It is a great system, and it works well. I have come to think that doctors have appointments in order to maintain an illusion of control, as mentioned above. If nobody came, so what? Slow day, that’s all. The other doctors in the practice used appointments, and saw half as many patients, and people would say when my doctor was covering their patients, “wow, that was much nicer than with that other guy.”

Being done. The MD programs are growing, though a little. The osteopathic side, they opened two or three schools in the 1990′s. By absolute numbers and percentage growth, the osteopathic schools grew a lot more, and their historical trend was primary care, I assume that is still the case as far as I know.

>>Or allow a certain level of problem to be treated by a non-physician.

Also being done. A lot. It varies state-by-state, though. Nurse practitioners have independent licensure in many states. They can go out and set up shop in my area. And they do. There are at least three independent nurse practitioner clinics in my county. That “certain level of problem” that a nurse practitioner can handle in my state, is just about anything.

My PCP is usually behind schedule, but she doesn’t rush me, answers my questions completely, explains things with out being prompted, and seems to be actually in treating me. Since she doesn’t rush me, I can’t really complain that she didn’t rush the guy before me. She’s a good doctor, so I cut her a lot of slack on the scheduling issues.

On the other hand, I used to go to an idiot of a urologist who was a little better about seeing me on time, but he always seemed to get out a fast as possible, never gave more than the shortest possible possible answers to the most direct questions, and never seemed to listen. I was less inclinded to feel understanding and eventually “fired” him about a year later than I should have. (A long story, but looking back there were so many things screaming “change doctors” )

Not rushing patients and saying “Sorry that we’re are running behind because…” can make up for a lot of lateness.

That being said it would be nice if the receptionest could say something like “It’s been a busy morning and we are running an hour behind” or something to that effect.

As for paying more to get longer appointments, I would be glad to, but it can’t happen in todays system. Most people have no choice in what insurance plan they use. You use what your employer picks and most insurance plans set the price period. That’s just the way it is. In a sane world the doctors would set the price and the insurace companies would decide whether or not to cover that doctor, but in the real world it’s the opposite.

Finally, to all of the other patients out there : please be on time or even a little early. Remember, when you are late and they fit you in anyway, you are not just wasting the doctor’s time, you are wasting the time of every patient after you.

I have a little problem accepting that a patient can determine the seriousness of their medical problem by the quantity of money they have.

The idea presented above that patients who want their primary care physician to schedule their appointments based on how much a patient is willing to pay just sounds like a bad idea. “I’m sorry Mr. Jones, I have to reschedule your appointment again. Mr. Smith wants the doctor to look at a wart, and is willing to pay more than you possibly can afford.”

I do like the idea of a computer monitor showing the queue. I might suggest a little privacy be observed. Maybe by giving people numbers and showing the numbers on the monitor. I wouldn’t necessarily want to display my name and reason for visit to an entire waiting room. “Flex – Awaiting Rectal Exam in Room 3.” Not so good.

There are other solutions. Maybe find ways to train more doctors. Or allow a certain level of problem to be treated by a non-physician. If I know that I need a salve for a rash, I don’t necessarily need to see my primary care physician. There may be ethical concerns with this type of solution, but they may be addressable.

Personally I am a rather calm person, and usually schedule a good deal of extra time when I go to my primary care physician’s office. I realize that there is a wide variety of conditions that a physician may see in a day. Some are easy to diagnose and treat, others may be very difficult. What would be very helpful, and I’m just thinking out loud here, is a way for a physician to get some idea of the patient’s condition before an appointment is scheduled. Reducing the surprises for the physician may go a long way toward allowing them to create a manageable schedule.

Can you tell it’s the end of a workday and I’m ready to go home?

Cheers,

-Flex

Right.

And if we can’t cover “what needs to be covered” in that time?

Then what?

Out the door with you in mid-sentence and a followup next week to continue? Right in the middle of your “By the way, I’ve been having this odd chest pain lately …”?

Or have the next patient wait a bit till “what needs to be covered” is understood and dealt with?

Once again, you can’t have it both