Why You Don’t Get The Medical Care You Feel You Deserve – Part I

Health_Healthcare2.jpgI’m am more than occasionally approached by a friend or associate with complaints about how their doctor does not give the medical care they feel they deserve. The most common complaints are that the doctor does not spend enough time with the patient during office visits, does not address all of the patient’s medical problems, and does not have enough availability for semi-urgent appointments.

Since I’m a physician, I’m here to let you as the patient understand the forces at work that create this dynamic. I’m not saying it is right or wrong, but the better you understand the pressures your physician faces on a daily basis, perhaps you won’t take it personally next time this happens. Perhaps you’ll look for another physician who meets your needs. Or even better, you will find ways to get your physician’s radar as a “VIP” type of patient.

First of all, you need to understand that economics of medicine have changed. Your physician is running a business — the business of helping patients. Unfortunately, the reimbursement for standard office visits barely covers the doctors overhead including office space and staff. Your doctor likely gets paid only a small amount for the office visit, regardless of whether it takes 15 minutes or three hours, or whether you have a simple ear infection or a complicated systemic problem.

Given these constraints, most doctors either have to see more patients during the day or alter their practice towards things that make them more money so they can pay their bills. If you have the preconceived notion that physicians are all rich and white-collar folks, you are incorrect. Most graduates of medical schools have 100k to 250k in school debt from medical school. If they also have debt from college, then you can probably add another 100k in debt.

Thus physicians, particularly the younger ones have some serious cash flow problems and need to get back above water. If they are surgeons, they need to do surgery to make money. If they are not surgeons, then they need to either see more patients or need to do some kinds of office procedures to boost their income. If you didn’t know already, the reimbursement system i set up to reward procedures more than rewarding “thinking.” The more you “do” the more you get paid.

Thus, if you have a medical issue and your physician uses his physical exam and clinical experience to diagnose the problem and solve it, you’ll get better and you’ll feel great. But he won’t get paid that much for his “brains.” He’ll actually get paid more if he does something like inject your joint or unplug your ear that is full of wax.

If you haven’t figured it out, this puts the physician in the role of a businessperson. And consequently some patients are more profitable than others. I’m not saying that it matters much to the physician whether you are a profitable patient or not. If the doctor is in private practice, he is aware of it. If he works in an HMO organization and is salaried, then he probably doesn’t care, but some manager up above him does care.

Thus, if you want to get to your doctor, try and figure out how he is trying to shape his practice. Is he the procedural type of doctor? Does he focus more on certain types of patients? The sooner you figure this out, the sooner you can decide whether you want to stay or go.

  • Susan M.

    I think you are right. It is economics. This is good common sense.

  • Pingback: How You Can Get Better Medical Care - Part II | GNIF Brain Blogger()

  • Dr. Steven Seagal, Ph.D. in Neckchopping

    I don’t believe sick people should have to shop for a doctor as you suggest. Seriously, what is this country coming to? There are some things capitalism just should not have control over.

    I mean get real… am I supposed to feel bad for going to see the doctor because I only have a 30 minute appointment and he doesn’t make as much of a profit on me as someone that walks in missing limbs? Seems pretty ridiculous to me. And really who gets on these “VIP” lists you mention… families and friends of yourself or coworkers typically (i.e. other rich families). That whole statement is ridiculous… even if you did get on the coveted VIP list there are is still the 97% of the doctor’s other patients who get the snub. Why don’t you apply this to every other service you get? What if you had to be the VIP customer at every business and service you ever went to? You should just go there expecting to get sub-par service? I think this is especially heinous considering your health is the last thing you’d want to fuck with (I wouldn’t mind as much if the guy who drains my septic system doesn’t have me on his VIP list).

    I don’t really blame the doctors. I do, however, blame the insurance companies! Still, your statement about debt seems pretty inaccurate to me. You’d have to be going to a hell of a school and getting basically no financial aid whatsoever and taking out nothing but loans to rack up as much debt as you have there. And these loans are generally pretty lax in payback terms (e.g. subsidized loans with extremely low interest that let you wait to pay back until after you start your career).

    Just to let you know, I’m a senior in college and I cannot afford health insurance. I just got back from an optometrist appointment (just a check up) and it cost me nearly $100, and when I tried to order contacts online at a cheap outlet with the prescription I got the eye doctor denied me and made me pay double the price through him. Also, my wife has had severe stomach problems for quite some time… the last time we went to the hospital for a check up, we waited for 1 hour to see the doctor. He showed up for less than 10 minutes, seemed totally confused as to her symptoms and completely forgot about half of her issues. We got billed just under $100 for his time, which ended up being nothing but a recommendation to exercise more. I would have liked to drop the guy right there on the spot.

    Anyway I’m pretty tired and this is mostly rambling nonsense due to that fact, but your article struck a nerve with me. I know you’re just spelling things out as the way they are, but I have to tell you that I really don’t think that this is the way things should be (it’s totally unjustified) and that it needs to change. With all the power (i.e. money) that the insurance conglomerates have now, this will probably not happen in a short amount of time.

  • buga.daniel

    Yeah, well in my country if you don’t give them some ‘attention’ – as in money or gifts, they won’t even look at you!


Dr. JC is a medical doctor who has a passion for health promotion and education.

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