quote:

Originally posted by sigmonkey:
"So, I see from your resume, that you flew a fixed wing without depending on airflow and lived. Your perfect for the position. Start after lunch?"

quote:

Originally posted by PASig:
Say the place can reasonably handle 40 visits in one day but they are packing in 100 per day.

Overbookings can and do happen. It's part of the business. Let's say the practice has a 10% no-show rate (not uncommon at all). Using your numbers, the place can handle 40 appointments per day, but odds are that 4 of those patients won't show up, so the place only sees 36 patients.

Let's say for each patient seen the practice gets $50. For those 4 who don't show, the practice doesn't earn $200 that day. For the week that's $1000. Over a year.....it's a lot of lost revenue.

So what is a business supossed to do with anticipated excess capacity? Not use it? Is that good business? So, in anticipation of 10% of tyhe patients not showing up, they book 4-5 additional patients. That will usually give them full capacity....the problems start when they all show up.


Everyone thinks because they have an appointment they should be seen at that time. I do too when I go to the doctor. Unfortunately it doens't always work that way for some (and many more) of the reasons I mentioned.

Let take a tire changing business. You'd think they'd run on time without any delay. If it takes 10 minutes to change a tire, and another 5 minutes to get the vehicle on/off the lift, that's 45 minutes per vehicle. They should be able to see around 10-11 vehicles per 8-hour business day. Make appointments every 45 minutes and it should run like clockwork, right? I mean, it's tires for Pete's sake. How hard can it be?? Yet everytime I go to get my tire changed I always wait some period of time beyond my scheduled appointment or longer than the alloted time to change tires. Why?

quote:

Originally posted by mojojojo:

Overbookings can and do happen. It's part of the business. Let's say the practice has a 10% no-show rate (not uncommon at all). Using your numbers, the place can handle 40 appointments per day, but odds are that 4 of those patients won't show up, so the place only sees 36 patients.

Let's say for each patient seen the practice gets $50. For those 4 who don't show, the practice doesn't earn $200 that day. For the week that's $1000. Over a year.....it's a lot of lost revenue.

Prior to my wife's retirement, she was a provider in a mental health practice. Late cancellations (less than 24 hours) and no-shows were charged. When they showed up for their next visit, they had to pay the fee before being allowed to see their provider.

We used to be able to do that years ago. Private groups may still do it but we can't.

However, if a patient cronically doesn't show up for their appointments we will dismiss them from the practice. But that's drastic and rarely used. But there are times when it's been done, but those are patients who made appointments 4,5,6+ times and never showed up even after confirming each time they would be there.

quote:

Originally posted by hudr:
Ok, sure.
How about you DON’T leave me out in the waiting room until 45 minutes AFTER my scheduled appointment?

I was taught to be on time for stuff. I know things happen that throw wrenches in schedules, but for the first appointment of the day?
And these schedule/wrench interactions can’t happen everyday, at every appointment time, can they?
And for every single doctor?

Yep. I mentioned this in another thread a while back. My doc had an annoying habit of leaving you waiting 30 or more minutes after you checked in.

One of the nurses always had the stock answer that the doctor was dealing with a patient emergency. After I got that excuse several times, when the doctor finally saw me, I asked if the patient survived. I don't think I was the only one getting fed up because after that he showed up within minutes of my being checked in.

Current doc has online portal, all the paperwork is done on your PC, and every year you do have to update the paperwork, just did that with my first appointment, but it is all done through the portal.

Show up, pay the co-pay, have a seat, I waited maybe 5 minutes, if that to be called back.

It's been the same with all docs I've seen on the portal, the few not, a bit more paperwork, but most here are part of the digital network.

quote:

Originally posted by tatortodd:

quote:

Originally posted by P250UA5:
This is why I try to schedule appts for the first time slot available, pretty much as they're unlocking the doors. And you still end up waiting a bit.

I do this too. It's pretty obvious why I'm waiting if I sit in the waiting room where I can view the staff entrance. Half of them walk in 15 or 20 minutes after my appointment time. So either they're all slacking or the MBAs decided to have patients show up before they start paying their staff.

4:30pm dental appt for my daughter today.
Got here about 4:10, left early in case of the usual traffic en route. She's in the chair at 4:20.
Gold star for them today, but we rarely have much of a wait here.

I do not have this problem as I foster a realtionship with the receptionist. She knows the best time to go.

My wife takes those waiting times into account. She doesn't care if she's late as even if she's late, she still has to wait.

If they'd just have the courtesy to text "hey we're currently running 35 minutes behind" we could adjust.

quote:

Originally posted by ridewv:
If they'd just have the courtesy to text "hey we're currently running 35 minutes behind" we could adjust.

Right?!! I'd be fine with some acknowledgment that my time is as valuable as theirs.

Two comments.

