hours or weekends, there is no one to cover for them or an answering service to relay the call.
I wouldn't be calling unless it were urgent - not urgent enough for the Emergency Room but enough to get a quick answer or solution that shouldn't have to wait overnight or a weekend.
Never experienced that before. Maybe that, too, is a sign of the times.

They all say, In Case of An Emergency, Dial 911.
That just blows me away. Maybe I have the wrong doctors. :dontknow:

[barb1191]

WOW Jan....... Did you hit a sore spot with me!! Totally agree with you.

Bill and I decided to become full-time residents in TV, after having been snowbirds for a number of years. When we attempted to find drs (specialists), no easy task, we were totally disenchanted and so returned to the snowbird status because of the very very poor medical attention in FL.

Having a terminal illness, I really didn't feel that any of the medical care I received in FL didn't come close to the great care I had experienced in Boston. Was told by one oncologist to just wait it out and then go to hospice!! I walked out of that dr's office having the feeling of being handed a death sentence! Now back in Boston, with the best medical care, has given me hope as they take the pro-active approach.

Another thing I noticed is that the gp's in FL seemed to have no equipment in their offices, merely take your vitals and send you to various specialists as needed. Guess I'm used to going to a dr who's office is fully equipped with various testing devices. It seems there's the dr and a computer, a receptionist and a nurse who takes your bp and pulse.

This experience is not to discourage others, however, be your own advocate and insist on what's best for you.

barb

[billethkid]

I find it to be almost exclusive (almost!!) to TV.

The demand is so great they do not have to do what others in their profession do to provide satisfactory service.
And this also does not apply to all the physicians here. I find if you mention it to the doctor, he will often times not be aware of the short comings his staff has introduced into the process to make their job easier.

The other irritation when a new arrival is can take months to get an appointment. Even doctors who advertise they are taking new patients, it is not uncommon to be one plus months out.

I have resorted to specialists with offices in and around MRMC South of Ocala just off SR 200. The Ocala physicians/specialists do not have the pent up demand as in TV. Then I book one of those far out appointments with one in TV I would like to eventually wind up with. I will not go without the appropriate and TIMELY care because of TV bottleneck.

The physician location problem overall is also exacerbated when trying to find one that speaks understandable English!!!

BTK

[chuckinca]

I find it to be so maddening that in order to make an appointment with a doctor, you have to leave your name and number on an answering machine and they will call you back at their convenience. That means you now have to sit around and wait for the call. If you miss it you are out of luck. What's next, "Hello, you have reached 911, please listen to our options, as they have changed recently. If you are having chest pains, push 1. If you have been cut by a chain saw, push 2. If you are trapped under a bulldozer, you'll have to call back during regular office hours of 9 to 5.....Good bye."



Jan:

We don't even call 911 in the Norcal Bay area - the phone just rings and rings without an answer. Have to call the local police or fire dept to get any emergency response.

[SteveFromNY]

Jan, this seems to be the trend not just with doctors though. Lots of service folks do it too. I hate it. When I call, I want to talk to someone, even if only to be sure they got the message. When I do leave a message, I leave my cell number and carry that with pretty religiously.

[graciegirl]

I think Barbara stated the facts about medical care in Florida very wisely. Unfortunately the "meccas" of certain specialties are not in Florida. My folks who lived in Venice would schedule quarterly trips to Ohio. I think that we will as well. I don't want it to be so, but it is.

If you have a life threatening cancer than you should be flying to Anderson in Texas, or Sloan Kettering in New York. If you have a cardiac issue that is dangerous, fly to Cleveland Clinic




This is my opinion. Please don't jump on me. I am having a bad day. I fell off the toilet. :joke:

[Russ_Boston]

I am having a bad day. I fell off the toilet.

You're just begging for this post to go off topic with that statement :joke:

Not as serious as falling off the wagon but I hope that you are OK.

As far as the topic goes - My PCP just put one of those in. But usually you can circumvent by dialing '0' and get to the secretary.

[Shirleevee]

In days gone by..........we had a, "family" doctor. He gave shots, took x-rays, tested blood and urine in office. My oldest son received his allergy shots from him. His wife was an OB-Gyn and took care of womens needs.

Today, I go to my Primary doctor, (if I can get through to make an appointment), he takes my blood pressure and anything else is referral-ed out to other doctors, that I have to pray will answer their messages..............

911 ??? When my husband had a heart attack in 2001, 911 informed me that our address did NOT exist........well, where have we been living for the last 35 years? Thank G-d for the NYFD/NYPD
New trends equal FRUSTRATION!!!!!! IN ANY STATE

Shirleevee

[billethkid]

There is an MD Anderson extension in Orlando.

There are a substantial amount of specialties in the medical field in and around Miami.

When my wife needed a specialty surgery, one of the only places in the country that could handle what she needed was at the Miami University Hospital.

A lot closer than ANY points North. I would venture to say almost anything you needed back home (some where up North) is available here in FL. The drive is much shorter and no snow!!!

BTK

[graciegirl]

There is an MD Anderson extension in Orlando.

