These issues are complex and must be dealt with by the entire team so that respectful, cost-effective strategies are implemented….

I don’t think any reasonable person would understand how difficult it is to run on time when there are walk-ins with emergencies or a doctor’s spending more time with a patient. But why is it difficult for someone in a doctor’s office to pick up a phone and say “doctor is running 2 hours late. Would you like to reschedule or come in later?”. A lot of people are going to a doctor’s office from work. Being able to spend extra time at work may mean being able to meet a deadline (and keep one’s job), not to have to ask one’s manager for time off or, for people who are paid by the hour, to earn some money. Then there are also people who are genuinely not feeling well. These people may feel more comfortable waiting at home than in the office where they may even run risk of infecting other patients. How difficult it is to call someone’s at his cell or office?

I am not talking about 15 minutes or half an hour late – I understand that these delays are difficult to predict before the patient gets to the office. But if you are running an hour late and think you are likely this delay to increase, why can’t someone in your office call? How difficult is it?

It’s not just the doctors. I was once made to wait for well over an hour for a pelvic ultrasound. Would’ve waited longer had a woman who was ahead of me not taking pity on me and letting me go ahead. You know, right, it’s when you have to drink a lot of water but can’t go to the bathroom. So this extra hour meant being literally in pain. This could’ve been easily avoided had the lab called and said “we are running an hour late, don’t drink the water just yet”. But nobody there gives a damn.

You’re right in that the current market for cash is small. I’ve seen the same things you have; many patients simply feel that our services should be free of any out of pocket costs to them.

However, private practices are going bankrupt rapidly and the big clinics now have less need (and are less able) to subsidize service at their clinics from profitable procedures and tests. Among the effects of this will be even longer waits, more rushed appointments, more midlevels handling more complex cases, and crappier service from overworked physicians and clinic staff in general.

Some subset of patients will become fed up enough to support a larger viable market for cash outpatient practices in each area, especially if those practices keep the price reasonable.

These are some of the same reasons many insured patients currently use the ER for nonemergencies, it’s faster and they feel it’s worth the higher copay.

You say the quoted statement is not true and yet contradict yourself in your last paragraph.

If patients will not pay cash for services, what besides an expression of their “demand” is that. My statement is true, most won’t pay cash if they can at all avoid it. Many will drive long distances and spend more time and money than they realize avoiding having to pay cash. Many more will wait long periods for appointments elsewhere. It isn’t logical but it is true.

The first statement is not true. The second may be true only if Obama and Stark outlaw or cripple cash practices.

Compared to most medical expenses, outpatient visits, especially in primary care, can be a bargain when you strip off the overhead involved in dealing with government and insurers. Most patients pay more each year for cable.

It’s true that many are currently unwilling to pay directly for physician visits because they feel entitled to this or they feel they already paid for this via taxes. As ‘normal’ clinics and physician offices service begin to resemble 1970s Soviet department stores more and more, this will likely change.

1. Doctors really see their actions as a little moral melodrama. (But we work so hard, and are so dedicated how can we be considered BAD for being late all the time.) But, they are bad from an economic perspective. Everyone’s time is money and doctor’s inability to stay on schedule in theft, at least from a utilitarian perspective.

2. Medicine is a limited good. It is rationed, either by the market or by a (insurance or government) bureaucracy. Wait times are the clearest evidence of that rationing. Do you want to pay for a prompt physician–or do you want some bureaucrat deciding that an average 20.4 minute wait is OK. Ah . . . Obamaland.

Unfortunately, too often what I get is a doctor who’s running half an hour behind, who’s harried and stressed out and who rushes me through my appointment in less than 10 minutes and doesn’t have the time to discuss or explain anything. I try to hold up my end of the bargain by being concise and providing the most useful information I can, so I don’t waste his time, but I always walk out of there wondering if any of it sank in or if I’m going to end up with some horrific problem that got missed because the doc was too busy and distracted to pay attention.

Don’t talk to me about the money. My health plan has small numbers in my particular market so we are paying through the nose. On $1,000 in gross charges last year, I paid $825 out of pocket, insurance covered another $125 or so and the rest was written off to discount. By my calculations, that’s around 95 cents on the dollar – yet I don’t get any more face time with the doctor than someone on Medicaid or Medicare. And out here in Sticksville, there just aren’t enough doctors to go around, so *everyone* has to wait, regardless of who you are or how well your insurance pays.

I just keep my mouth shut and try to be pleasant, because I can see the doctor is doing the best he can with the resources he has. But I don’t like it. The last time I was at the doctor, I felt rushed and unwelcome, like I was just some impediment to be raced over on his way to the next patient – even though I was probably the best-paying patient he saw all day. When I had a question about his treatment plan, he cut me off.

Presumably he doesn’t like the situation any better than I do. But how do you even begin trying to fix a system that is so broken? I have to say I pity you guys. I can deal with it by simply not going to the doctor unless I really, really have to, but you’re forced to deal with it day in and day out. No wonder so many of you are getting bitter.