Why do I only get 10 minutes with my doctor?

Next in a series.

Good question. You call for an appointment and are told it will be about 20 days. You arrive on time only to sit in the apt named waiting room for 40 minutes. Finally you get to see your primary care doctor (PCP). You begin to explain why you came in but are interrupted within about 23 seconds even though it would have only taken you about 6 more seconds to finish your “opening statement.” The doctor asks a few questions, does a brief exam, gives you a prescription, suggests you see the specialist and off you go, all within 8-12 minutes. At the exit desk you are told you owe a $30 co-pay. “Visa or MasterCard please.” And in no time at all you are out the door.

No time for delving deeply into your issues. No time to build trust. No time for compassion. No time for actual healing.

Why so quick? It is all in the numbers. At the risk of being boring, here they are. They might surprise you.

According to the New York Times a PCP earns on average $150,000 per year. A survey from Medscape pegs it at $170,000-180,000. That is about what a newly minted law student gets at a prestigious large firm or a just graduated MBA gets at a big consulting company. But how does our PCP actually earn that money?

If the PCP has a private practice, in order to earn $150,000, he or she needs to bring in about $350,000 to also cover office expenses. Given what insurers like BlueCross, Aetna, United Health Care, Medicare and Medicaid pay per visit, the doctor needs to see about 25 patients per day. That is $30 to the PCP’s pocket for each visit. No wonder the visit is so short.

Said a different way, the PCP has to see 15 patients to cover expenses. Any patients over 15 and the income goes to him or her. So the PCP works for others until about 2pm.

The typical PCP takes 24 phone calls per day, 17 emails, processes 12 prescription refills (above those handled during visits), and reviews 20 laboratory reports, 11 x-ray reports and 14 specialist consult reports. These are all done outside of the visit and obviously take substantial time.

Look at the numbers a different way. A PCP who worked for a well-known HMO in California earned $140,000 and was assigned a panel of 2,200 patients. That is $64 for each patient for the entire year. That is probably less than you spend taking your car for a twice yearly oil change and checkup. If each patient came in three times per year then each visit was worth $21. This PCP found herself highly stressed, unable to keep up to the level she thought appropriate and went home exhausted only to ignore her family and “crawl into bed realizing  it would start all over again tomorrow.”

On the east coast, a highly regarded PCP told me that “I thought I was going to die, literally, if I kept this up. I could not give the type of care and attention that I felt was best for my patients, I could not be compassionate. All the things I treasured doing as a doctor had vanished.”

The answer is straightforward. Pay the PCP more. Not more in total (although that might also be appropriate) but more per visit and have the PCP take care of substantially fewer patients.

There are many ways to approach this. Increase the fee for service payment in return for more attention to, at least, those with chronic illnesses who need close care coordination. At least one example of this with a Blue Cross plan has worked well. In a capitated system, assign fewer patients but pay the same total amount to the PCP. Maybe 1,000 patients instead of 2,200 for that $140,000. Or if the population in the pool is high risk with either mostly elderly people or those with multiple chronic illnesses, set the capitation rate so that it works with just 300-500 patients. There are good examples of this being highly effective as well.

Yes, in each of these examples the amount of money going toward primary care per capita is increased but the total costs of care comes way down. It comes down because high quality primary care takes care of most issues, offers better preventive care and coordinates the care of those with chronic illnesses. This means less referrals to specialists, less unnecessary testing and prescriptions and fewer trips to the ER or the hospital.

For PCPs in private practice, they can switch to retainer or membership models where the patient pays directly (direct primary care) by the visit or on a monthly or annual basis for all primary care in a setting where the PCP only has 500-700 patients, offers same day appointments, access to his or her cell phone 24/7, and perhaps reduced cost laboratory testing and even generic medications. Some of these practices are quite affordable — “blue collar.” And the savings on drugs can often offset the membership fee.

Insurers should consider paying the retainer for those who buy a high deductible insurance policy since quality primary care substantially reduces the total costs of care.  Employers could either buy the retainer or place an equal sum in an HSA for the employee who takes out a high deductible policy through the company. Alternatively, the company might initiate its own in house primary care clinic designed so that the employed/contracted PCP has only a reasonable number of employees to care for. In any of these models, the use of health coaches can further improve wellness, maintain health and assist with illness care.

