I would love to spend at least 20-25 minutes per patient face time, chat about family, friends, and the weather, but my fee, laboratory testing, and their medication bill could easily be $500 or more. Simply put, this is patently unaffordable for the average patient for a routine visit to the family practitioner they might visit 2 to 4 times per year (a patient making 30k per year might be spending 5% of their gross income on me alone! Dream on.)

This is not to berate or diminish concierge practices. Just accept them for the luxury that they are.

As for surgical procedures, you are generally wisest to go to a moderate to high volume and efficient surgeon. Interestingly, higher volume surgeons are often faster and have lower complication rates than their slower counterparts who probably consider themselves underpaid rather than inefficient. Isn’t that interesting?

If you are seeing that many patients and think you are practicing medicine, you are kidding yourself–you are only pretending to practice medicine. You aren’t even paying enough attention to know how much you are missing and how many bad outcomes you are leaving in your wake. Your patients are coming to you for your standardized mindless script–when they want real medical care they go to someone else and you never know because you never take a history anyway and are in and out so fast that if they try to tell you, they are talking to our back as it goes out the door.

Those of you who practice like that can rant about the bureaurocrats and manage care all you want–YOU are the ones who have in fact already sold out to the dollar, lock stock, and barrel. You may or may not be mature enough to be honest with yourself about it. You may or may not be moral enough to feel guilty about it. Either way, you are not a physician–just a person with a license who pretends to be one.

This is why it is morally imperative that physicians set their own fees. There is ALWAYS someone whore enough to give less service for more volume and take a lower fee–even if it means faking it. There must free fee setting so that quality medicine can survive.

1) overprescribing antibiotics; it is easier to write for a z pack than take time to explain to a patient why it is not needed
2) ignoring psychologic issues, ie depression/anxiety, that frustratingly do take time
3) not providing informed consent, ie explaining side effects of medications, for example
4) poor documentation, putting yourselves at medicolegal risk
5) lack of encouraging preventative care, ie colonoscopies

I am sure that there are other items to add to the list.

You guys who see patients that quickly are simply “mills” that undermine the dignity and importance of primary care.

When friends and family ask me what they look for in a doctor, I advise them to inquire how often patients are scheduled. Any doctor who sees patients more frequently than every 15 minutes is either a genius or sloppy, and there are not many geniuses around.

Underpaid in New York

I do think that she must extend herself beyond human limits. I know her socially and have some sense of how much she gives, and not just to me.

I thanked her profusely both when I saw her and afterwards. But I should say that her checking in on the other issue was supremely helpful and touching, and I suspect that that sort of care has sets of effects which are not always immediately measurable, yet they are important, at least to me.

Zubeldia

Umm…What could take 45 minutes to evaluate re: a suspected fracture? How many patients behind you were really pissed off and walked out or chewed your GP’s head off when they were finally seen? Or perhaps you and your GP are wise and this is a concierge practice. If so, my apologies. If not, you better buy that GP one nice gift, especially if you were seen “insurance only”!

Zubeldia