Hi, Jill -
As both a patient and a physician, I am often just as frustrated by the irrationality of our so-called "system" of health care. 20 years ago or so, you would have probably been seen by your pediatrician that day, and maybe even by an orthopedist that afternoon following a call from your pediatrician asking him to see your son.
As patients, we are led to expect prompt, thorough, competent and compassionate care (nothing wrong with that ideal). And you did the right thing seeking advice about your son's discomfort. But I can attest that we have also developed an expectation that any & all medical problems, once we've decided we have one, no matter how minor, will be resolved "today" - on no notice. If we can't be seen now, we want wildass-guess treatment by phone - just do something and do it now... whatever you do, don't ever make us go the ER, even if it's real emergency. None of us have time for the inconvenience of an illness, because we've got a wedding to go to, or a vacation starting tomorrow, or a dinner out tonight, or an important meeting in Dallas on Monday, or a son's soccer tournament on Saturday... you get the point.
As physicians, we are expected to operate as a "business," getting paid (when & if we get paid) progressively less and less over time, forcing us to squeeze more & more patients into already busy schedules and function wtih the help of fewer and fewer staff (our largest expense, after all), simply because we'll go out of business if we don't. And we're expected to make zero errors in judgement and have no bad outcomes.
Insurance companies operate on the principal that physicians are criminals by definition and the companies aren't going to part with a nickel until & unless we prove we are innocent. No matter that a service was rendered to an individual in need in good faith, if there's a typo in the claim form or there is some fine print in a contract that can enable them to avoid paying, they're all over it. In the eyes of many patients, if an insurance company denies a claim, or determines it is the patient's responsibility, then the doctor did something wrong or didn't file the claim properly and doesn't deserve to get paid. I practice a primary care specialty in which revenue is earned from lots of small-dollar-amount services. If an insurance company decides, for whatever reason, justified or not, to not pay a $38 bill, I'm better off not even arguing about it because it will cost me $50 in staff time and resources to contest it - I'll "only " lose $12 if I "succeed" and $88 if I fail. We are truly in a no-win situation when that happens, and it happens more often than I care to think about. And there's the problem of the crazy medical liability lottery and its consequence, defensive medicine (a large part of the reason you were advised to see a specialist), which further contributes to the sense of frenzied harrassment physicians live with day in & day out.
Even with all that, I'm proud to say that in our practice it is rare for anyone to wait more than 10 minutes, if that, past their appointment time to be seen, and not by a physician extender, but by the physician. We can't fully anticipate everyone's needs so the schedule inevitably bends to meet them on the fly, but I spend as much time waiting for patients late to their appointments as they do waiting for me. I see 18-25 patients in a full day, while the physicians in the practice downstairs see 50-60 or more, many of whom wait an hour or more to be seen. However, providing that kind of service means I earn about 40% of what I took home in 1981 (in 1981 dollars). In actual dollars, I take home almost exactly what I took home in 1981, but the dollar's purchasing power is only about 40% of what it was then. If I were to tell you in advance that the pay for the job you were about to start would lose 60% of its value if you stayed with it for 25 years, you would probably look elsewhere for a job.
More and more of the hard-earned money you spend on insurance premiums is being skimmed off the top by opportunists (insurance companies and lawyers) who contribute absolutely nothing to your health or well-being. And it is showing up in the "wasted another day at the Dr." problem that prompted your article. I wish there was a quick and painless solution to the problem, but I'm not optimistic one will be found before my career is finished, or before your son has children of his own, I'm afraid. I just want you to know that physicians are not any happier about it than you are and that the barriers to providing the kind of care you expect and deserve have been growing taller and taller as third parties have aggressively and progressively invaded the physician-patient relationship.
Cheers,
Daiwa
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