There are a substantial amount of specialties in the medical field in and around Miami.

When my wife needed a specialty surgery, one of the only places in the country that could handle what she needed was at the Miami University Hospital.

A lot closer than ANY points North. I would venture to say almost anything you needed back home (some where up North) is available here in FL. The drive is much shorter and no snow!!!

BTK


I am delighted to stand corrected! :) :bigthumbsup:

[serenityseeker]

Wow! The frustration is palpable here!
I understand exactly what alot of you are saying and experiencing but let me give you some information from the physicians perspective.
Voice menus are definitely irritating to alot of us, but I think many physicians have no choice at some point. Figure the average physician has between 2000-4000 patients. The fielding of those phone calls on a daily basis is an enormous task. Couple that with pre-approval calls to insurance companies for nearly every test and referral, calls about billing issues,lab results and others and you are tying up 1-2 full time people just for phone calls. The typical environment that you never see or hear in the office is one of barely controlled chaos.
The physician doesn't "choose" to have so many patients in most cases, it is a necessity to survive in todays medical/business culture. Reimbursements drop every year from insurance companies and the government payers, but all of us know that costs rise EVERY year, and the overhead to run an office does to. This is a losing battle and physicians are forced to try to see more patients in the same amount of time. It still isn't working. Most physicians (almost all) in primary care are taking salary cuts each successive year. They spend more time with patients and address more problems than the sub-specialists and yet not only are paid the least, but usually are the first to see the cuts.
Things like automated voice menus, giving up in-house labs(very expensive equipment and onerous government regulations) and overscheduling patients are a last ditch effort to survive. In what other fields can a professional spend so much time, effort and money on education and training and know up front they will take a pay cut each year? Many physicians assistants and nurse practitioners salaries rival or exceed those of primary care physicians. Money is not the be all end all but who wants the pressure, responsibility and liability, coupled with long stretches away from family, on top of the pressures of trying to run a business(a full time job in itself) with a non commensurate "reward" for it?
As far as waiting times for new appointments, get ready, it is going to get much worse all around the country. Dramtically less medical students are willing to enter primary care for the above mentioned reasons, we have been seeing it for a few years now. Estimates of the shortage of primary physicians in the next 10-20 years are staggering and frightening. This is happening at the worst possible time as our population ages. Waits are so long for new appointments because their are not enough primary care physicians and the forecast is only that it will get worse.
As far as weekend call coverage goes, let me try to give a couple of bits of information. Many primary care docs have simply given up their outpatient practice and turned it over to hospitalists(groups that specialize in in patient care only) because the time it takes to round on just a few sick hospital patients robs multiple people of office visits.. After 5-6 days a week of long office hours and having been pushed into giving up inpatient practice, most take their 1-2 day weekends(the part that is not used catching up on charts and billing) to have with their families and leave those after hour"emergencies" to others. No one wants to take call. If you do carry your pager and are deluged with calls all weekend there is no reimbursement for your time, expertise, or offset of the liability of prescribing by phone and taking a chance on a poor outcome when you didn't physically see the patient.
What it boils down to is a broken system. The business of medicine and the high cost associated with liability are strangling the system.
As far as specialty care goes, some times a place like M.D. Anderson is a good choice. For the vast majority of care, we all practice according to the leaders in the field, and the difference is scant on many issues. This of course does not refer to specialized procedures that are only done by a few, or places where procedures are noted to have superior outcomes. The bypass surgery at Cleveland Clinic is the same done at hundreds of other hospitals in this country.
For those of you with compassionate and dedicated primary care physicians, take the time to let them know you appreciate them. Educate yourself about the system and talk to your elected officials(how many of you are aware of the yearly battle with looming 5% medicare cuts and last minute bail out efforts) about cuts and reimbursements for primary care physicians.
Please excuse the length of this but their is no short way to address it. We have to become more educated and proactive in the system, and someone needs to advocate for the primary care docs before we hit the shortage/crisis full bore. If you have any doubts just Google info about shortages in Family and Internal medicine.
Just wanted to take the time to let you know a little of what goes on behind the scenes every day.

thanx for listening

[Mikitv]

These experiences in TV sound like what we have here in Northe East Arkansas. Doctors office is a large clinic with lab and x-ray in the building. Call the office you get a machine, leave a message and wait for someone to call you back hopefully the same day. Like others I leave my cell phone because it is with me all the time. I was hoping the medical would be better in TV but it doesn't sound like that. When they cancel our appointments here because of doctor scheduling problem it takes another month to get in again. Arrive for appointments on time and then sit there. When doctor does come in he gives you maybe ten minutes. He is internist and everything does get referred out. It seems to be the same all around our area. Too many people coming in here for doctors since we are largest city in North East Arkansas. Maybe some one should send the doctors in TV a note about TOTV and see what is being said about them. Customer service is certainly lacking in this world today. Maybe they need to see a few less patients and make a little less money so they can truly be doctors. IMHO

[efrahin]

It is the same in NY. When my daughter-in-law started her practice as an OBYN I help her choose a computer system. At that time I noticed that none of the ones in the market have any online appointment feature. I figure that if the Airlines can do it, whay not a physician. Just a few weeks ago she told me that the system she uses announced that the patients will be able to do their appointments on line, which is going to help a lot the front office staff. The medical system is a full train wreck, and I dont see any fixed for it.

