>>If I walk into the clinic and offer to meet whatever price the doctor asks, in cash, up front, will I really get an appointment that’s as long as I want? Can any doctor actually make the time to do that, unless their practice is made entirely of cash-up-front patients?

If you entered a taxicab in San Francisco and offered enough money, I suspect you could get a ride to Boston.

If you want your own private physician, pay the average annual salary of that physician, and I would imagine you could have your own private physician with all the time in the world to devote to your medical problems and no one else.

The upper-upper-level VIP’s of the world. The types who would generate a media frenzy just sitting in a waiting room. I suspect they can get the physicians to come to them. And they pay accordingly.

I trained at one of those medical centers that gets internationally famous VIP’s. They had to clear out 10-bed ICU’s for one patient. Security.

When the doctor has to clear out the entire afternoon schedule for one patient and ten bodyguards, or a 10-bed ICU for patient and Secret Service, I suspect they paid accordingly. Not that I would know, I was just the grunt.

The docs I met at that place, those who went back to the UK and Europe, they described working in their country’s socialized system, and if they could rise high enough in the pecking order, they got to see patients privately as well.

So, if willing to pay enough, can you get unlimited amounts of the physician’s time? It’s true in the rest of the world, I daresay it would be true in the USA as well.

If the insurance card isn’t absolutely clear and verifiable, get a deposit as well. “Worn out” and undecipherable insurance cards don’t fly. If the insurer does not verify eligibility, the visit has to be paid for by deposit unless the insurer clears the claim.

are you the “tool” police? I can use whatever words I like to describe somebody whose opinion I feel is asinine. You must, at least subconsciously, know how ridiculous you sound, as you maintain anonymity.

I am a board-certified internist working solo (except for my wife, whose training as a board-certified pediatrician makes her LESS valuable than an office assistant). I pay a fortune in business costs, and the declining insurance reimbursements limit my ability to hire a practice manager. Therefore I am acutely aware of ALL the costs of running my practice.

So I know pretty much within a couple of weeks after seeing a patient whether they

1-paid their copay
2-HAD valid insurance the day I saw them
3-have crappy insurance
4-had a deductible that hadn’t been met
5-gave me the wrong contact information so I couldn’t try to collect from them
6-their insurance reimbursed me below cost for a vaccine.

why do you feel that being conscious of running your business AND having compassion for patients (I do, for those who are suffering) are mutually exclusive???

Go to your compassionate naturopath, faith healer, or chiropractor, and see if they’ll fix you for free!

Comments like these amaze me.

1. The physician has the same right to comment on the activities of other people as you do about the physician. If he/she thinks the consultant is a tool, fine. If you do not think it is fine, than look in the mirror. Why do you believe that the physician does not have the same right comment on others as you have to comment about him/her?

2. Contrary to popular belief, running a medical practice costs money. Lots of it. We don’t get special breaks on rent, payroll, insurance, electricity, water, office supplies, equipment that other business do not get. It all has to be paid for. It would be irresponsible to conitnue to engage in business practices that threaten the economic viability of the practice (business). Talking about money is NOT taboo.

If seeing a certain sub-population (especially without limit) is going to cause the business to ultimately fail, the business owner has the responsibility to limit access to that population (notwithstanding a certain amount of charity care, etc).

If you don’t like reading physicians discussing the business of medical practice with other physicians on a physician oriented medical blog, don’t read it.

Of course, you can put you head back in the sand comfortable in the knowlege that doctors will continue to practice in spite of declining revenues, that you don;t have any responsibility for your bill, and that eventually the government will fix everything, and then you will get exactly what you wanted. Good luck.

And the person had a problem with me, when I suggested we break it up, take the problems one at a time. That could take a lot of visits, but then again, there were a lot of complaints.

I’ll second the first comment. Anyone who continues to give my staff a hard time is gone. Hey, anybody can have a bad day, people can be irritated because of underlying disease and all that.

But continuous harassment of my staff, I have no hesitation to dismiss the person from the practice.

I am not a public utility, and I am sure as hell not a doormat.

People who act like that are also lawsuit risks. You can’t please them. Anything really goes wrong, you’re in court.

In my state, we tried to get tort reform passed. The voters rejected the reforms. The people have spoken. They place more value on the ability to SUE doctors than HAVING doctors.

Now they wonder why they find it so hard to find a doctor.

When MDs speak of others as “tools” and “cash-paying” customers ( not patients ), you know we’re on the downward slope to big Doo-Doo land.

No compassion and only the big $$ is important to so many MDs. Why did they ever enter the profession (?) of medicine, in the first place?

He was about 25 yrs old (probably freshly earning a CSW or RN), clueless, and apparently makes between $80 and $200/hr! I had to explain to him the coverage rules regarding medicaid / medicare/ homecare etc.

He sounded just like the uninformed tool (i love that word) in this post.

http://www.usatoday.com/money/perfi/eldercare/2007-06-24-elder-care-costs_N.htm

I am sick of docs herding people through like cattle–but then I don’t take Medicare. Those who do have to push or they lose money.

I agree with the doc about the office staff. After losing some valuable office staff, I learned to make it explicit to those who like arguments to confine their arguments to me. I’ll go toe to toe with them if that is what makes them happy, but they have to treat the staff civily or it’s out the door. Zero-tolerance.