Wife was ill... I decided to save her time sitting in the walk in clinic waiting room... one we used multiple times before... so I used the "online check-in". Did all the forms online, went in and told them the online check in was done. She still had to do ALL the same thing on paper anyway. I asked why? I shit you not the Receptionist said... In case anything has changed. WTF, In the last hour??? I was pissed but let it go because my wife needed to be seen.

Had an 8:00 o'clock... Got the generic instruction to arrive 15 early.
I arrived at 7:40. I sat in the car 20 minutes! They didn't even unlock the door until 8:00 and I still had to wait in the waiting room a while.

quote:

Originally posted by cparktd:

Did all the forms online, went in and told them the online check in was done. She still had to do ALL the same thing on paper anyway. I asked why? I shit you not the Receptionist said... In case anything has changed. WTF, In the last hour???

That's when they receive "the V-Tail stare."

I had a noon appointment at my cardiologist last week. Saw him for about 10 minutes while he started at the computer screen and asked me a couple of questions. Didn't get out of there until after 4 pm. I've about had it with this doc, its like this every time. Going to have to find a new doc.

I might be to blame, at least partially ,
six times

I've arrived an hour or more early,
Three of those times they took me right in .

No problem, they said.

I schedule early morning appointments to avoid these issues, and it usually works out well. I don't mind running a few minutes behind...stuff happens...but I don't want to waste half my day sitting in a waiting room catching who knows what from all the sick people. The problem is typically other patients screwing up the flow of things, not the doctor or the staff.

That said, I've about had it with my dentist. My wife had a cleaning scheduled last week, and as is our normal practice, she scheduled it at opening time (8:00am). A few days before her scheduled appointment, she got a call from the office telling her they needed to re-schedule her appointment, because the hygenist had to drive herself to work, and 8:00am was too early for her to get up. My wife said she could tell the lady calling her was pissed about it, but had clearly been told to make the call. If I was the boss and an employee told me they didn't want to come in at opening time, I'd just fire her ass and find somebody else .

Ever since my doctor joined Cleveland Clinic, it's been great. Text says arrive 15 minutes early as well. My appointment yesterday was for 11:20am. I got there at 11. I was taken in at 11. I was out by 11:25.

Yesterday I had an appointment at our skin clinic. I had an acute care need, and my dermatologist is booked far in advance, so my appointment was with a CNP. I assume the problem was that the Nurse Practitioner had all kinds of miscellaneous cases dropped in her lap, but I kept seeing people arriving after me, and getting called back while I sat waiting.

After waiting 30 minutes I went to the front desk and said, “You didn’t tell me you were running 30 minutes late this morning.” She informed me that I was “next up to see” the CNP. 30 more minutes, I was an hour late to be called back for my appointment. I was standing at the front desk to cancel the appointment and reschedule with my regular doctor (no matter how long it took) when she walked into the waiting room and called my name. She was apologetic, but I never really understood why it ran so late.

Appointments with my dermatologist are never late like this.

The most important quality in a physician is his knowledge. Think of how long you wait in line at the grocery and other venues. Here is article t consider:

First, her favorite doctor in Providence, Rhode Island, retired. Then her other doctor at a health center a few miles away left the practice. Now, Piedad Fred has developed a new chronic condition: distrust in the American medical system.

“I don’t know,” she said, her eyes filling with tears. “To go to a doctor that doesn’t know who you are? That doesn’t know what allergies you have, the medicines that make you feel bad? It’s difficult.”

At 71, Fred has never been vaccinated against covid-19. She no longer gets an annual flu shot. And she hasn’t considered whether to be vaccinated against respiratory syncytial virus, or RSV, even though her age and an asthma condition put her at higher risk of severe infection.

“It’s not that I don’t believe in vaccines,” Fred, a Colombian immigrant, said in Spanish at her home last fall. “It’s just that I don’t have faith in doctors.”

The loss of a trusted doctor is never easy, and it’s an experience that is increasingly common.

The stress of the pandemic drove a lot of health care workers to retire or quit. Now, a nationwide shortage of doctors and others who provide primary care is making it hard to find replacements. And as patients are shuffled from one provider to the next, it’s eroding their trust in the health system.

The American Medical Association’s president, Jesse Ehrenfeld, recently called the physician shortage a “public health crisis.”

“It’s an urgent crisis, hitting every corner of this country, urban and rural, with the most direct impact hitting families with high needs and limited means,” Ehrenfeld told reporters in October.

In Fred’s home state of Rhode Island, the percentage of people without a regular source of routine health care increased from 2021 to 2022, though the state’s residents still do better than most Americans.

Hispanic residents and those with less than a high school education are less likely to have a source of routine health care, according to the nonprofit organization Rhode Island Foundation.

The community health centers known as federally qualified health centers, or FQHCs, are the safety net of last resort, serving the uninsured, the underinsured, and other vulnerable people. There are more than 1,400 community health centers nationwide, and about two-thirds of them lost between 5% and a quarter of their workforce during a six-month period in 2022, according to a report by the National Association of Community Health Centers.