[swrinfla]

serenityseeker:

Certainly appreciate your side of this issue. Fact remains, however, that the patient does always seem to get the short end of the stick! >:(

SWR

[njgranny]

What annoyed me one day was that I was in my PCP's office and the receptionist took a call. She then got a call on her cell phone and put the person on the regular phone on hold. She then proceded to have a personal conversation on her cell phone. I couldn't help wondering if all those times I've been placed on hold and sometimes "forgotten," if she'd been taking a personal call on her cell phone.

We are lucky here that we usually get a person when we call for appointments. Only one time this week, my husband's cardiologist's office went to voice mail. I just called them again later.

It takes forever to get specialist's appointments, though. Not enough doctors around.

[Talk Host]

serenityseeker:

Certainly appreciate your side of this issue. Fact remains, however, that the patient does always seem to get the short end of the stick! >:(

SWR


You can say that again. Doctors can frame it however they like, the fact remains that we are not only patients, we are also customers. We are their book of business. They are required by good business practice and ethics to treat us as both.

It is my firm belief that doctors have turned the health insurance industry into a money mill for themselves. If looked at under a microscope, that is called thievery.

[barb1191]

Touchy situation for which I can hardly feel that the medical profession is suffering that much. My experience showed that doctors put in a 9-5 day and 12-1 lunchtime. With all due respect, I find that the major problem is mismanagement.

Big difference here in Boston. We have world-renowned medical facilities such as Mass General Hospital, Dana Farber Cancer Center, Childrens' Hospital.....to name a few.

My PCP is extremely organized and is associated with another very well-known hospital, Beth Israel in Boston. His office is equipped with all hi-tech specialties in their offsite building in the suburbs. There is also a computer site they maintain where a patient can email their doctor and get same-day responses. A patient can logon to this site and see their own personal records, complete with test results. The patient can logon and make appointments and even request prescription refills which, when approved by the dr, will be called in to the pharmacy for patient pickup. Doubt you'll ever see that in FL, unfortunately.

Returned to my oncologist at Dana Farber and had an appt with him within the week we returned to MA. They are all fully staffed here and well organized. Even the small country doctor is still around and he still makes house calls. That's Bill's dr who is sharp as a tack and extremely well organized.

Maybe it's the slower pace in the South; don't really know, other than I do know where we belong in time of serious medical needs.

[LvmyPug2]

Just wanted to add my 2 cents. I have been a health care exec for 25+ yrs. The trend that is constantly discussed among my collegues (but you don't see much in the popular media) is the shortage of primary care physicians. Med students are just not choosing Family Practice and Internal Medicine anymore because they can make more $ and work less hours in specialties. With an aging population, trying to get in for non urgent visits are getting more and more difficult all over. Add to the mix the fiscal realities of our healthcare system and we just don't have the access we once had.

I am sure there are many good physicians and mid level providers that provide excellent care in FL. The problem, remains however that in areas with a high concentation of Seniors, the demand for care is greater and the payor mix has a higher percentage of Medicare (which often is less than expenses reimbursement rates). This can mean care is often harder to access, less comprehensive and treatment may be less aggressive than other areas.

[graciegirl]

Touchy situation for which I can hardly feel that the medical profession is suffering that much. My experience showed that doctors put in a 9-5 day and 12-1 lunchtime. With all due respect, I find that the major problem is mismanagement.

Big difference here in Boston. We have world-renowned medical facilities such as Mass General Hospital, Dana Farber Cancer Center, Childrens' Hospital.....to name a few.

My PCP is extremely organized and is associated with another very well-known hospital, Beth Israel in Boston. His office is equipped with all hi-tech specialties in their offsite building in the suburbs. There is also a computer site they maintain where a patient can email their doctor and get same-day responses. A patient can logon to this site and see their own personal records, complete with test results. The patient can logon and make appointments and even request prescription refills which, when approved by the dr, will be called in to the pharmacy for patient pickup. Doubt you'll ever see that in FL, unfortunately.

Returned to my oncologist at Dana Farber and had an appt with him within the week we returned to MA. They are all fully staffed here and well organized. Even the small country doctor is still around and he still makes house calls. That's Bill's dr who is sharp as a tack and extremely well organized.

Maybe it's the slower pace in the South; don't really know, other than I do know where we belong in time of serious medical needs.


