In a room that looks like a cafe with colorful tablecloths and vases of lilies, speed dating is about to begin.
But the 20 people attending this Tuesday afternoon rendezvous aren’t looking for romance. The Dallas-area hospital running the event hopes to hook up people needing doctors with physicians looking for new patients. It’s a tool hospital administrators use to recruit doctors ”” critical drivers of revenue ”” and consumers.
Physicians and parents pair off for five minutes, then rotate into new conversations.
The key phrase is “Reservations for the Doc Shop are necessary, as sessions are scheduled in 30-minute increments and appointments are limited.”
The major problem is that folks with good insurance (the kind that actually pays your overhead) have jobs. They therefore cannot agree to come in the morning and wait around until there is a cancellation or noshow, or wait 4 months to ensure that they will, by golly, be seen by the primary care physician or specialist who cannot then “abandon them”.
Folks with medicare and medicaid for the most part are very willing to do this. This means that even if the number of “new medicare/medicaid slots are limited”, simple mathamatics means that physicians schedules eventually fill up with medicaid/medicare follow ups, simply because they are willing to wait 4 months.
This means that each 15 min primary care slot is filled with a medicare patient with 12 different lethal problems who is partially deaf, refuses to go to assisted living, and lands in the hospital monthly, or is filled with either spanish speaking individuals with no insurance who demand that the physician pay for a translator (often required by law in some states), or the medicaid patient with “fibromyalgia” and “bipolar disease” who will spend 40 minutes trying to explain to you why you need to fill out several long forms and participate in a legal interview on behalf of her lawsuit against the restaurant who fired her against the Americans with disability act because she insisted on taking 15 minute breaks every hour in order to have a “physician prescribed nap”.
This crowds out the folks with decent insurance who have straight forward problems that can be easily managed in 15 minutes. These (very reasonably) complain that “the doctor will never see me, and he’s always rushed (interpreted as meaning “he doesn’t care”). Once a physicians Medicare/medicaid/uninsured population goes over about 60% the practice goes into the red which means that you cannot pay either yourself or your office staff. (This dynamic will worsen under Health Care Reform, beginning in June with the 20% slash in Medicare payments).
Thus, this “doctor shop” is a way of attracting new patients who can actually pay the bills, and who are neither litiginous, at deaths door, or whose various medical and social challenges are guaranteed to make the rest of your patients (the ones who pay the bills) wait over an hour for their appointments. (At which time the paying patients will leave saying that you are rude and always “overbook” and have no respect for their time) .
Because you can bet that folks who say “I have medicaid and I’d like to come to the doctor shop” will find that all appointments are full. Even if they fail to disclose their insurance, the folks who do show up, who are obviously going to be a black hole for both time and money, are likely to find their doctor “date” unpleasant, arrogant and “cold” while those who have straightforward problems (like the pregnant young woman) will find a pleasant and friendly person available.
Mind you, having clarified expectations does help. I would like to post a large sign saying “Do not ask me for Ritalin unless you have a sleep study that documents Narcolepsy. I do not believe in adult ADHD, and I expect a great deal from kids with ADHD before giving them stimulants (including eliminating all TV, routines, regular and vigorous twice daily exercise, discipline, and evaluation for other causes of attentional deficits such as processing disorders, sleep apnea etc).
And don’t get me started on the narcotic seekers.
Good for you Clueless! I’m so glad that other docs are also “unbelievers” such as myself. Of course, that means that you and I “don’t care” about others.
It’s kind of the same if you are a “global warming sceptic”, which means that you hate animals.
Of course, the fact that you can actually articulate why the finances of medicine are doomed also shows what a mean person you are. Nice doctors shrug their shoulders, quietly retire and leave it to BHO & Co. to define the problems, which of course is currently BIG INSURANCE and insufficient socialization of the healthcare industry.
#1&2, couldn’t have said it better. However, the powers count on this all being too complicated to connect the dots or blaming them. I have found peace on all this in that I just don’t see those types of problem patients. If it is stupid, nonproductive, not appreciated by who pays the bill, then I am not interested either. A day without firing a patient is a day withour sunshine. Love it.