Look around you. When good doctors decide to not play that game and set their fees, spending more than the 2 minutes that jb thinks it takes to follow-up a person with hypertension, people pay those fees because they also values the doctors time more than the non-patient third party.

I hope jb never manages hypertension. If he does do so with those 1-2 minute viists, then he will never learn that the guy who says he doesn’t smoke means he doesn’t do it all day like he used to, his marriage is driving up his blood pressure, which is further exacerbated by the bottle of vodka in his desk which he starts nipping at by 1 pm (it used to be a shot at 4 “to get me through the last hour”) to deal with a soul killing job. He will certainly never learn that sometimes, upon hearing these things empathetically, a few well-times comments can give the guy the nudge he needs to start cleaning up some of this business.

So I don’t agree that “most” patients take very little time. It just depends on what kind of patients you have. And if the message is that you lose money seeing older sicker patients, then that is a situation that should be changed.

I agree that surgeons are getting screwed just as much as primaries.

“the rational economic incentive is for the doctor to see patients as quickly as possible…” No kidding. How is this different for surgeons? We get a fixed amount for a procedure- we do not have the option of upcoding to a higher level as E/M allows if the patient has multiple problems. We bill for a 44950 to remove an appendix, whether the patient is 22 years old, thin and healthy and goes home the next day, or older, morbidly obese, diabetic and stays in the hospital a week and requires a dozen office visits for a wound infection. The global fee covers all care within 90 days of the procedure. If we do more procedures every day, we earn more money, just like you do with office visits.

Guess what- we don’t get paid for thinking, and the rest of the world doesn’t either. With rare exceptions, no one gets paid for thinking. You will get paid for the time you spend evaluating and managing sick people if you document it. Some of your visits will require a great deal of thought and even looking stuff up, but most of them do not. Writing a prescription for a classic UTI or re-evaluating a patient with stable hypertension requires minimal thought, yet you will get a 9921x out of it, and face time with the patient can be only a minute or 2. With that level of intellectual effort, you should not expect more than a couple of dollars by your standards, but you will get whatever 9921x allows despite the absence of thought.

If you want to get paid for your time, charge your patients by the minute. That way if they want to bring up every little problem, it’s on their nickels. You won’t get an insurance company to play that game, but I have heard of some docs who do not deal with insurance at all, and they charge patients directly, by the minute.