In my very humble opinion, I think Boston is the center for excellent health care in this country and probably the world. Boston Childrens is the NUMBER ONE kiddies hospital in the country, (Our Cincinnati Childrens is number three by this years account) I am sad to hear of your health challenge Barb, but so glad to hear that you consult THE experts. Kindest wishes and hugs, GG

[graciegirl]

Just wanted to add my 2 cents. I have been a health care exec for 25+ yrs. The trend that is constantly discussed among my collegues (but you don't see much in the popular media) is the shortage of primary care physicians. Med students are just not choosing Family Practice and Internal Medicine anymore because they can make more $ and work less hours in specialties. With an aging population, trying to get in for non urgent visits are getting more and more difficult all over. Add to the mix the fiscal realities of our healthcare system and we just don't have the access we once had.

I am sure there are many good physicians and mid level providers that provide excellent care in FL. The problem, remains however that in areas with a high concentation of Seniors, the demand for care is greater and the payor mix has a higher percentage of Medicare (which often is less than expenses reimbursement rates). This can mean care is often harder to access, less comprehensive and treatment may be less aggressive than other areas.



Thank you for this excellent post. It looks like we will be driving outside the area for routine Doctor visits. I wonder if it will be Jacksonville, Tampa or...........Orlando?

[serenityseeker]

"It is my firm belief that doctors have turned the health insurance industry into a money mill for themselves. If looked at under a microscope, that is called thievery."

I am astounded by that statement. Doctors have turned the Health Insurance Industry into a money mill for themselves? If this wasn't such a harmful statement it would be laughable.

Perhaps patients don't realize it but physicians practice in a price controlled environment. Physicians do not set prices and fees..the insurance companies and the government do and the physicians and hospitals have no say in the matter. Any one can "charge" anything they want to but the reimbursements are fixed as noted above. How many people think price fixing is OK?

If you want to talk about thievery put your microscope on the insurance industry. HMO's PPO's and all of the other permutations are amongst the most profitable businesses in the country year after year, and the do it on the backs of the physicians and patients, often times by simply denying care or payment for care. From their very inception around the Nixon era prices have soared and services do not keep up. Then look at the malpractice industry...if you don't get sued your premiums go up, if you do you can't get insured. That doctors profit from this is indeed laughable and a pitiful notion at the same time.

A 9-5 day with a 1 hour lunch time?? Sign me up. Most of my colleagues in primary care work 10 hour days, and if they see hospital patients crank that up to 13-14. Lunch? Maybe a quick sandwhich shoved in while dictating charts, returning phone calls and checking lab results while the staff is on their 1 hour lunch break.

I think most physicians associated with major teaching hospitals are fortunate in that they can avail themselves to the technology and support that comes with large teaching institutions, such as electronic medical records and on-line scheduling. It is difficult for private practice physicians to come up with the 50-70,000 dollar investment when there 80,000 dollar malpractice is due.

Do the patients ultimately get the short end of the stick? YES! And that is a big part of the point here. They get it because those that controll the purse strings deem it so, and make no mistake, so do physicians.

Lest you think I am some bitter complainer know this; I still feel that being in medicine is the ultimate privilege. I have been on both sides of the doctor/patient relationship. What I do feel so disappointed by is the assumption that doctors are rich and have it easy and are involved in "thievery" to any degree. Physicians are leaving medicine in droves. Depression, suicide, drug and alcohol abuse, and divorce rates are higher in physicians that almost any other professional. Why? Because the responsibility of someone's health and well being is daunting in and of itself, add the pressures noted above and you come up with an incredible high stress life. Further ,add attitudes like doctors practicing thievery and it overwhelms many, it simply is not worth it to them.

I offered my comments so that some of you might be able to see the other side of the coin, as there really are two sides to every issue and compassionate understanding, or the willingness to at least try benefits all of us. I am worried more than I can tell you about our system, and want to see intelligent people inform themselves and demand change and accountability rather than casting the very people that sacrifice so much of their lives helping others as the villains. I really wanted to let you know why so much of this madness occurs and that it is not for a lack of caring from the physician most of the time.

I think somehow I have not been successful but it was with good intentions that I tried. Remember, there really are alot of people staying in many fields of healthcare that are doing so because they really do love it and consider it a noble calling, and if not for that they would leave as many other doctors and nurses are now.

Thanx for listening folks and take care.

[carlent]

my 2 cents:
We have lived in Florida off and on for 30 years. We now live in NEw Hampshire, before that (besides Fl) St Louis, Before that, Chicago, before that Washington D.C. Here is my point. I can not comment on the care in TV. However i can say with certainty that the state of Fl has some of the finest Doctor's and Hospital's in the nation. When I lived in Chicago for example and needed the best eye care, i was sent to U of Miami, Bascom Palmer. Jackson Memorial Hospital is one of the best anywhere. Shands in Gainsville (close to TV) is a leader in the world in Cancer care. I could go on and on. All of you who are berating the medical community in Florida, need to do a little research. You really need to get it straight as to what is available and understand that the quality is here. Maybe not on top of you in TV...but in Florida

My 2 cents from the cheap seats


Carlent

[graciegirl]

You can say that again. Doctors can frame it however they like, the fact remains that we are not only patients, we are also customers. We are their book of business. They are required by good business practice and ethics to treat us as both.

It is my firm belief that doctors have turned the health insurance industry into a money mill for themselves. If looked at under a microscope, that is called thievery.


