re: Doctors, specifically pediatricians, who can’t keep appointment times

The trifecta of:
1) docs taking vacation time the next two weeks, stressing the schedule of the working partners
2) lots of patients trying to get shite done the next two weeks because they’ve already met their deductible for the year
3) people with a cold/flu this time of year

I've never waited more than 5-10 minutes at my pediatrician's office.

Maybe look for other options?

If running more than 15 minutes late, offer to reschedule. I don't mind that as much as being made to wait. frick people who have no respect for my time.

Wait until you get older and have to see specialist. I always expect my cardiologist to change the appointment I make to a later date. Why? Because it happens ever time. I'm not having any problems, but still go in for an exam yearly. Since I am having no problems, the exam is just a quick listen to my heart and me talking with him for 10-15 minutes. I go in for a 1:45 appointment and leave at 4:30.

I don't care how long it takes because he's the best in NELA, and I know he'd break an exam with another healthy person, to see me if I had a problem. It's happened before with family members.

I live in Ruston, but I have a different cardiologist in Lafayette that takes care of my left leg, that has nerve, and vascular damage. He is reputed to be the top leg man in the country. He is only sees patients one day a month, so I go on that day if I have problems. He always sees me first thing in the morning, so there's time that day to set up any testing that might be needed. If he's there on a Tuesday, I drive down on Monday and spend the night.

If you are fortunate enough to find, great doctors, seeing them is worth whatever wait you have.

Because 18 pts per day on a 9 hr work day barely covers the overhead of a medical office when all the patients have good insurance. If you prefer to take care of elderly and children then you are seeing medicare and medicaid patients in most locations which pay even less.

Sadly medicine has become a volume business due to the ever decreasing compensation for care, increasing state and federal regulations, and increasing overhead.

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How much commission you get a pop?

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Not exactly how it works. But based on the way the game is currently played, he gets to collect usually (estimated) around $0.60 of what he billed which he gets to then split up among overhead and salary. So yes, the more patients seen more or less equates to more money. But it also turns into patients being happy for not being turned away.

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How much commission you get a pop? I bet you make a killin squeezing in all those extra's.

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Most primary care physicians myself included do not make a commission off of patients seen. We get get compensated for services rendered.

Many physicians are moving toward employed positions instead of independent practice. Most of those docs are on salary, contracted to see a minimum number of patients, and rewarded with a percentage of production above a different set number of patients.


My partners and I practice within a physician-owned and physician managed group. In our arrangement we share some overhead but essentially practice independently. The days and hours I work and the number of patients I see is entirely up to me and the patients' choice. We are on what you might call an eat what you kill dinner plan.

As stated warlier in this thread the vast majority of office visits are billed based on 2 categories and 5 different evaluation and managment complexity levels. The bulk of a PCPs visits will be 99213 and 99214 visits.

Across all insurances over the last calender year my average reimbursment for a 99213 is $58 and for a 99214 is $94. For medicaid patients those reimbursements drop to $37 and $52.86 dollars respectively.

Nation wide most primary care offices have overhead that runs 55 to 65% of reimbursments. We manage well and have overhead that is right under 55%.

At medicaid rates that equates to $17 and $23 respectively after overhead.

90% of my same day sick walk in patients are medicaid children. About half of the visits are 99213 ($17) and the other half 99214 ($23). Thus on average about $20 per walk in is what I make.


So...
Mon 25 to 43= 17 add ons $340
Tues 22 to 38= 16 add ons $320
Wed 26 to 40=14 add ons $280


All for the low price of working through lunch, not getting to sit down at my desk, some pts being upset about taking too long, and needing to sign off on labs at home that I didn't have time to do in the office. And of course the up to 21 yrs liability on each kiddo.

But I am caring for my community, my neighbors, patients the best way I know how. Helping parents get back to work and kids back to school quicker, reducing the further spread of disease, lowering patient and healthcare system cost by being an alternative to the ER, and reducing pain and suffering as quickly as possible.

Why does Medicare reimburse so low?? Just curious -- some of those people take longer due to more complicated cases and a variety of issues.