All of this!! I have thought about writing something like this to explain to my patients, though I agree that most patients who have been in the system for a while get it, for better or worse! It's new or young patients who may be confused, not knowing everything else we are juggling. I was heartened by a patient Press Ganey comment that said "I answered the question about wait time indicating that I waited more than 15 minutes beyond my appointment time. Personally, the wait time is not a problem for me since I know I will have [the doctor]'s full attention when we are together in the exam room and, I assume, the reason I am waiting is that she does this for all of her patients." When my day is running extra behind, I try to remember this! (It does still annoy me a bit that this question exists because it implies that being seen within 15 minutes is the expectation, when if we are trying to do things that we know are good for health outcomes like fitting complex patients in to provide continuity of care, it generally does mean we'll end up running late.)
I am lucky to have 30 minute visits right now, instituted thanks to the pandemic but retained now since my clinic has been able to demonstrate sufficient RVUs to merit it, with a usual practice of some double booking and doing dual preventive + E&M visits where appropriate. The new coding scheme of being able to bill a 99215 for 40+ minutes spent on the day of service has helped, since a lot of my visits wouldn't have met high complexity criteria for medical decision making but require a ton of time in care coordination or counseling/motivational interviewing. However, if I was on a 20 minute template I probably wouldn't code many 99215s for time since spending that amount of time would mean I'd have no hope of being able to eat lunch. I like that it allows me more time to get to know my patients and talk about overall health goals, but it creates some access challenges which I haven't totally decided how to manage since my panel size is still better fit to the 20 minute standard. It means many of my patients go to urgent care/virtual care for the quick visits (UTI, URI, vaginal discharge, STI check) and only see me for higher complexity issues or for an "annual physical" where they update me on everything that has occurred the last year and a few other things they've been saving for me as their PCP, which can be a lot!
What a perfect list! I try not to feel bad about being late anymore, since as you point out it’s clearly not our fault. I think my patients don’t usually mind because they know it evens out in the end since I will always go through their entire Notes app list of questions and answer their questions about siblings I am not seeing 😊 I love the issues you choose to write about and bring visibility to, keep up the great work!
Here are a few more reasons: getting the prior authorization approved, needing to send the client to the ER, needing to treat a low blood glucose, needing to interrupt a session to speak with another provider who called and if you don’t take the call … being pulled out of a room during a session because…supporting your client to grieve, checking when the next AA meeting is, calling to find transportation, waiting for the interpreter…helping a co-worker…going the bathroom, eating lunch…
As they say, "don't hate the player, hate the game." There's just no way to do everything we want/should do in primary care. Either we see fewer patients and the system collapses into concierge practices serving 10% of the population, or we keep doing the best we can, knowing that it actually takes 26.7 hours per 24 hour day to accomplish all that we primary care docs are expected to do! Great points, thank you.
I don't see it as an all-or-nothing situation. We have MDs unionizing at Allina in MN, and I think that that collective voice can change the power imbalance. Big corporations suck. They don't care about providers or patients, but about profits. We all need to give each other some "space and grace" and realize that we are on the same side, and push back at every opportunity. Patients can confront big corporate medical with strong complaints about how the system has set us all up for assembly line visits. Screw Allina and every other big system that puts greed before people.
Thank you so much for this! My doctor is often very generous with her time when I see her, and yes, she is always running late. I will try to be aware of her time in future, knowing how very much likely her day resembles yours. And I definitely will make telehealth appointments instead of asking for things online through the portal. I am amazed that you all are not burned out.
I agree! As a Family Physician that sees mostly geriatric patients, I would be sunk if I had no control over my visit times. But even with the occasional 40 minute slot to see a complicated post-hospitalization patient, I can still run late. I apologize, but mostly I thank them for their patience. We are a long way away from fixing medicine.