Jan,

I quite disagree. There are doctors and there are doctors. It is the patients job to find one that suits his or her needs. It has been my privilege to know and consult many excellent,dedicated doctors in my life time for my daughter who has practically grown up at Cincinnati Children's, and recently for me with a bout of Cancer. You cannot say that doctors that practice at large teaching hospitals are greedy. They earn much less than doctors in private practice and are the cutting edge( no pun intended) in their knowledge.

I think that because many doctors are so very smart and educated and they interact with us when we feel frightened and are very vulnerable, that they are sometimes maligned because of our general fear. I am not canonizing all of them, but they do have a long haul when it comes to education, a long, VERY expensive haul.

Just my humble opinion.

GG

[barb1191]

Appreciate your input, Serenityseeker. That's the view from your side. I am expressing my experience ONLY; not heresay.....what I actually experienced. That's the only commentary that I can share; not anybody else; just hubby and me.

I do believe this is what most have expressed in this forum; one's own experience, be it good or bad. Unfortunately, the majority is unfavorable...with just cause.

Can empathize with your position that seems to be a losing battle. However, you hang in there and you are to be admired for your perseverance. :#1:

barb

[Talk Host]

I am not coming at this from an outsiders perspective. I have been around the medical business for a long time. I was president and CEO of Medlink International from 1995 to 1998. I had more than 200 doctors working for me in countries all over the world. On a regular basis, I had direct contact with nearly every major hospital in the United States. Some of my best friends in the world are physicians.

One friend, who is an orthopedic surgeon, told me that their practice has so much money that they are having trouble knowing what to do with it. Another doctor, who is a GP, and works with a group of 200 physician serviices corporation , said the egos in the company were so great that they have a hard time keeping the business running. He said their appointment scheduling was so complicated it was impossible to understand. (if you're young and healthy, you get 4 a minute appointment, if your old and sick, you get a seven minute appointment.)
Another friend who is a ophthalmologist told me that her office schedules five people for each appointment time slot.

I have another close friend in New York who is a General Surgeon. When we moved to Florida, he said to me, "If you ever need surgery, don't let them do anything to you until you call me." Gee, I wonder why he said that.

How many doctors do you know that drive a ford escort.

[serenityseeker]

Its funny that most of what you reference is surgeons and your secondhand information. Also as CEO of Medlink I'm sure you didn't mind taking money from the "thieves".
You had an opportunity to hear another side of the debate, an informed an honest one,and to learn something yet you choose to disregard it with irresponsible comments and preconceived notions. There is something to be learned by all that are willing to look at all sides of a debate, especially when someone knowledgeable is offering a truthful behind the scenes look. It is often easier to hold on to ill informed preconceived ideas than actually opening one's mind to other possibilities or other "truths" within the same subject.
How many docs do I know that drive an Escort? None right off hand..would that make them a better doctor to you? Would the fact that my closest colleague drives a 15 y/o pick up be a more satisfying scenario, or that I have an older model truck myself, or that my boss drives a 15 y/o automobile? This whole preoccupation with the "rich doctors" and failing to even attempt to recognize the major factors that contribute to this mess is part and parcel of the lack of knowledge that is assisting in the death of the system as we know it. It is also attitudes just like that that that do condemn so many physicians that don't fit your stereotypical set up that simply add to the difficulty of practicing today. I have heard many describe practicing medicine as being in an antagonistic environment. Keep painting all physicians with the same broad brush of ill informed negativism as you ask yourself why we don't have enough physicians, why we can't get appointments, why no one will go into primary care. Who could blame them with attitudes like this. There are bad apples in every field, but irresponsible accusations and condemnations of a professional group as a whole serve no positive purpose for those that perpetuate them or those that are falsely accused.
I have said more than enough here. I offered real world experiences with the hope that I could shed some light on some of the truths that a lot of people don't realize. It is not worth any further effort at this point. In fact the whole point of the effort has been lost in this morass of pettiness. My apologies for contributing to that part of it.

Fini

[Talk Host]

Its funny that most of what you reference is surgeons and your secondhand information. Also as CEO of Medlink I'm sure you didn't mind taking money from the "thieves".
You had an opportunity to hear another side of the debate, an informed an honest one,and to learn something yet you choose to disregard it with irresponsible comments and preconceived notions. There is something to be learned by all that are willing to look at all sides of a debate, especially when someone knowledgeable is offering a truthful behind the scenes look. It is often easier to hold on to ill informed preconceived ideas than actually opening one's mind to other possibilities or other "truths" within the same subject.
How many docs do I know that drive an Escort? None right off hand..would that make them a better doctor to you? Would the fact that my closest colleague drives a 15 y/o pick up be a more satisfying scenario, or that I have an older model truck myself, or that my boss drives a 15 y/o automobile? This whole preoccupation with the "rich doctors" and failing to even attempt to recognize the major factors that contribute to this mess is part and parcel of the lack of knowledge that is assisting in the death of the system as we know it. It is also attitudes just like that that that do condemn so many physicians that don't fit your stereotypical set up that simply add to the difficulty of practicing today. I have heard many describe practicing medicine as being in an antagonistic environment. Keep painting all physicians with the same broad brush of ill informed negativism as you ask yourself why we don't have enough physicians, why we can't get appointments, why no one will go into primary care. Who could blame them with attitudes like this. There are bad apples in every field, but irresponsible accusations and condemnations of a professional group as a whole serve no positive purpose for those that perpetuate them or those that are falsely accused.
I have said more than enough here. I offered real world experiences with the hope that I could shed some light on some of the truths that a lot of people don't realize. It is not worth any further effort at this point. In fact the whole point of the effort has been lost in this morass of pettiness. My apologies for contributing to that part of it.

