When many people think about the U.S. health care system, they think of hospitals, doctors and nurses.  They may remember when their children were born or the time they spent visiting their grandparents while they were in the hospital.  Professionals in these hospitals care for patients or clients with the goal of making them better.  And while Marcus Welby or Dr, Gregory House may be your image of health care, there is another side we should talk about. 

Health care is a business.  And as a business, one of the primary goals is to make money. 

Now, I know, this is not news.  But we must not lose sight of the conflict between the need to care or cure and the need to make a profit.  It is very real and drives much of the chaos that we experience.

Physicians basically have two things to sell.  Expertise and time.  They are highly educated people who have knowledge and experience that they share with the public for a price.  It’s what they do.  But unlike other businesses, their ability to maximize their earning potential is limited by the number of hours in a day, unless they hire physician extenders like nurse practitioners or physician assistants.  And since they are people, they do other things that people do, like sleep.  So they cannot bill for unlimited hours or minutes because they are human.

Enter the insurance industry.  Physicians or their partners, sign contracts with insurers for members or clients as they say in the industry.  They are paid based on services they provide and based on the number of members they are contracted to care for.  With some managed care contracts, the physician is paid a monthly fee regardless of whether the patient comes in or not. 

Visits to the doctor are measured in minutes, not hours.  The more patients he or she can see, the more money they can potentially make.  It’s that simple.  And they cannot just raise their rates when they feel the need, because most of them have contracts that bind them to a fee structure.  Is it just me or is it getting uncomfortable in here? 

This brings me to my point.  Time is money.  Patients are not widgets. Unlike an assembly line, the doctor cannot turn up the machinery and process more of them. Patients are needy creatures who want the doctor’s time and attention.  What the patient doesn’t understand is that since time is money, they have about 10 minutes to state the problem, get a diagnosis and usually a prescription, and vamoose.

What if you have a lot of problems and it’s going to take longer than 10 minutes? 

Tell the receptionist when you make the appointment that you need an extended time.  You’ll pay for it most likely, but the doctor won’t be double booked while you talk about all of the other issues you brought with you.  If you don’t, you’ll be into the most interesting part of the story, the doctor will edge out the door and you’ll leave feeling like a jilted bride (or groom) at the alter.

This is one of the reasons we should all bring a list of questions to ask, a bag with our medications in it and someone who has a clear head.  This is going to go fast and we’ve got to be prepared!  And of course, we want to be polite and not be late, because after all….. oh, well, you know.

Next time we’ll talk more about time as it relates to tips on working with the office staff.