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Why are doctors in such a hurry?

Feeling rushed when going to the doctor is a common occurrence these days. A big part of the problem is how doctors are reimbursed by insurance companies.

How often do you feel rushed out of your doctor’s office? How often do you feel like you waited forever just to see your doctor for 5 minutes? How often have you felt like your doctor doesn’t even listen to you? If you’re like most people, this seems pretty typical of going to the doctor these days.  “The physician’s interview of the patient has been called ‘the most powerful, sensitive, and versatile instrument available to the physician,’ yet recent research found doctors listen to patients for just 11 seconds on average before interrupting.” It’s frustrating, disheartening, and sometimes feels just plain rude. It turns out it could also be a detriment to your health. 

A study published in the JAMA Health forum found that shorter doctor visits led to inappropriate prescribing of medications. The less time a patient spent with their doctor, the more likely the doctor would prescribe unnecessary antibiotics for upper respiratory infections or co-prescribe benzodiazepines and opioids, a combination that could lead to life-threatening overdose. 

These short visits also contribute to physicians not fully understanding patient complaints, which can lead to non-compliance of treatment plans, more emergency room visits, and a sharp decline in patient satisfaction. 

Why is this happening? 

In short, doctors are attempting to make up for stagnant or diminishing reimbursements from insurance companies. For traditional Primary Care Physicians, time really is money. Most PCPs are paid per visit, so the more patients they see in a day, the more money they get from the insurance companies. 

 “Doctors are thinking, ‘I have to meet my bottom line, pay my overhead, pay my staff and keep my doors open. So it’s a hamster wheel, and they’re seeing more and more patients … And what ends up happening is the 15-minute visit,” said Dr. Reid B. Blackwelder, president of the American Academy of Family Physicians. 

Experts point to Medicare’s 1992 adoption of a payment model that depends on “Relative Value Units” (or RVUs) to calculate doctors’ fees. These RVUs only take into account the effort the physician may need to put in and the cost of running a practice, and not how much time the physician is actually spending with their patients. Soon after Medicare started relying on RVUs, private insurance companies followed suit. Thus, further compounding the issue that doctors needed to see more patients in a day to avoid decreasing income, and patients paid the price. 

What can be done? 

Well, a complete overhaul of the American healthcare system is a bit of a stretch, but there are other options. This is where Direct Primary Care physicians come in. DPCs don’t rely on insurance company reimbursements. Instead, they use a monthly fee system, kind of like a Netflix subscription for healthcare. Most DPCs have a smaller panel of patients because they don’t have to rely on quantity over quality, so that means they are able to spend more time with their patients to get to know them, truly listen to their concerns, and create a treatment plan that works. In addition, patients don’t have to wait weeks or even months to see their DPC physician. More often than not, patients are able to book same day or next day appointments, as well as call, text, or email their physician directly. Many can even prescribe medications directly to the patient at wholesale prices. 

Conclusion 

Insurance companies have forced doctors into spending less and less time with their patients. Direct primary care offers an alternative where one can spend more meaningful time with their physician, while also saving money in the process. If you are looking to enjoy a better relationship with your physician, and possibly save some money in the long run, then direct primary care may be a great option for you. Regardless of which route you choose to go down when exploring medical care options, understanding what is available and suggesting methods of improvement can only have positive outcomes for our society’s overall healthcare system. 

Sources 

Fulton, R. (2023, March 17). Less time with patients, more inappropriate prescribing. Medscape. Retrieved March 21, 2023, from https://www.medscape.com/viewarticle/989818?src=FYE  

Hannah T. Neprash, P. D. (2023, March 10). Association of Primary Care visit length with potentially inappropriate prescribing. JAMA Health Forum. Retrieved March 21, 2023, from https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802144  

Millenson, M. (2019, November 20). Why your doctor appointment is so short. Medium. Retrieved March 21, 2023, from https://elemental.medium.com/why-your-doctor-appointment-is-so-short-ec2b8d4d61ea  

Rabin, R. C. (2014, April 21). 15-minute visits take a toll on the doctor-patient relationship. Kaiser Health News. Retrieved March 21, 2023, from https://khn.org/news/15-minute-doctor-visits/  

Linzer, M., Bitton, A., Tu, S.-P., Plews-Ogan, M., Horowitz, K. R., Schwartz, M. D., Association of Chiefs and Leaders in General Internal Medicine (ACLGIM) Writing Group*, Poplau, S., Paranjape, A., Landry, M., Babbott, S., Collins, T., Caudill, T. S., Prasad, A., Adolphe, A., Kern, D. E., Aung, K. K., Bensching, K., & Fairfield, K. (2015, November 22). The end of the 15-20 minute primary care visit. Journal of general internal medicine. Retrieved March 21, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617939/  

DPC Nation. (n.d.). What is direct primary care? DPC Nation. Retrieved March 21, 2023, from https://dpcnation.org/ 

Erin McGreal RN, BSN

Upper Echelon Medical in Fullerton, Orange County, East LA, and Inland Empire, California, provides comprehensive primary care services to patients of all ages living and working in the local community.
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