Fini


You are right. I am so sorry. I don't know what came over me. How could I possibly expect, as a mere mortal, to know how awful it is to be a DOCTOR?

[Russ_Boston]

Jan - let me play moderator here you might be too involved to be arms length. Both of you need a time out!

We can appreciate all sides by reading both of you and your opinions and experiences are worthy of consideration. Let's remember that as the nation tries to grapple with rising health care costs by moving towards a managed care practice situation, we (the patients) and they (the PCP practices who are the gatekeepers) will need patience. Until PCP's are paid a proportionate share of the revenue there will be more and more specialists who don't have to worry about that gatekeeping function. I agree with Barb regarding our situation in Boston, the managed care situation in Boston is starting to work well. I can only hope that these best practices migrate into the rest of the country including FLA.

[Russ_Boston]

Having said that let's also remember that every doctor who drives the BMW 7 series now had to work for 4 years in Med school without pay and 5-6 years in residency for what amounts to slave labor wages to earn that reward. How many of us would come out of college (say with a degree in software engineering like me) and work 10 more years without a decent competitive wage?

Do we need changes in this country regarding how medicine is distributed? Sure. Will it happen overnight? Heck no.

[Avista]

I was just commenting to my husband how great the physicians have been in The Villages area. We moved here 18 months ago. I started doing research (I'm an RN) and soon had my and my husband's physicians lined up. Have been pleased with every one of them. I have had one visit to The Villages Hospital ER, 2 surgeries, and 3 and 5 days in the hospital. So I guess I have used the system. I had a very early Cancer 6 years ago and go to Moffit Cancer Center once a year to be monitored for that.

I'll write back if I have a bad experience, but so far have been quite pleased.

[Russ_Boston]

It's nice to hear some positive info on health care in/around TV. I assume that it is all in the homework.

I will be working at TVRH (RN) and I'm sure that there are good and bad stories and experiences just like any hospital.

I hope you are well!

Russ

[MikeH]

Talk Host,

What you say is interesting. Having lived a number of places in the country, I can say for sure that the delivery of medical care has and is changing. If you live in a small town it's likely the Dr's own their practice, take urgent calls at night and on weekends. But, that is changing. If you live in a larger town or city, the Dr is probably part of a "Group" or even may be an employee of a Corporation. The office is open M-F 9-5 and refers you to the hospital emergency room after hours. That may be why we see the growth in the number of 24 hr Urgent Care Facilities.

Also, I have found the quality of medical services available here in Fl and The Villages to be as good or as bad as almost anywhere else in the country. For example, I went to Mayo Clinic for second opinion and was told to go home. My Dr in The Villages had more knowledge and experience than any of the Dr's at Mayo for that medical problem. Interesting!

[swrinfla]

Too bad this thread has raised so many hackles!

I had a good friend "up north," an oncologist in his early 60s and well-known in the vicinity for his care and bed-side manner. He didn't really want to stop practicing, but did so because he was so frustrated by the tons and tons of paperwork he had to do to satisfy governmental, insurance and professional rules and regulations. I can remember him telling me shortly before he decided to retire that "last week I spent nearly two days doing nothing but paperwork, causing all sorts of heartburn among my loyal patients!"

A sad, sad state of affairs.

SWR

[rshoffer]

