Lack of Customer Service in the USA

[gemini5362]

I do not claim to be wise or even great at customer service, but on this point I will take some credit. I do not overbook or double book. But before I toot my own horn let me tell you why many if not most doctors do it.

It is a combination of money and genuine concern for patients. The money part is easy to understand. The more patients you see, the more money you make. Period. And the way the industry is configured, margins are narrow. Narrow margins drive volume. But, many times a doctor will have a full schedule but people still want to see that doctor that day. Many of my partners feel that getting them in that day is good customer service, and it is. It makes that patient happy. So that doctor makes someone happy and increases their income. So they do it a lot. And especially if that doctor is slow, well, it puts them behind and people have to wait. And it amazes me that so many people just take it for granted that they will have to wait two hours for a 10 minute appointment and it doesn't seem to bother them.

I'm like you. My time is valuable. I don't want to wait that long. And to a certain extent I think it is arrogant for doctors to assume that their time is more valuable than yours.

Now, I'm very different from most doctors in this respect. I am driven (my partners thing I'm a little nutty about it) to see my patients on time. If I tell someone to come in at a certain time, I feel obligated to do my best to see them then. And, to be honest, it suits my personality too, so I like it that way. My patients rarely wait more than 20-30 minutes and then it is usually due to an emergency or some type of patient complication. And when that happens, I apologize to the patient and they usually understand. There isn't much I can do about that sort of thing. With this system I'm happy because I like running on time and my patients are happy because I don't tie them up for hours.

But as you can see, there is a trade off. To stay on time, I can't really double book. That makes me less accessible. So let's say you have a sinus infection and want to see me this afternoon. I have no appointments left so I say no, I can see you tomorrow morning. You might not like that and might even consider it bad customer service. And, I make less money. And despite averaging more than 28 patients a day, I'm the lowest earner in the office. (But don't misunderstand, its still a good income and I am not complaining, its how I want it.)

So what happens is that patients who like me and value being seen on time gravitate toward me even though they know I might not drop everything to see them on the spot. Patients who like another doctor and value being seen at any time (and often having to wait long periods) gravitate toward other doctors. And this works out pretty well.

So, its a tradeoff. Neither way is totally right or totally wrong, but at least we offer both ways. We also rotate as walk in doctor. So one of us is always there with a totally open schedule for anyone who wants or needs urgent care that day. You might not get to see your doctor, but you'll get seen that day. Now, that is a first come first serve sort of thing and if lots of people are showing up for urgent care, well, they may have to wait. We explain that right up front and I really don't apologize for that.

Every office is different and there are many other factors such as how fast/efficient a doctor is or how many regular appointments they schedule per hour. Some patients really like a doctor who will spend a ton of time with them even for small problems. That sort of doctor will always run behind. Other patients want a doctor who gets stuff done and gets them out the door. It is often a balancing act between the two extremes in order to make everyone happy. And some doctors are just slow.

Interesting post. Too many years ago for me to like to think about We had a gp with your attitude. I can not remember ever waiting for more than 30 minutes to see him or for one of my kids to see him. He was a phenomonal doctor and I was very disapointed when my company transferred me out of that city. My doctor I have now does not get me in that quickly but she does get me in within a couple of hours. There have been times when I have been sick and needed to see a doctor where I have been told they are extremely full and that i need to go to a walk in clinic. That approach seems to work fairly well. I dont get to see my doctor but the patients with appointments do not have to wait for her to see someone without an appointment.



Let me do some math. You see 30 patients a day. My doctor charges 100 dollars a visit. Assuming you are charging similar fees and even if you lose a huge chunk to overhead that is still a long ways from 28 cents an hour. .

 

[N80]

Let me do some math. You see 30 patients a day. My doctor charges 100 dollars a visit. Assuming you are charging similar fees and even if you lose a huge chunk to overhead that is still a long ways from 28 cents an hour. .

I'm not sure what you're trying to say, but remember (as I mentioned above), we don't see anything near that $100. That $100 is a fluff number. I'm not complaining, we currently get paid just fine, but you can't use that $100 to do the math cause it aint real.

And you are right, the overhead is huge. We run a tight ship (amomg the lowest overhead in the system) and I think it is still way over 50%, mostly to pay for all the employees to manage billing, referrals, posting, etc etc. Positions that exist to manage the terrible insurance system we all deal with (I'm a patient too, so I know how bad it is on that end as well.) Those positions provide no benefit to patient care. None.

 

[dmccarty]

Talking about overhead. A few years ago I heard a report about the premiums some Doctor's had to pay. I think this was around Washington DC and it was for practices that can get sued frequently. OB/GYN if I remember correctly. Though it might have been brain/spine related. I had to guess at how many patients a doctor would see per day and per month but when one did the math each patient's bill had a pretty large charge just to cover the premiums.

This was years ago so I can't remember the details anymore but each patient was paying for the overhead.

