Poll: Should doctors be forced to treat patients promptly?

New regulations to reduce wait times for medical care in California are due to take effect next year.

Under the proposal, primary care doctors employed by HMOs are required to see patients within 10 days of the appointment request, and specialists must see patients within 15 days. Telephone calls must be returned within 30 minutes and patients needing urgent care have to be seen within 48 hours.

But will these mandates actually improve patient care?

In San Diego, patients wait an average of more than 3 weeks for a routine physical. In Los Angeles, the average approaches 2 months.

A severe shortage of doctors is primarily responsible. Replacing retiring primary care doctors is becoming increasingly difficult, as most medical students today prefer the lifestyle of specialty practice. Without additional resources to expand the primary care workforce, doctors will be forced to spend less time with more patients.

30 percent of primary care doctors plan to leave the field within 5 years because they are burned out. Asking them to do more will only worsen the situation.

And if health reform passes, the workload will increase by millions of patients.

Patient advocate groups are applauding the legislation to force prompt care. And I agree; patients need to be seen more expediently. But whether there are enough primary care doctors to meet this mandate remains very much in doubt.

I encourage you to listen and vote in this week’s poll, located both below, and in the upper right column of the blog.

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  • Vox Rusticus

    Besides Kaiser Permanente, who else does this apply to in California? How many doctors outside of Kaiser are “employed by HMOs?”

  • Vox Rusticus

    This is actually an understandable requirement, provided it is restricted to HMOs. Those are prepaid plan organizations that restrict where you can go for care and have a strong gatekeeping requirement. Callbacks are essential and that is probably relegated to a call center or a phone screening nurse in a large outpatient facility. Having an appointment time available to offer is probably all that is required; not necessarily an appointment with a particular doctor, or at a particular time or day. If you call and they say, “come in today at noon” and you say you can’t make that, that probably ends their obligation under the regulation right there. If they then offer you an alternative six weeks hence, they are still OK, since you were offered an earlier appointment but declined.

    HMOs have an incentive to overbook since their business model is like that of an insurance company and not that of a fee-for-service professional model. Where there is little plan competition, there is the temptation to under-invest in support staff and physician employees and to maximize filling of schedules (better to put an appointment in at eight weeks for a patient than to hire someone additional who could see the same patient tomorrow).

  • richard md

    mandatory interpreters even for foreigners regardless of their ability to pay, Family Medical Leave for ppl who ought to be working, now madatory visit time guidelines. Spin this straw into gold or else,………….
    The emperor has no clothes and nothing will change until this country is broke or we get more Dr’s in government.

  • David Allen, MD

    How crummy. I guess the writers off such non- sense bills think practices WANT to make patients wait for appointments. They just don’t understand business and will end up driving good care further from their state.

    While were at it, let’s force nice restaurants to open a table within an hour of our call, let’s force colleges to admit more students, and let’s force amusement parks to have shorter wait times for rides. It’s so fun to be a Liberal!

  • Erik

    Can we force patients to actually take their meds and follow the orders of their docs? Nothing more irritating than someone who comes to the ER at 3 AM for one weeks of back pain who then refuses any workup.

    Where is patient responsibility in this equation?

  • farrel klein

    They did this in Britain. Some docs just stopped answering the phone.

  • Christine

    Manitoba, Canada’s system has extreme waits, over 1 month for a psychiatrist, MRI’s non-urgent- 6 months, months to see a specialist, severe shortage of family doctors. months to one year to get into the pain clinic. I think we get what we pay for. Our system isn’t perfect. I recently went to the US and got an mri in a week.

  • Amelia

    They’re not saying the doctors need to work harder. They’re saying the HMOs need to stop taking premiums if they can’t provide the services. Out this way, some doctors say “Not accepting new patients” if they can’t accomodate them. I’ve never heard an HMO do that, they just keep taking the money. Once in an HMO, for 2 years they told me “the doctor’s booked for the next two months, just keep calling back because that’s as far out as we book.”

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