Wow! The frustration is palpable here!
I understand exactly what alot of you are saying and experiencing but let me give you some information from the physicians perspective.
Voice menus are definitely irritating to alot of us, but I think many physicians have no choice at some point. Figure the average physician has between 2000-4000 patients. The fielding of those phone calls on a daily basis is an enormous task. Couple that with pre-approval calls to insurance companies for nearly every test and referral, calls about billing issues,lab results and others and you are tying up 1-2 full time people just for phone calls. The typical environment that you never see or hear in the office is one of barely controlled chaos.
The physician doesn't "choose" to have so many patients in most cases, it is a necessity to survive in todays medical/business culture. Reimbursements drop every year from insurance companies and the government payers, but all of us know that costs rise EVERY year, and the overhead to run an office does to. This is a losing battle and physicians are forced to try to see more patients in the same amount of time. It still isn't working. Most physicians (almost all) in primary care are taking salary cuts each successive year. They spend more time with patients and address more problems than the sub-specialists and yet not only are paid the least, but usually are the first to see the cuts.
Things like automated voice menus, giving up in-house labs(very expensive equipment and onerous government regulations) and overscheduling patients are a last ditch effort to survive. In what other fields can a professional spend so much time, effort and money on education and training and know up front they will take a pay cut each year? Many physicians assistants and nurse practitioners salaries rival or exceed those of primary care physicians. Money is not the be all end all but who wants the pressure, responsibility and liability, coupled with long stretches away from family, on top of the pressures of trying to run a business(a full time job in itself) with a non commensurate "reward" for it?
As far as waiting times for new appointments, get ready, it is going to get much worse all around the country. Dramtically less medical students are willing to enter primary care for the above mentioned reasons, we have been seeing it for a few years now. Estimates of the shortage of primary physicians in the next 10-20 years are staggering and frightening. This is happening at the worst possible time as our population ages. Waits are so long for new appointments because their are not enough primary care physicians and the forecast is only that it will get worse.
As far as weekend call coverage goes, let me try to give a couple of bits of information. Many primary care docs have simply given up their outpatient practice and turned it over to hospitalists(groups that specialize in in patient care only) because the time it takes to round on just a few sick hospital patients robs multiple people of office visits.. After 5-6 days a week of long office hours and having been pushed into giving up inpatient practice, most take their 1-2 day weekends(the part that is not used catching up on charts and billing) to have with their families and leave those after hour"emergencies" to others. No one wants to take call. If you do carry your pager and are deluged with calls all weekend there is no reimbursement for your time, expertise, or offset of the liability of prescribing by phone and taking a chance on a poor outcome when you didn't physically see the patient.
What it boils down to is a broken system. The business of medicine and the high cost associated with liability are strangling the system.
As far as specialty care goes, some times a place like M.D. Anderson is a good choice. For the vast majority of care, we all practice according to the leaders in the field, and the difference is scant on many issues. This of course does not refer to specialized procedures that are only done by a few, or places where procedures are noted to have superior outcomes. The bypass surgery at Cleveland Clinic is the same done at hundreds of other hospitals in this country.
For those of you with compassionate and dedicated primary care physicians, take the time to let them know you appreciate them. Educate yourself about the system and talk to your elected officials(how many of you are aware of the yearly battle with looming 5% medicare cuts and last minute bail out efforts) about cuts and reimbursements for primary care physicians.
Please excuse the length of this but their is no short way to address it. We have to become more educated and proactive in the system, and someone needs to advocate for the primary care docs before we hit the shortage/crisis full bore. If you have any doubts just Google info about shortages in Family and Internal medicine.
Just wanted to take the time to let you know a little of what goes on behind the scenes every day.

thanx for listening

From a fellow physician who recently moved to TV but who is NOT able to retire for the myriad of reasons mentioned above the key phrase in this excellent post is ... "we have a broken system". The legal problems and insurance companies have destroyed healthcare in America. We spend more on health care per person than any developed country yet rank near the bottom on most measures of health. When older physicians like myself are asked in surveys if they would go into medicine now most say absolutely not. And, as stated, it's only going to get worse.

[serenityseeker]

"From a fellow physician who recently moved to TV but who is NOT able to retire for the myriad of reasons mentioned above the key phrase in this excellent post is ... "we have a broken system". The legal problems and insurance companies have destroyed healthcare in America. We spend more on health care per person than any developed country yet rank near the bottom on most measures of health. When older physicians like myself are asked in surveys if they would go into medicine now most say absolutely not. And, as stated, it's only going to get worse."

rshoffer, thanx for taking the time to reply. i think you can probably see what I was trying to relay information wise. There is so much peripheral stuff that goes on out of the physicians control that most people don't realize because they just haven't been exposed to it. unfortunately the docs bear the brunt of it as the frontline target. i just wanted folks to know a little of it.

i am sure i will still be working for a long while after i get there full time. no dreams of early retirement here lol.

hope to meet you sometime, would love to talk.

take care

[gfmucci]

Every successful business has lots of customers, or "patients" if you will. There is no excuse for crappy customer service, medical or otherwise.

My suggestion: If this un-customer-friendly policy is more irritating than changing doctors is, then change doctors.

[Russ_Boston]

I agree with that.

You could also say "if being a doctor is that aggravating then do something else".

Every profession has its issues. Either fix them, deal with them or QUIT!

This is coming from someone who IS doing something about it. As you know I'm leaving my current profession of 30 years and going to nursing school for my RN. Will I be happier? Who knows, but I'm trying to alter my path instead of just saying how bad i have it. We make our own destines in life.

Whew, that felt good.

[serenityseeker]

Good point from both of you. Just want to be clear here...not saying I'm a miserable physician. Am still the luckiset guy in the world most days at work. Just want to give people some of the true info without the varnish on it..I think we all need to know the things the media and others don't share so that we can make informed decisions and demand acoountability and help make changes and improvements to a system we are going to need.
And Boston...more power to you and congrats on your choice. Likely one of the most important(and difficult) jobs in the world. Much respect to you.

