[rubicon]

Too many posters are taking this issue too personally. There is a substantial community here and around The Villages that keeps growing leaps and bounds.
The government continues to expand its regulations while decreasing payments for services rendered. Insurance companies also entangle a physician in paperwork. Mal practice insurance only goes up and the costs to run an electronic medical records systems, billing etc are eating up doctors profits. Many physicians are walking away or joining groups.

Many doctors want to provide quality care to their patients, guard against errors and respond to people's health needs.

So what some may define as overbook others may say that all of the abov place a doctor un an untenable position

[dillywho]

Originally Posted by Mikeod

To provide a view from the other side.

The last 28 years of my professional life were spent in a medical group where everyone was salaried, so our income was not affected by how many patients we could cram into the day. My day was fully booked in advance, all day. We also had a policy that if someone presented to the clinic with a problem, they would be seen. If a patient was very late for their appointment, they would be seen. If a patient showed up on the wrong day, they would be seen. Added to those were patients sent to us by other departments. And, of course, we added our own patients who required follow-up even though there were no available appointments.

My early patients were generally seen on time. But, as the morning progressed, patients who required more time than was booked plus those other add-on patients caused me to be farther behind time. Most of the time I would finish my AM patients a bit after my PM patients were already checking in. A lunch break was a dream. Grab a bite of sandwich and a sip of a drink and get back to work. I would finish my PM patients well after the clinic closing time. Then I could embark on finishing my charting, preparing for the next day's patient load, read my messages, return phone calls from patients or colleagues, or go over lab or technician results.

Fortunately, my front office staff kept our patients informed of the wait.

Just to say that overbooking occurs for other reasons than revenue. Sometimes it's medically necessary.

Thank you! A voice of reason and should be able to be understood by all. That is a much better way than being told that you can be seen in two weeks/months when you have a problem NOW. (Or clogging the ER unnecessarily.)

Many of the doctors here ask that you NOT make any other commitments for the day of your appointment because the length cannot be guaranteed, and especially so if you are having some procedure done.

I personally prefer the doctor that takes his time and especially the time to listen to me. I hate the Wham-Bam-Thank-You approach.

Not only do I write down my questions but also what scripts need to be renewed/refilled. I do this on the notepad of my phone. I also record with my phone the visit with the doctor and that way I know exactly what he told me. I do the same for their hospital visits. They are really receptive to that idea and it saves their office time in case I have a question that they would have to interrupt their day to answer. I am my husband's caregiver so I have both of us to keep all of this for.

I have only ditched one doctor and that was because he didn't have "time" to answer a very important question concerning a medication for my husband. I needed to know if he wanted him to continue a med that the cardiologist who placed his stent had prescribed and if so, I would need a new script since the one he had was only for 30 days with no refills. The doctor who I got to replace him said, "Absolutely." and wrote a new script. He still takes that particular one and always will.

I will always gladly wait for caring and competent care.

[MoeVonB61]

Read and listen to Gracie Girl's and Sunnyatlast's posts...YOU ARE IN THE VILLAGES....people 55 years old and up go to the Dr., get diagnostic imaging and take prescription drugs 3 TIMES more than the younger population.......BTW Biker1......the MAYO clinic Jacksonville not only has "excess staff headcount" but they also deal with very advanced or complex illnesses and the CPT CODES they can bill Medicare reimburse a much higher rate ....... I spent 11 years as a Revenue Management Analyst at Disney....hotels and airlines ALWAYS overbook at least by the percentage of their historical no show factor.....always have, always will......

[biker1]

Mrich1, the number of staff members at Mayo doesn't matter when it comes to the overbooking of a specific Dr. The fact is the orthopedic guy I saw on several occasions wasn't overbooked and saw me on time. This was not true at two sports medicine practices I tried first. That was my only point. Also, I didn't say airlines and hotels don't overbook. I only stated that airline overbookings are not nearly as common as in the past. When I traveled frequently, I only saw a hotel overbooking once in 20 years. I believe over 2 million miles on airlines makes me some what qualified to comment on this.

Originally Posted by mrich61

Read and listen to Gracie Girl's and Sunnyatlast's posts...YOU ARE IN THE VILLAGES....people 55 years old and up go to the Dr., get diagnostic imaging and take prescription drugs 3 TIMES more than the younger population.......BTW Biker1......the MAYO clinic Jacksonville not only has "excess staff headcount" but they also deal with very advanced or complex illnesses and the CPT CODES they can bill Medicare reimburse a much higher rate ....... I spent 11 years as a Revenue Management Analyst at Disney....hotels and airlines ALWAYS overbook at least by the percentage of their historical no show factor.....always have, always will......