The result: More time with the doctor. More time for the PCP to listen, more time to think, more time to diagnose and treat, more time to coordinate care for those with chronic illnesses and more time for better preventive medicine. So better care, better health, less frustrations, more satisfaction and much reduced total costs of care. Now you will no longer be wondering why the doctor allots you so little time.

Why do I only get 10 minutes with my doctor?Stephen C. Schimpff is a quasi-retired internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center, senior advisor to Sage Growth Partners and is the author of The Future of Health-Care Delivery: Why It Must Change and How It Will Affect You.

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  • Kristy Sokoloski

    I talked to a friend of mine who lives in the UK and they only get 5 minutes with their doctors, but she said if it goes over that 5 minutes that there is not going to be a problem. I am ok with only getting 10 minutes with my Primary Care Physician. Sometimes that’s all I need to take care of the problem I am there for. But if I need more time I make sure to let the girl scheduling my appointment know that I have some other things I need to discuss with him and they try to schedule me accordingly. With my gynecologist I get about 15 minutes with her and that time is well spent. Same with my other doctors. If I need to have more time to talk with my gynecologist I let her know that I need to spend a bit more time with her during the visit and she makes sure I get it.

    • NewMexicoRam

      The way the reimbursement system is set up, the pay for the higher level (more complicated and longer) service does not increase proportionately. In other words, I can make more money seeing 5-6 uncomplicated patients per hour than 2-3 complicated patients per hour. And guess which way allows me to finish quicker and feel better refreshed at the end of the day?

      • Suzi Q 38

        The 5-6 uncomplicated patients per hour?

        • NewMexicoRam

          You win!
          Actually, as the patient, maybe you lose.
          Welcome to Medical Economics 101.

          • Suzi Q 38

            I would lose, as I am the complicated patient.

    • Suzi Q 38

      “…….I am ok with only getting 10 minutes with my Primary Care Physician….”

      I finally accept this as the “new norm.”
      I have decided that if I have more questions about another condition, I will just have to make another appointment.

      • Kristy Sokoloski

        All my visits have been about 10 minutes with my Primary Care Physician, even long before all the things going on now. Yep, even 20 and 30 years ago my appointments were 10 minutes long.

  • JR

    Is $30 the average pay the office makes per visit or the average take home pay of the physician? I have “low pay out” crappy ACA insurance that no one takes that pays out a total of $110 a visit (what they paid + my co-pay). 15 visits a day x 4 days a week x about 52 weeks a year… about 343k a year with 30 minute patients? Which means about $150k take home? Hmm, so that’s how my doc makes it work. (That’s just the visit, no labs which I’ll assume go straight to the lab)

    Please be cautious of this argument: That is about what a newly minted law student gets at a prestigious large firm or a just graduated MBA gets at a big consulting company.

    Law schools are graduating 2 students for every one law job. That’s a 50% unemployment rate. Medicine has the exact opposite problem.

    MBA’s who get the big bucks? They have relevant job experience before getting the MBA. I’d never recommend someone who just got their BA go get an MBA, go get some work experience first or it’s wasted money. It’s like opposite of med school, instead of school + residency, it’s residency (work experience) then school.

    • Suzi Q 38

      I heard that the law schools were telling students that since there are too many lawyers, don’t count on a job. Make sure to work for mom and dad (if they are lawyers).
      The average MBA is not guaranteed a job at $150K a year.
      I have known MBA’s to not only make far less, but be unemployed. Why? No “skill set” to their line of work.

      • JR

        Yeah I was reading an article that while people at the top MBA colleges are getting offers for 150k, those in the bottom are getting offers for $30k. I know someone who was a manager making $38k and they had an MBA (though not from a ‘top’ college).

        • Suzi Q 38

          Like a lot of articles, this one is convenient as far as selecting the higher salaries for the MBA and/or lawyer, and the lower salary for the physician.