All of this!! I have thought about writing something like this to explain to my patients, though I agree that most patients who have been in the system for a while get it, for better or worse! It's new or young patients who may be confused, not knowing everything else we are juggling. I was heartened by a patient Press Ganey comment that said "I answered the question about wait time indicating that I waited more than 15 minutes beyond my appointment time. Personally, the wait time is not a problem for me since I know I will have [the doctor]'s full attention when we are together in the exam room and, I assume, the reason I am waiting is that she does this for all of her patients." When my day is running extra behind, I try to remember this! (It does still annoy me a bit that this question exists because it implies that being seen within 15 minutes is the expectation, when if we are trying to do things that we know are good for health outcomes like fitting complex patients in to provide continuity of care, it generally does mean we'll end up running late.)
I am lucky to have 30 minute visits right now, instituted thanks to the pandemic but retained now since my clinic has been able to demonstrate sufficient RVUs to merit it, with a usual practice of some double booking and doing dual preventive + E&M visits where appropriate. The new coding scheme of being able to bill a 99215 for 40+ minutes spent on the day of service has helped, since a lot of my visits wouldn't have met high complexity criteria for medical decision making but require a ton of time in care coordination or counseling/motivational interviewing. However, if I was on a 20 minute template I probably wouldn't code many 99215s for time since spending that amount of time would mean I'd have no hope of being able to eat lunch. I like that it allows me more time to get to know my patients and talk about overall health goals, but it creates some access challenges which I haven't totally decided how to manage since my panel size is still better fit to the 20 minute standard. It means many of my patients go to urgent care/virtual care for the quick visits (UTI, URI, vaginal discharge, STI check) and only see me for higher complexity issues or for an "annual physical" where they update me on everything that has occurred the last year and a few other things they've been saving for me as their PCP, which can be a lot!
Yes yes yes to all this!!! 😅
What a perfect list! I try not to feel bad about being late anymore, since as you point out it’s clearly not our fault. I think my patients don’t usually mind because they know it evens out in the end since I will always go through their entire Notes app list of questions and answer their questions about siblings I am not seeing 😊 I love the issues you choose to write about and bring visibility to, keep up the great work!
Thank you! People are always so gracious -- it really restores faith in humanity when my patients extend empathy to me! 😍
Here are a few more reasons: getting the prior authorization approved, needing to send the client to the ER, needing to treat a low blood glucose, needing to interrupt a session to speak with another provider who called and if you don’t take the call … being pulled out of a room during a session because…supporting your client to grieve, checking when the next AA meeting is, calling to find transportation, waiting for the interpreter…helping a co-worker…going the bathroom, eating lunch…
Yep.... Going to the bathroom 😂
It is so easy to see providers as people without human needs, which is a seed of oppression. 😳🤔😣
As they say, "don't hate the player, hate the game." There's just no way to do everything we want/should do in primary care. Either we see fewer patients and the system collapses into concierge practices serving 10% of the population, or we keep doing the best we can, knowing that it actually takes 26.7 hours per 24 hour day to accomplish all that we primary care docs are expected to do! Great points, thank you.
https://link.springer.com/article/10.1007/s11606-022-07707-x
I don't see it as an all-or-nothing situation. We have MDs unionizing at Allina in MN, and I think that that collective voice can change the power imbalance. Big corporations suck. They don't care about providers or patients, but about profits. We all need to give each other some "space and grace" and realize that we are on the same side, and push back at every opportunity. Patients can confront big corporate medical with strong complaints about how the system has set us all up for assembly line visits. Screw Allina and every other big system that puts greed before people.
100%. Keep on fighting the good fight!
Excellent excuses! And from the patient's point of view, so helpful to understand what you're up against.
We are a team! All trying to do our best in the era of corporate medicine.
Thank you so much for this! My doctor is often very generous with her time when I see her, and yes, she is always running late. I will try to be aware of her time in future, knowing how very much likely her day resembles yours. And I definitely will make telehealth appointments instead of asking for things online through the portal. I am amazed that you all are not burned out.
❤️
I agree! As a Family Physician that sees mostly geriatric patients, I would be sunk if I had no control over my visit times. But even with the occasional 40 minute slot to see a complicated post-hospitalization patient, I can still run late. I apologize, but mostly I thank them for their patience. We are a long way away from fixing medicine.
Indeed. I like that framework -- thanking them.