[Russ_Boston]

Thanks - Obviously you can imagine how much I respect physicians. Even the most miserable, overworked, underpaid residents make time to teach me if I ask.

[KayakerNC]

**Snip** As you know I'm leaving my current profession of 30 years and going to nursing school for my RN. Will I be happier? Who knows, but I'm trying to alter my path instead of just saying how bad i have it. We make our own destines in life.

Our Family Doctor has 3 or 4 PA's on staff.
Easier to see than the Doctor for most visits, and great people to deal with. The PA I normally see has his background as an RN. He seems to enjoy the hours and working conditions as a PA much better then the hectic/heavy schedules of a hospital RN. Thank God for dedicated medical professionals!

[Russ_Boston]

Actually i like hectic that's why I'm leaning towards the ER. Besides at 51 y.o. already I'll be ready to retire before I can completely burn out!

If I had more time I might consider the PA route though.

[rshoffer]

I agree with that.

You could also say "if being a doctor is that aggravating then do something else".

Every profession has its issues. Either fix them, deal with them or QUIT!

This is coming from someone who IS doing something about it. As you know I'm leaving my current profession of 30 years and going to nursing school for my RN. Will I be happier? Who knows, but I'm trying to alter my path instead of just saying how bad i have it. We make our own destines in life.

Whew, that felt good.


Although I suspect most practicing physicians have days when "quitting" crosses their minds the vast majority do NOT quit for many reasons, not the least of which is a devotion to medicine. Remember, at THE VERY LEAST, all practicing physicians have 11 years of education after high school invested in their profession. The true practice of medicine is rewarding beyond description. Unfortunately, the lay public isn't aware of the medicao-legal and 3rd party (insurance companies... especially Medicare) intrusion into and near destruction of what the practice of medicine once was. Now, when a doctor thinks a study or procedure is indicated, he/she has to get "prior authorization"... which means essentially begging some non-physician functionary to allow the procedure. It wastes hours daily and comes right out of the doctors pocket. Most offices have had to hire personnel just to do prior auths. That's just one very annoying thing your doctor puts up with,day in and day out. The cost to do the mountains of paperwork to practice is breaking the backs of most practices. Medicare has over 100,000 pages of guidelines for doctors on how to document correctly to avoid a problemmatic audit. You, the patient, gets lost in this mess and now the system is imploding. It's been sad to watch this happen.

[serenityseeker]

rshoffer, true, true and more true.

its really scary, you have been doing this longer than me and really have watched as this "system" crumbles around us. the govt and media have done a fair job hiding the depth of the crisis from the lay public thus far, but it cant last a lot longer.
i personally think we will have no choice but to end up with some nationalized plan. Heck we already have it, it called th E.R.

[rshoffer]

I was a U.S. Army doctor for 9 years ('76-'85) before I foolishly left for "private practice". My 9 years as an Army physician were the best and most rewarding of my medical career. The quality of care was superb, insurance was not an issue and the new private got the same care as a bird Col. (except the Col might get flowers on his meal tray). I am 100% for a single payor form of health coverage. There is a groundswell of physicians in support of this... something which would have been anathama 10 years ago. It's interesting that healthcare is NOT an election issue now that gas is 4 dollars a gallon. In the meantime, I love seeing my patients and probably will never fully retire, even if it was economically realistic. But, the battle goes on with "the beancounters" who delude themselves and their customers into thinking that they are there to "control costs". Wrong--- they've become part of the problem rather than part of the solution. My plea to disheartened or disgrunteled patients is to speak to your doctor when things in the office are not what you think they should be, but to also try to understand he/she are fighting battles and fires on many fronts and are weary.

[Talk Host]

I talked with my doctor today about the answering machine debacle. He said the right things, took ownership of the mistake and announced what I think will be a fantastic solution to this part of the overall problem.

By the first of next year, they will have an on-line, patient interactive, appointment system. I will be able to go to their site and schedule my own appointment, view my records or print any material that pertains to me.

It sounds like this solution of one portion of the overall complications is a winner.

JLK

[barb1191]

I talked with my doctor today about the answering machine debacle. He said the right things, took ownership of the mistake and announced what I think will be a fantastic solution to this part of the overall problem.

By the first of next year, they will have an on-line, patient interactive, appointment system. I will be able to go to their site and schedule my own appointment, view my records or print any material that pertains to me.

It sounds like this solution of one portion of the overall complications is a winner.

JLK


fantastic, Jan..... So good to hear that your doctor is joining the winners' circle for providers. As I had mentioned before, this website-patient system has been here in Boston at least since I've been on the scene from 2005. That is wonderful news and let's hope that it will spread to more providers. It is a great improvement in the ability to correspond with the providers, as well as have your medical history at your perusal.

[Russ_Boston]

Speaking of medical history. The day will come in the not too distant future, that we will all be carring around our history (with MRI scans, x-rays etc.) on our own smart cards. Right now the specialist you go to may not have instant access to your records if they are from another health care system. This system works in many countries that have National Health systems such as Great Britain. Our privacy laws are much stricter but it would be a good thing in my opinion.