I was 'somewhat surprised' to learn just how overwhelmed my primary care doctors are with the current system. While I have always greatly appreciated my doctors and the excellent care they give me, you can bet that next time I see them, I will endeavour not to waste too much time unnecessarily and to be even more thankful of all they do for me and my family. Nobody is saying anything about what patients can do to 'help' their doctors give them the best care.

Thank you anonymous 5:07p. Please ignore crazy doc. He likes to bite the hand that feeds him.

If you don't want patients with $0 copays, you need to negotiate better with your payors, or not accept that insurance. you are right, it is assinine for the patients to have nothing invested in their time with you, but it is also assinine for you to encourage that by giving them the option.

This is all about supply and demand. Fewer people will go into primary care for the next 5 years, congress will wake up and raise the 99213/99214 codes or give some other incentive to the poor primary care people (I am one for another 9 months) and then everyone will want to do primary care again. Doctors are just like everyone else, we want to be respected and paid well and if a group is neglected, then fewer medical grads will go into that specialty. (the conversation 5 years from now will be about general surgery, mark my words)
b

My Hero, a family practitioner in a big urban area and an osteopath, wanted me to go into primary care when I rotated with him for a month. I have to admit, it was tempting. He had a great system--first come first served. Appointments were made generally--"here are my hours, come in in 10 days to two weeks". Amazingly, the waiting room was never overcrowded, and the few times that it was, patients simply either came back later or another day. Simple. He's a great guy, Italian, always asking about your family and your life. Simple problems like work notes (ya gotta come in, but he's pretty lenient otherwise), prescription refills for scheduled drugs, and follow-up test results for normal physicals are dealt with expeditiously. Coughs, colds, and other low-acuity stuff are accompanied by a moderately more intense approach, and initial visits, post-hospital visits, depressed or "in-crisis", and Real Medical Issues are times for sitting down and getting to it, but even these are usually managed and charted within half an hour. He keeps his staff busy but happy with his glad-handing of drug reps, leading to frequent free lunches and drug crippy-crap like pens, post-its, and stress balls.

He uses one medical assistant who escorts patients into rooms, takes vitals, and draws bloods. He has her do H/H's, BNP, chem 7's, and urine dipsticks in the office. Everything else goes to Quest or Labcorp. Two secretaries wrangle the phones, pull charts, and keep an eye on the waiting room. Before he comes in to work he'll round on his patients and those of his partners in his office, 2 internists who run comparatively miniscule practices yet draw comparable salaries, a constant source of irritation to my hero. I sympathize and squint like Clint at the other docs when they come in.

During slow times he does billing on software maintained by a practice management company--this takes no longer than 1/2 an hour per day. He cashes the checks and does a lot of his own paperwork. He doesn't take (new) medicaid patients, but will happily accept medicare. A good chunk of his patients are HMO/PPO/union insured.

He doesn't do OB/GYN or peds. Most of his patients are walking wounded, or with stable chronic conditions, and are not the medical train wrecks I see at the hospital. I assume that's due to his skillful management, but it could be skillful patient selection--I don't know.

The hospital he has priveledges at has clinics with residents who cover medicaid patients. He works himself some weird hours, but his patients appreciate it--Mon 8-3, tues off, wed 10-8, thurs 3-9pm, fri 8-3, and sat 8-3. So on average about 35-40 actual clinic hours, plus time spent on rounds in hospital and working as a local medical examiner. I'd say he sees 15-20 patients a day, 1 or 2 sent to the ER, no sweat. The patients love him. I did too and immediately made him my PCP.

He lives nearby (20 mins to work), drives a nice car but drives the sensible-but-beater car to work, is in his late 30's and married to an anesthesiologist with 3 kids, has a boat, and can usually be seen to be having a good time.

So why do I not want to be a primary care doctor again?

Let's see, what about that "married to an anaesthesiologist" thing . . . .

i am surviving on 10to 15 patients a day, at $100 a pop, people are willing to pay this when i give them free medicines. the above assumes no insurance, which i dont take anyway