I’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.

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