Re: Is this a nationwide trend, or just here?
 

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

Re: Is this a nationwide trend, or just here?
 

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

Re: Is this a nationwide trend, or just here?
 

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.

Re: Is this a nationwide trend, or just here?
 

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

Re: Is this a nationwide trend, or just here?
 

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.

Re: Is this a nationwide trend, or just here?
 

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.

Re: Is this a nationwide trend, or just here?
 

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.

Re: Is this a nationwide trend, or just here?
 

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.

Re: Is this a nationwide trend, or just here?
 

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

Re: Is this a nationwide trend, or just here?
 

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?

Re: Is this a nationwide trend, or just here?
 

"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.

Re: Is this a nationwide trend, or just here?
 

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

Re: Is this a nationwide trend, or just here?
 

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

Re: Is this a nationwide trend, or just here?
 

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

Re: Is this a nationwide trend, or just here?
 

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.