[biker1]

Mrich1,

I can't comment on Medicare reimbursement rates as I am not on Medicare and my insurance does cover Mayo. I saw all the insurance statements from the times I went to Mayo and it wasn't clear to me that they were charging some sort of premium over other facilities and I doubt they would have been in my network if they did.

Originally Posted by mrich61

Read and listen to Gracie Girl's and Sunnyatlast's posts...YOU ARE IN THE VILLAGES....people 55 years old and up go to the Dr., get diagnostic imaging and take prescription drugs 3 TIMES more than the younger population.......BTW Biker1......the MAYO clinic Jacksonville not only has "excess staff headcount" but they also deal with very advanced or complex illnesses and the CPT CODES they can bill Medicare reimburse a much higher rate ....... I spent 11 years as a Revenue Management Analyst at Disney....hotels and airlines ALWAYS overbook at least by the percentage of their historical no show factor.....always have, always will......

[Abby10]

Originally Posted by rubicon

Too many posters are taking this issue too personally. There is a substantial community here and around The Villages that keeps growing leaps and bounds.
The government continues to expand its regulations while decreasing payments for services rendered. Insurance companies also entangle a physician in paperwork. Mal practice insurance only goes up and the costs to run an electronic medical records systems, billing etc are eating up doctors profits. Many physicians are walking away or joining groups.

Many doctors want to provide quality care to their patients, guard against errors and respond to people's health needs.

So what some may define as overbook others may say that all of the abov place a doctor un an untenable position

Bingo!! I think you summed up the real issues very well. Unless you are in the industry, it is very hard to see and understand the hurdles that many of us in healthcare are expected to jump to provide the quality services that we were able to provide many years back when the issues that you mentioned above were not in play. Thank you for voicing so well what many of us who in the industry feel, but often are too exhausted and frustrated by the end of the day to manage to put into words.

[biker1]

Rubicon,

I am not sure how your statements apply to the concept of overbooking patients and then expecting them to routinely wait extended periods of time past their scheduled appointments. Not all offices do this but presumably all offices are subject to the same pressures you expanded on. Also, this is not a phenomenon unique to The Villages. Medical practices are businesses providing a services. In my mind, they are no different than any other business. Again, I can accept that there are emergencies but these can be accounted for in the scheduling. I don't take it personally - I actually take it professionally - they are wasting my time for their own bottom line and I won't play and neither should anyone else. Keeping you waiting is a business decision - plain and simple. I dismiss the concept that "Drs are special and we should be thankful they keep us waiting". I bend over backward for my customers, often working evenings and weekends so they are provided the level of service they were promised.

Originally Posted by rubicon

Too many posters are taking this issue too personally. There is a substantial community here and around The Villages that keeps growing leaps and bounds.
The government continues to expand its regulations while decreasing payments for services rendered. Insurance companies also entangle a physician in paperwork. Mal practice insurance only goes up and the costs to run an electronic medical records systems, billing etc are eating up doctors profits. Many physicians are walking away or joining groups.

Many doctors want to provide quality care to their patients, guard against errors and respond to people's health needs.

So what some may define as overbook others may say that all of the abov place a doctor un an untenable position

[rn1tv]

Rubicon,

I am not sure how your statements apply to the concept of overbooking patients and then expecting them to routinely wait extended periods of time past their scheduled appointments. Not all offices do this but presumably all offices are subject to the same pressures you expanded on. Also, this is not a phenomenon unique to The Villages. Medical practices are businesses providing a services. In my mind, they are no different than any other business. Again, I can accept that there are emergencies but these can be accounted for in the scheduling. I don't take it personally - I actually take it professionally - they are wasting my time for their own bottom line and I won't play and neither should anyone else. Keeping you waiting is a business decision - plain and simple. I dismiss the concept that "Drs are special and we should be thankful they keep us waiting". I bend over backward for my customers, often working evenings and weekends so they are provided the level of service they were promised.[/QUOTE]

[Villages PL]

1) Now that I'm retired I need to remind myself that my time is no longer valuable, except in my own egocentric mind.

2) Multiple health issues means more doctor visits and more waiting, so I must always remember to take my health seriously, and refrain from eating junk food.

3) If I have to wait, I might use the time to read my newspaper, which I would do anyway if I were home. Other than that, I might use the time to think and reflect on why I need to be so busy with non-essential retirement activities.