Another 15% of FQHCs reported losing between a quarter and half of their staff. And it’s not just doctors: The most severe shortage, the survey found, was among nurses.

In a domino effect, the shortage of clinicians has placed additional burdens on support staff members such as medical assistants and other unlicensed workers.

Their extra tasks include “sterilizing equipment, keeping more logs, keeping more paperwork, working with larger patient loads,” said Jesse Martin, executive vice president of District 1199 NE of the Service Employees International Union, which represents 29,000 health care workers in Connecticut and Rhode Island.

“When you add that work to the same eight hours’ worth of a day’s work you can’t get everything done,” Martin said.

Last October, scores of SEIU members who work at Providence Community Health Centers, Rhode Island’s largest FQHC, held an informational picket outside the clinics, demanding improvements in staffing, work schedules, and wages.

The marketing and communications director for PCHC, Brett Davey, declined to comment.

Staff discontent has rippled through community health care centers across the country. In Chicago, workers at three health clinics held a two-day strike in November, demanding higher pay, better benefits, and a smaller workload.

Then just before Thanksgiving at Unity Health Care, the largest federally qualified health center in Washington, D.C., doctors and other medical providers voted to unionize. They said they were being pressed to prioritize patient volume over quality of care, leading to job burnout and more staff turnover.

The staffing shortages come as community health centers are caring for more patients. The number of people served by the centers between 2015 and 2022 increased by 24% nationally, and by 32.6% in Rhode Island, according to the Rhode Island Health Center Association, or RIHCA.

“As private practices close or get smaller, we are seeing patient demand go up at the health centers,” said Elena Nicolella, RIHCA’s president and CEO. “Now with the workforce challenges, it’s very difficult to meet that patient demand.”

In Rhode Island, community health centers in 2022 served about 1 in 5 residents, which is more than twice the national average of 1 in 11 people, according to RIHCA.

Job vacancy rates at Rhode Island’s community health centers are 21% for physicians, 18% for physician assistants and nurse practitioners, and 10% for registered nurses, according to six of the state’s eight health centers that responded to a survey conducted by RIHCA for The Public’s Radio, NPR, and KFF Health News.

Pediatricians are also in short supply. Last year, 15 pediatricians left staff positions at the Rhode Island health centers, and seven of them have yet to be replaced.

Research shows that some of the biggest drivers of burnout are workload and job demands.

Community health centers tend to attract clinicians who are mission-driven, said Nelly Burdette, who spent years working in health centers before becoming a senior leader of the nonprofit Care Transformation Collaborative of Rhode Island.

These clinicians often want to give back to the community, she said, and are motivated to practice “a kind of medicine that is maybe less corporate,” and through which they can they develop close relationships with patients and within multigenerational families.

So when workplace pressures make it harder for these clinicians to meet their patients’ needs, they are more likely to burn out, Burdette said.

When a doctor quits or retires, Carla Martin, a pediatrician and an internist, often gets asked to help. The week before Thanksgiving, she was filling in at two urgent care clinics in Providence.

“We’re seeing a lot of people coming in for things that are really primary care issues, not urgent care issues, just because it’s really hard to get appointments,” Martin said.

One patient recently visited urgent care asking for a refill of her asthma medication. “She said, ‘I ran out of my asthma medicine, I can’t get a hold of my PCP for refill, I keep calling, I can’t get through,’” Martin said.

Stories like that worry Christopher Koller, president of the Milbank Memorial Fund, a nonprofit philanthropy focused on health policy. “When people say, ‘I can’t get an appointment with my doctor,’ that means they don’t have a usual source of care anymore,” Koller said.

Koller points to research showing that having a consistent relationship with a doctor or other primary care clinician is associated with improvements in overall health and fewer emergency room visits.

When that relationship is broken, patients can lose trust in their health care providers.

That’s how it felt to Piedad Fred, the Colombian immigrant who stopped getting vaccinated. Fred used to go to a community health center in Rhode Island, but then accessing care there began to frustrate her.

She described making repeated phone calls for a same-day appointment, only to be told that none were available and that she should try again tomorrow. After one visit, she said, one of her prescriptions never made it to the pharmacy.

And there was another time when she waited 40 minutes in the exam room to consult with a physician assistant — who then said she couldn’t give her a cortisone shot for her knee, as her doctor used to do.

Fred said that she won’t be going back.

So what will she do the next time she gets sick or injured and needs medical care?

“Well, I’ll be going to a hospital,” she said in Spanish.

But experts warn that more people crowding into hospital emergency rooms will only further strain the health system, and the people who work there.

LINK: https://www.dailykos.com/stori...osing-their-doctors-

My daughter had a dental appointment for 4pm on Thursday. On Wednesday they called saying that unfortunately we’d have to change the appointment to 3:30 or they’d have to cancel.

We moved some stuff around and made it work and I took her in at 3:20. They didn’t call her back until 4:10.

I’m glad I rearranged my meetings so that I could get there 50 minutes early