  • Suzi Q 38

    I do agree that the PCP needs to get paid more.
    Would it help if I separated one visit with 2 problems into two shorter visits? Would my PCP get paid more.
    What else could I allow my PCP to bill for in order to make it more worthwhile to see me?

  • kullervo

    Be happy you’re on ten minutes. It’s like waiting in the ER. The person to pity is the one they take straight back. I’m now a forty-five minute patient with my PCP. I’d rather not have the reasons for that.

    • Kristy Sokoloski

      “I am now a forty-five minute patient with my PCP”.

      Even with all of my health problems that make for a complicated history I still wouldn’t have enough to discuss that would take up more of my Primary Care Physician’s time to make it a 45 minute visit even if I wanted to ask for that much time on the schedule.

  • JR

    Oh, my insurance doesn’t pay $110 either, my physician’s office gets paid $110 when you add insurance + my co-pay. Shouldn’t you normally add a co-pay of $20 – $55 onto what the insurance pays?

    I checked the average payout from Medicare to my physician is $83 per visit. That may not include a co-pay from the patient, so that’s a much smaller amount.

    Isn’t registering/rooming/taking vitals/etc done by staff at most places?

    My doc does his documentation in the room with the patients and lets them see it/asks for their input on it. He then prints out a summary every visit. Helps keep it all accurate. Since he’s independent, he gets a say in which EMR he uses and it’s integrated into his routine.

  • Lisa

    Same here.

  • MentalPatient

    Kind of a rambling post, but here it is. It’s my impression that nearly everyone in our society is being forced to work harder for less or the same money. Seems like nearly everyone is overwhelmed with endless paperwork. At least a doctor can afford to hire someone to change their oil or fix their plumbing or electrical problems. Many of us have to figure it out on our own to make ends meet. The mechanic has overhead too so to compare the charge for an oil change vs. what a doctor takes home as pay isn’t correct. All this said, I do empathize with the stresses doctors face. But I know so many people who are more stressed due to serious lack of income and all those consequences. It seems everything is becoming less humane in our society and we are being worked to death, but maybe the stress isn’t new. Now, we can all comment online, even anonymously (for now), whereas perhaps 50 years ago, people kept this stress to themselves.

  • Suzi Q 38

    You make so much sense.
    Thank you for your viewpoint.
    There are a lot of other added costs on top of just the 10 minutes with the patient and doctor.
    I have learned to be very direct and to the point.
    It is not as fun, but it is what it is.

  • http://www.zdoggmd.com ZDoggMD

    Um, what Stephen said. Spot on.

  • Elaine

    I have started asking for the last appointment of the day. It’s working out well so far. My PCP is more relaxed and able to take time to discuss my overall health not just whatever brought me that day

  • David Dougherty, Ph.D.

    I receive my health care from a big city Community Health Center where I spent 14 years on the Board. The government saw fit to set daily patient visit targets for physicians or lower level providers that basically worked out to 6 patients per hour. That is ten minutes per patient. If a provider’s numbers fell below the target, our government funding was jeopardized. So our Practice Managers at each facility pushed providers to meet targets. Every month the Board scrutinized the numbers to admonish slow providers. Either be fast, or work longer hours if you want to see fewer than 6 patients per hour. So when do you eat or consult with a specialist or see a drug rep to get a big bag of free drugs to give to patients who cannot afford to buy their own? How do you spend enough time with a patient who is a train wreck?

    Six patients per hour may sound like a doable goal to a bureaucrat, but less so to a patient. And for the record, we hired physicians at just a tad over $100,000 per year. They had to do the job for love, not money.

  • Monique Bryher

    and physicians wonder why patients are seeking “alternative” medicine providers, who listen to them and actually interact, as opposed to providing orders and interacting with the patient like he/she is processed meat on a conveyor belt.

    • Lisa

      I use alternative medicine providers (acupuncture, massage) for chronic pain issues, I pay out of pocket for these services, which my PCP is not trained to provide. He has knows I use these providers and approves because my other options are drug based.

      I still need the services of my PCP. And most of what I need him for can be done in ten minutes or less, quite frankly. But even if I see him for a short period of time I don’t think he is treating me like a piece of meat.

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