Beware the barrenness of a busy life. -----Socrates

[CFrance]

Originally Posted by Madelaine Amee

When I was working and living in Massachusetts I was a patient at the Beth Israel in Boston. They finally put a satellite clinic out in a town called Burlington, so I was able to avoid driving in and out of Boston. At the time they opened this clinic I received a letter telling me to please bring a note containing all the questions I wished to discuss with the doctor. At the time I was a bit annoyed, but after seeing how efficient it is to have your questions written out before you and to be able to hand that the doctor for him/her to answer, I realized how smart it was. I still do it to this day, and now they scan it into my chart.

How many times do you get to the doctor's office and forget what you wanted to ask him/her?

I agree about writing questions down. Also, our doctor, Martinez Cruz, gave us his email address, which he checks twice a day, even on Saturday. He will send in refill prescriptions, order prescriptions for a condition you've seen him for previously and now need something else for, critique specialists you are thinking of choosing--all by email. I don't have to take up his office time with follow-ups unless I want to.

He's on his own and doesn't overbook. I've only had one wait, due to an emergency.

[Halibut]

Most of the time I would finish my AM patients a bit after my PM patients were already checking in. A lunch break was a dream. Grab a bite of sandwich and a sip of a drink and get back to work. I would finish my PM patients well after the clinic closing time.

I understand getting behind, I do. But if it happens on a daily basis, to me that means you're scheduling too many patients per hour. Since you were salaried and seeing more patients did not equal more income, why not reduce the number of appointments per day?

I've been in offices where more than one patient was scheduled at the exact same time. How doctors can in good conscience allow/encourage that in their practice is a mystery.

[CFrance]

Originally Posted by Halibut

I understand getting behind, I do. But if it happens on a daily basis, to me that means you're scheduling too many patients per hour. Since you were salaried and seeing more patients did not equal more income, why not reduce the number of appointments per day?

I've been in offices where more than one patient was scheduled at the exact same time. How doctors can in good conscience allow/encourage that in their practice is a mystery.

I think it's what happens when accountants take over.

[CFrance]

Originally Posted by Villages PL

1) Now that I'm retired I need to remind myself that my time is no longer valuable, except in my own egocentric mind.

2) Multiple health issues means more doctor visits and more waiting, so I must always remember to take my health seriously, and refrain from eating junk food.

3) If I have to wait, I might use the time to read my newspaper, which I would do anyway if I were home. Other than that, I might use the time to think and reflect on why I need to be so busy with non-essential retirement activities.

Beware the barrenness of a busy life. -----Socrates

Now that I'm retired, I consider my time to be even more valuable, because there is a reduced amount of it left. And I might use the overbooking and consequential long waiting-room time to reflect on why it is wasting my day and what I can do about it.

[BarryRX]

1. No Shows
2. People call up and are ill and want to be seen without an appt.
3. Interruptions from labs, pharmacies, parents, etc.
4. People are late for their appts.
5. Really sick patients need more time or hospitalization or referrals.
6. People lie about the reason they want to be seen and more time is needed.
7. Paperwork
8. Try to see a patient every 15 minutes, but if each patient runs just a few minutes late the time is compounded by the end of the day.

[Mikeod]

Originally Posted by Halibut

I understand getting behind, I do. But if it happens on a daily basis, to me that means you're scheduling too many patients per hour. Since you were salaried and seeing more patients did not equal more income, why not reduce the number of appointments per day?

I've been in offices where more than one patient was scheduled at the exact same time. How doctors can in good conscience allow/encourage that in their practice is a mystery.

Let me answer by giving an example of a frequent occurrence in my day. Urgent care sends me a patient with an eye infection. I have to work them into my schedule. Turns out they have a serious internal ocular inflammation that could damage vision. I start them on a treatment and need to see them next day, but my schedule is already full, so I have to add them on again. To delay seeing them is malpractice, so, no choice. Then, next day, a patient of mine calls with ocular pain, so I must see them. And so forth and so on.

So, if I reduce my appointments to accommodate the "extra patients", I make routine patients wait longer and they're not happy. Access to care is a major concern among patients.

It is a delicate balance between too few staff and too many. The group has to be profitable enough to hire and retain quality staff. With insurance reimbursements falling and the ancillary costs of providing care rising (EMR, paperwork/reporting requirements, rent, utilities, equipment and supplies) the solution to keeping both patients and staff happy is not an easy one.