… I am an employed general internist. My medical assistant is a lovely person with a high school education , who was in the military and passed the MA certification. She makes less than an experienced grocery checker. She’ll be around until she can afford nursing school. Then I get another one who may be good or bad., I’m on salary, they don’t pay anyone to help me because I just work more hours . They don’t need anyone particularly well trained (my asst now is a jewel, but the major support of her family of 4 since her husband’s construction job is dead) because I will be there to complete their work and correct their errors, all for free.

The doc is making the appts , or at least giving a lot of direction because
1. The staff may not know what the problem/urgency is, especially with primary care where it can be diabetes or a brain tumor. This does waste everyones time . Ex: the receptionist scheduled a VQ scan (bad beans, good lungs) for 10 days later , not because she was evil, because she didn’t know. I can train her, but there are always new employees because we don’t pay that well.
2. The specialist office staff feels they are above talking to “a receptionist” even though that is the specialty staff’s job title. 90% of specialist also tell them, if its important the doctor will call me. It is alo true that the receptionts or MA at the specialty office may not realize “patient is urinating blood” sounds horrid, but is likley not something that needs to be fixed today
3. Some pulmonologists want a thin cut CT and complete PFTS before they see a patient with non-resolving infiltrates and some want to look at the plane film and order it themselves and some want to see the patients first. What is appropritae depends on the patients health and renal function. The assistant doesn’t know all of this , and it truly is my job to be sure the patient has a productive appointment.
4. In the case of the publicly insured patient they will force patients to go through hoops so they (the specialist) don;t waste their valuable time.

I have worked with NP’s in the past , now that we are employed we can’t afford one .Generally LOTS more work and malpractice risk for no extra compensation.

Just one comment -my employers system , like most others uses mid levels in our most difficult areas, like walk-in appts and urgent care centers . The easy stuff, like is your pottasium back to normal? or is your BP< 130/80 or your LDL< 70 all goes to the doc.

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There are a couple things you might do to be more efficient. First the calling in of prescriptions is time consuming. Do you have a nurse that can call those in for you? Also, using an electronic medical record can speed up doing refills as well. Also prescribing antibiotics over the phone for sinusitis? I would’ve done that as an office visit, same amount of time.

Sounds like you’re ‘too nice’ making appointments for your patients etc., just have them call and make the appt themselves.

The entire field of primary care is due for some office workflow re-design. It is so unsatisfying to be doing paperwork and telling a patient about their normal cholesterol level by phone. No wonder Primary Care is going the way of the dinosaur.

At least you got done at 4:30. Most of my colleagues are never home before 7 because they are doing all of those tasks after patients are gone.