Later,
Dan

 

[jdbower]

OB/GYN is one of the worst from a liability perspective. I saw a few years ago that the average income for an OB/GYN was close to $500k a year, that sounds like a lot until you saw the next line. Average cost of malpractice insurance was around $400k a year. Then tack on cost of employees, cost of the facility, probably high 6 figures of equipment and you get even lower. Makes all that med school and having to be on call 24x7 worthwhile, doesn't it?

 

[N80]

Malpractice insurance is a big expense for all doctors, but much worse for some. And much worse in some places, particularly where there isn't much tort regulation.

However, the hospital system I work for carries its own liability insurance and has its own legal department. So even though the actual cost will make your eyes bug out, mine is extremely low by national standards so that is one area in which I am very fortunate. It just comes at the price of being an employee and being just another cog in a very typical corporate machine and all the bull manure that comes with it. But that's life, no one gets to have their cake and eat it to.

I personally don't know how any doctors start their own, small, privately owned practices anymore. But I have great admiration for those who do, because in a perfect world I think that is the best way to do medicine and business. As things are, I don't have the patience or intestinal fortitude to do it.

 

[Bedlam]

I have had my long time doctor have to affiliate with the local hospital. Service went down hill fast. Almost everything has to go through the hospital. Even with computers., the hospital cant seem to 'talk' to the docs office. Ill have a test done and wait about 2 or 3 weeks, and go for follow up and he walks in and says hmm we haven't gotten the results. I'm like OK. so hows the golfing going. Seriously why would they waist his and my time?There is something wrong with that, and when he starts to complain to me how he is treated and how they don't communicate. All the hospital cares about is the bottom line. Which is contrary to their ads. LOL

 

[gemini5362]

I'm not sure what you're trying to say, but remember (as I mentioned above), we don't see anything near that $100. That $100 is a fluff number. I'm not complaining, we currently get paid just fine, but you can't use that $100 to do the math cause it aint real.

And you are right, the overhead is huge. We run a tight ship (amomg the lowest overhead in the system) and I think it is still way over 50%, mostly to pay for all the employees to manage billing, referrals, posting, etc etc. Positions that exist to manage the terrible insurance system we all deal with (I'm a patient too, so I know how bad it is on that end as well.) Those positions provide no benefit to patient care. None.

I am not going to try and defend the insurance corporations. I have had my share of problems with them just trying to collect claims. Most companies have overhead with people that are doing billing. I agree that insurance companies format makes it difficult to deal with a lot of the times but basically they are still a part of the billing department.

I am not sure what you are talking about when you call that 100.00 a fluff number. I get a statement from Blue Cross/ Blue shield telling me how much my doctor has billed them. How much they discount. How much my copay is and how much they paid them. When You add my copay to the amount they pay them it is right at 100.00 a visit. I am not sure what is fluff about that. It was mentioned here about the cost of equipment. I believe that any tests that are run which require special equipment is a seperate charge for that equipment. If my doctor takes x rays I get charged seperately for those x rays. If there is blood tests run those are a seperate billing. Once again I am not knocking what doctors make they have a lot of responsibilities and takes an awesome amount of trainging to get where they are. I have however never seen a doctor that has been practicing for a few years living in a shack. When you state that you are making more than 28 cents an hour that is I am sure a true statement but perhaps misleading. Are you a GP or a Specialist ?

 

[N80]

I agree that insurance companies format makes it difficult to deal with a lot of the times but basically they are still a part of the billing department.

I don't think you are paying attention. Billing is not the only issue with insurance companies. We have to have full time staff positions to make referrals to other physicians and we have staff that spend most of their time fighting with insurance companies to pay for your medication.

But what you really seem to be misunderstanding is that this hurts the patient. Not me. In other words, if I didn't require all this staff to get what should be very simple and transparent tasks done, I could charge you a lot less and still make the same amount of money. So make no mistake, just like overhead in any other business, it mostly hurts the customer. So when you hear me complain about that, its for the customer's sake not mine.

I am not sure what you are talking about when you call that 100.00 a fluff number.

I've explained it the best way I know how.

I get a statement from Blue Cross/ Blue shield telling me how much my doctor has billed them. How much they discount. How much my copay is and how much they paid them. When You add my copay to the amount they pay them it is right at 100.00 a visit.

I'm not going to try to decipher your medical bill since I can hardly figure out my own. And I have no idea how your doctor works with your version of BC/BS, but if you could get the right person on the phone at BC/BS, you're likely to find that that $100 is not what the doctor gets. But if it is, fine. That's one example. My office takes over 20 different forms of insurance. They're all different.

But again, I think you're missing the point. I did not share any of this to bemoan my situation. I shared it to explain why costs are so high for YOU and even worse for people without insurance. This system is not hurting me. And despite that I'm still willing to point out why I think it is a bad system. You do what you want with the info.

If my doctor takes x rays I get charged seperately for those x rays. If there is blood tests run those are a seperate billing.

So what's you point. Doesn't a mechanic charge for each thing that he does? And if it requires expensive equipment doesn't he have to pay for it? Why should it be different with your doctor? And once again, you're likely unaware of how that works. We make very little off of x-ray and lab. Even with our contracting clout, office lab and x-ray get severely lowballed by the insurers. Sometimes just breaking even. But we have it anyway because it makes life easier on both us and our patients.

