You wait for over an hour to see your doctor, only to be rushed out of his office in a few minutes. Why is this? House Call Doctor explains the 5 reasons behind the flawed primary care system in the U.S.
Waiting at the doctor’s office has got to be one of the most frustrating things we all deal with.
You are imprisoned in a cold, mundane room, bored out of your mind, listening to the ticking of the clock, feeling like every minute is a minute wasted. I know how you feel, because I’ve been there. I once waited for 4 hours to see my perinatologist (yep, 4 hours!) when I was pregnant with my twins. It's frustrating.
Yet, as we saw in my previous episode Why Is My Doctor Always Late?, I’m often guilty of being late for my patients. If you haven't had a chance to check out last week's episode, I urge you to do so right away. In it I describe a typical day in the life of a primary care physician and highlight some of the underlying problems of the profession.
The episode drew a huge response and I thank those of you who posted your insightful thoughts about this problematic situation.
One of the most frequently asked questions was “Why can’t the doctors’ appointment slots just be longer?” That way the time pressure would be alleviated and no one would be late and in a hurry.
That’s what we’re going to look at today.
Why Can’t Appointment Slots Be Longer?
I’ve practiced medicine in several different settings, including public health, an HMO system, and a large non-profit medical group. Amazingly, the time issue is the same everywhere.
There are 5 main reasons why appointment slots cannot be longer at your primary care doctor’s office:
Reason #1: Most Primary Care Physicians Are Employees
This means they don’t have the ability to make organizational decisions about the practice. They receive a mandate to see a patient every 15-20 minutes and they must stick to that.
How is this tiny timeframe decided? I'm getting to that.
Reason #2: Healthcare Is a Business
Even if your PCP does have decision-making opportunities (as in those in private practice), the fact is that healthcare is a business in the United States. That means medical groups and private practices need to make a profit in order to survive. Medicare and health insurance companies do not reimburse primary care services well, so in order to make a profit, physicians are required to see more patients and more quickly, whether they like it or not.
Let me be clear: This is not about greed (despite what some of you have suggested). It’s about survival. It’s sink or swim for primary care clinics.
Have you noticed that many smaller, private doctors’ offices are closing their doors? This is why. They cannot financially make it work. The overhead cost to run a primary care clinic is immense. It’s much more than just the doctors’ and nurses’ salaries. As many of you mentioned in your comments to last week's episode, it’s also rent or mortgage, gas, electricity, the photocopier, the ultrasound machine, various test paraphernalia, vaccines, syringes, exam beds, EKG machine, and EKG paper. Not to mention the costly malpractice insurance for both the office and the provider, the licensing fees, IT support, the cleaning crew, benefits for the staff, fees for biohazardous waste disposal, fees for the electronic charting system, building maintenance…I could go on and on.
This sink or swim phenomenon is another reason why medical students are choosing specialties, rather than primary care. They realize that not only would they be spending the next few decades having to work under stressful time constraints, but they would be doing so while simultaneously sinking in school loan debt.
Medical school tuition is on average between $30,000 and $40,000 per year (and that doesn’t even take living costs into consideration). Multiply that by 4 years, then add the school debt from 4 years of college prior, and the minimum of 3 years of residency where you make only enough to slide by while the loan interest accrues. That’s a minimum of 11 years of school loan debt that reaches anywhere between $150,000 and $200,000.
Who could blame medical students for passing on primary care? It’s exactly why we’re experiencing a primary care doctor shortage in this country.