Balls and Walnuts
more than you ever wanted to know
Slammed
Didn’t I take a vow, or an oath, or a New Year’s Resolution, to whine less?
No. I promised to whine more. Okay, we’re good.
In the office today, I saw thirty patients. Thirty. In the old days at County, back when I was paid little more than minimum wage, I doubt I saw this many. The other residents and I used to tell each other, “When we’re in private practice, no way are we going to do anything so ludicrous. If we allow ourselves to be this rushed, we’ll never practice quality medicine. We’ll make mistakes. We’ll burn out.”
But as I got older I got faster. I got better at the job. I don’t think I’m short-changing my patients with a schedule like this, but neither am I shmoozing them the way I would like to, nor do I have time to check the news during the day, nor can I keep abreast of my chart basket. I push more of the phone calls (to share results) onto my office staff, I get grumpy, I forget to feed the frogs.
As young docs looking forward, we saw this as a simple calculation. We would see the greatest number of patients possible while providing the high quality care we were trained to value. None of us were so greedy as to want to see more than that number. Even the docs-in-training whom I held in low esteem wouldn’t have cranked through the patients just to make more money. I’d like to think we were better than that, even the worst of us; at the very least, fear of malpractice would make a doctor shun such behavior.
I failed to anticipate the needs of my patient population, though. I’m the only ENT in town; the nearest other ENT is about 70 miles away (90+ minute drive, partly on curvy mountain roads). I’m sure he’s slammed, too, as are the ENTs in Grants Pass, Medford, and Coos Bay, who are even farther away.
I can pack ’em in like this and I’ll still have patients waiting to see me. Some of them really do need to see me yesterday or a week ago, but without seeing the patients, it’s nearly impossible to separate the true “urgencies” from the false alarms. (“Urgencies,” not emergencies. In my business, the emergencies are usually gushing blood from their noses or pus from their ears or slowly choking to death before my eyes. Pretty obvious, in other words. Yes, the emergencies do get priority over the “urgencies.”) So I have to fill the day’s schedule as best I can, and I can only see so many.
Why not bring on a partner? Because I know the numbers. This community needs 1.5 ENTs, not 2.0. Since I’m not ready yet to work part time, I would have to find someone else who is. Or we would have to cross our fingers and hope the numbers are wrong and the market could bear two of us.
So it comes down to a simple calculation, albeit a different calculation than the one I had in mind back in residency. I can see fewer patients, but then people who really need to see me will have to wait longer for their appointments. Or I can see more patients, cut out the shmooze, get the job done, take care of people, fix their problems, and they’ll still have to wait longer than I would like them to wait, but not quite as long.
There’s a doc shortage, have you heard? I think this is only going to get worse.
D.
I knew there was a nursing shortage, I didn’t realize it extended to doctors as well.
Do you think it has anything to do with the cost of getting a medical degree?
Is the cost of insurance a deterrent as well?
When a friend of mine finished up her med-peds residency, the offers she got to join practices (or help to establish her own) in rural locations were *insane*. And when she interviewed, she saw why: the doctor:patient ratio was double what she was used to, working in urban hospitals.
I suspect a number of factors, Sam. The cost of getting the education, the shrinking income (making it more difficult to pay off that education), the increased bureaucracy of the business — meddling from the government but especially from the insurance companies and HMOs. I’m not sure what it’s like in big cities; for a long time, for example, San Diego was doing just fine. Everyone wants to live in San Diego, apparently, even doctors. But in the rural areas? I could triple my income by moving to the Deep South. Here, where I live, which is a particularly beautiful area with no HMOs, repeat NO HMOs, YOU YOUNG DOCS, SO GET THE HELL OUT HERE, we’re still having a devil of a time attracting and retaining physicians. Primary care is especially problematic.
Yup, jmc, it’s Instant Practice. It’s like when I came out here in ’98. Forget the conventional wisdom about “building a practice,” I had one waiting for me.
Hey Walnut…just a thought , and a small one at that, if you only need .5 besides yourself , how abour a P.A. or as they call them in my state Nurse Practitioners? I have seen the help they can be in a rural and an urban setting.
Peace, TR
Oh, believe me, I think about it. I haven’t found a PA or FNP with ENT training (not one I liked), and the one time I THOUGHT I had one I liked well enough to train, another local doc stole her away from me. I was a bit burned by that. But you are right — if I could find the right person, he or she would solve a lot of my problems.