I have however never seen a doctor that has been practicing for a few years living in a shack.

I'm not sure what your point is. Would you expect to see a doctor living in a shack? Why? Besides, you should have seen what i lived in in medical school and residency. And for the record, a resident is a doctor. By the time you see what a doctor who has been in practice a few years, he had been in training, as a doctor, for 3-7 years not including med school.

When you state that you are making more than 28 cents an hour that is I am sure a true statement but perhaps misleading.

I don't recall ever saying anything about 28 cents an hour. Maybe I've forgotten but I don't know what you are talking about.

Are you a GP or a Specialist ?

You might call me a GP, but I'm a residency trained Family Medicine 'specialist' and I'm board certified.

But, if you don't like what doctors make, vote for Obama and Hilary. We'll be making the same as the postmaster and dog catcher.......and you'd probably get better care from the dog catcher when that happens.

 

[gemini5362]

let me briefly reply to your last post and I am not trying to say disparaging things about you or your profession.

If you say that blue cross does not pay the amount they send to me in the paperwork that I recieve, I am not sure why they would tell me that they do that. I just know that I recieve pretty simple paperwork it tells me how much the doctor bills how much they pay for that how much they are going to pay the doctor and how much I have to pay the doctor. If those numbers are fraudulent that would be interesting to know.


I think you have a perfect right to charge for xrays and specialty equipment. I was replying to a post where they talked about the high cost of equipment in a doctors office. Yes that is a high cost but it is payed for directly by patient billing. I am assuming of course that the charges for xrays, blood testsing equipment etcetera are applied to retiring the debt against those items. By combining in a clinic you have the equipment spending less time idle and I would hope you are able to retire that debt more quickly.


I understand why doctors make the money they do and I have said in earlier posts that the educational costs, the time, the responsibilites etc are extremely difficult and you should be paid appropriately.

Since I am a part time real estate agent I have seen some of the homes that doctors in this area live in that they are selling because they are moving to another home and they are quite a distance from being shacks. I realize that doctors that have finished residency and are starting a practice might be tight for money it does not take a long time to get ahead.

I believe what started this line of the post was my comment about letting people have access to more classes of medications at the pharmacy without seeing a pharmacist first. We obviously have a different opinion about that. I still think it would be beneficial to have our country have laws that allowed antibiotics and other non addictive drugs available from a pharmacy without a prescription. It is done in other countries. I feel like it would go a long ways towards helping with the cost of medicine in the United States. I know that you dont think that way. I dont think anyone should be able to sell their home without having to go through a realtor. I am sure most attorneys feel that people should not be able to do any legal activity without an attorney( before anyone mentions practicing law without a license. You can defend yourself if you are on trial for first degree murder, You can write your own contracts etc. ) Mechanics feel that no one should be able to buy car parts etc.

 

[jdbower]

While some equipment like X-Ray machines could be paid for through procedure charges, I doubt you've been charged directly for use of the exam table or the sterilization equipment. Plus some equipment can't reasonably be paid for by the people who use it - if there are too few people in need of dialysis in a region the hospital may not be able to charge enough for the procedure (at least in good conscience) and has to amortize the cost over the other patients somehow (whether it's a direct billing increase, increased taxes, or reducing the doctor's salary so you don't attract the cream of the crop anymore).

But the point is that looking at what the insurance company pays and trying to deduce what a doctor makes is irrelevant, it's like going to the grocery store to get the price of corn and then counting the ears in a farmer's field to figure out how much he makes, ignoring the cost of the seed, fertilizer, tractors, etc. In your case at $100 a pop the ear of corn you've sampled is from an upscale organic market, typically doctors get paid from the cardboard bin at the end of the Walmart aisle.

I dont think anyone should be able to sell their home without having to go through a realtor.

Actually George stated that it's his belief (and one that I share) that improper use of medications like this will INCREASE his business and may be one of the reasons why a lot of socialized health care countries have so many issues - if something's free and easy to obtain it's not treated with the respect it deserves.

Ironically, as you've phrased this (and I'm willing to assuming it's a phrasing issue) is the root cause of the lack of customer service in the USA (not to derail the conversation back to the original track ). It shouldn't be that a service should want people to be forced to use them, a service needs to carve out a niche that makes the extra money required worthwhile. I've dealt with realtors who were awful, I had to bring a list of properties from realtor.com myself because they wouldn't listen to what I wanted (or were too incompetent to figure out the search) and all they did was drive me around because only they could open the locks - that wasn't worth the 3% commission they get (even worse was when I used Foxton's to buy where the Foxtons realtor was absolutely fantastic and the seller's did nothing, Foxton's only got 1% and the seller got 5%). On the other hand I've also had realtors who were able to tell what we did and didn't like about a house and were able to guide us into a more appropriate purchase - without regard to the size of their commission. Because they went out of their way with the customer service they deserve their commission. It's the entitled attitude of some people that breeds contempt and the associated lack of service when they don't get what they think they deserve. As I mentioned this isn't directed towards you directly, just towards the out of context statement that probably doesn't represent what you really mean.