But seriously, the only issue with yichud is when I do a pelvic, and then I have a nurse in the room, as do all male physicians.

Sorry, I still don’t feel much pain. There are a lot of professions in which people spend hours before and after without any guarantee of being paid.

Most of the docs I know do not work for free and are not handling a lot of the administrative duties.

If people cannot pay they get shuffled out to county or some other low income clinic.

Don’t get me wrong, I think that docs deserve to be well compensated. But I have a hard time accepting some of the cries I hear from my doc friends. It is not as bad as they like to say.

Edgy Mama: Good luck with your dad. This interview came about largely through commiseration with Neil regarding care our parents received at various hospitals. I blogged extensively about my dad’s illness and death (http://psychotoddler.blogspot.com/2006/01/dads-status.html) but you may want to stay away from that right now.

Dana: Ok, that’s something else. You’re just not confident that they’re doing their jobs correctly or listening to what you have to say. As my wife likes to say, “Click ‘Next’”.

Gorillabuns: Drug Repping is one job I know I would be lousy at…

Jack: …and digging ditches is another. Trust me. You DON’T want me digging your ditches. I’m happy to stick my finger up your butt, but leave the ditch digging to the professionals. Did I ever mention that I shoveled dog crap for the summer prior to medical school?

Marilyn: NOT PRACTICING MEDICINE HERE but it is common to prescribe blood thinners like Lovenox (probably what you’re talking about) after hip surgery to decrease the chance of blood clots in the legs or lungs. Yes, they’re uncommon, but I see a few every year (I’ve got one in hospital right now) and trust me, it’s better to prevent them than get them. Aspirin is not that great at preventing them. Usually they use warfarin, which is a cheap pill, to prevent the clots. Some doctors will use the injectables until the blood test for the warfarin is therapeutic. BTW don’t underestimate the thoroughness of either the nurses or the PAs: they really are keeping it all together.

Pearl: Was that a shot? Are you taking a shot at me?

Kanani: I think a lot of people don’t really understand that a “copay” is not an extra little fee dinged on by the clinic or insurance company to keep nuisance patients away, but is actually part of the payment for the doctor visit. I have patients whose insurance requires a $25 copay. What that really means is that the insurance has cut its reimbursement to me by $25 and now expects me to collect that directly from the patient. So if my visit fee is $50, and I don’t collect the copay, I’m only getting paid half.

A consult comes into our office. She bitches when we ask for her $10.00 copay.

Now, prior to coming in, we’ve done the following:
-checked the referral and authorization
-booked the initial appt. by calling the patient
-took and input the information into our database
-called for various test and reports that might be needed for our consultation.

THE DAY OF
-checked in the patient. reviewed the records. ascertained it was all correct.
-took patient history. spoke to patient before doctor came in. wrote down history. input history into computer.
-examined patient. talked to and advised patient. answered any questions.
-ordered labs. wrote prescriptions.
AFTER PATIENT HAS LEFT:
-dictated or wrote patient history. gave diagnosis about current condition. made recommendations.
-sent copy of consultation to the referring doctor.
-copied all relevant documents and sent to biller.

If the patient needs surgery, we will spend extra time seeking an authorization from the insurer. Once we get it, we have to spend time scheduling it and then sending further instructions to the patient.

In all we’ve spent an easy 2 hours on each patient….. and that’s without scheduling surgery yet! Add another 2 hours just for that! If they decide to cancel, we have to do it all over again.

Factor into this that the patient has seen or talked to at least 3 different office personnel. They’ve spoken to the doctor, who has at at least 12 years of education.

Our pay? Because it’s an HMO, we’ll get anywhere from $25 (Medi-CAL)to $70 for an office visit. That’s it.

Break it down hour by hour, and it comes close to making less than a clerk at Costco.

This is why medical school enrollments are down. Quite frankly, in the future you’ll have a better chance of finding a veterinarian than you will a specialist in many areas of the US.

But then this could be convenient. Just take your dog in and ask the doc to have a look at what’s ailing you too.

Great interview questions, Neil. I like this “Get To Know Your Readers” format; hope you do it again.

When my Mother-In-Law came home from her latest hip surgery they proscribed a really expensive anticoagulant that Hubby would have to inject into her every day. As she was leaving a nurse made an offhand comment along the lines of, “I wonder why they did that”. Hubby called to talk to the doctor who had proscribed it and got a PA who was very rude and said, “well, she was JUST a nurse”. Hubby said, “I asked to talk to her doctor and you are just a PA”. When he got the doctor on the phone and it came out that she hadn’t taken any anticoagulants in the hospital, he said, “well, just have her take an asprin every day”.