Thursday, October 24, 2013

Money changes everything


Dear Dr. Cashpay,

I know you don't remember what it was like to be a peon. It's been several years since you last saw an average patient. Nowadays people pay you $5000/year to "belong" to your practice, and then another $400/hour if they actually have to see/speak/text/stand in your radiant aura.

And you normally don't refer to me, anyway. Since I take insurance, I get paid the same amount of money to see one of your self-important assholes as I do for a decent, but non-wealthy person. So I don't give your patients the priority attention you feel they deserve. But, occasionally, one of them will show up on my doorstep and I'll see them. As did Mr. Rich last week. Unlike most of your peeps, he was quite pleasant.


3 days later:


Mary: "Dr. Grumpy's office, this is Mary."

Lacey: "Hello, this is Lacey, calling from Dr. Cashpay's office. He wishes to discuss Mr. Rich's case with Dr. Grumpy."

Mary: "Hang on, he's between patients, so let me get him."

Lacey: "No, we don't work that way. He'd like to schedule a 15-30 minute appointment to discuss Mr. Rich by phone."

Mary: "Wait... You're actually trying to schedule a phone call for the doctors to talk?"

Lacey: "That's what we do here."


This was a first for my office. Mary grabbed me, and I got on the phone.


Dr. Grumpy: "Hi, this is Dr. Grumpy."

Lacey: "Dr. Cashpay would like to schedule a 15-30 minute phone appointment to discuss a mutual patient."

Dr. Grumpy: "That's a lot of time. Is Dr. Cashpay going to pay me for this phone call?"

Lacey: "Certainly not. He works for his patients."

Dr. Grumpy: "But he'll charge Mr. Rich for the time he spent on the phone on his behalf, right?"

Lacey: "Of course. And rightfully so."

Dr. Grumpy: "Look. I've get about 5 minutes on the phone between patients right now. So Dr. Cashpay can talk to me now, at no charge. But I really don't have time to set up phone appointments for this sort of thing."

Lacey: "He's with a patient, and doesn't allow interruptions."

Dr. Grumpy: "Then he can try later, and see if I'm available. Show him how to dial. Goodbye."

19 comments:

RehabRN said...

Good job Grumpy!

Guess he forgot to figure in collegial discourse into his fee structure.

A nice goal for next year's pay hikes.

Heidi said...

About 5 years ago we had a PCP we liked very much. He switched to being a "concierge" practice, for which it would cost us $1,500 each/year to join. Much as we liked him, we declined.

PediNP said...

Good for you!

There's no guarantee that those cash only docs are giving any better care than anyone else. And I don't care how renowned those physicians might be, I won't throw any business their way. The ones who see my medicaid patients, those are the ones who get my insurance and cash patients.

steph said...

My physician of 28 years has just done this. We cant afford the $1,700 per person a year to see him. I actually cried when I read the letter. I loved his solo practice. I have many health issues and dread starting over with a new doctor. :-(

Anonymous said...

As a PCP, I feel you were much nicer than I would have been. My reply would have involved some anatomically challenging activities.

Anonymous said...

Brilliant! From now on, to get the coveted after school appts in my speech therapy practice you're going to have to be a PLATINUM member.

What is health care coming to?

Anonymous said...

This is why I read your blog. Nice one!

Ms. Donna said...

Go Ibee! Go Ibee! Go Ibee! Go Ibee! Go Ibee! Go Ibee! Go Ibee! Go Ibee! Go Ibee!
My old doc (I had to leave her practice because of insurance issues.) had a market research firm call my mom (a current pt.) to ask what she would pay per year for a concierge practice.

Mom was devastated, and she is scared that she will have to find a new PCP.
I can see Doc X's point. She is a GREAT doctor and deserves to make more.

HOWEVER, for my mom, who is in her 80's, and has numerous health issues, finding a new doc might tip her over.

So, I repeat, Go Ibee! Go Ibee! Go Ibee! Go Ibee! Go Ibee! Go Ibee! Go Ibee! Go Ibee!

Anonymous said...

In third grade, mother enrolled those of us with born with two left feet in folk-dancing class. We were exposed to (and learned for better or worse) Irish jigs and hornpipes to Greek line dancing, from Japanese Coal Miners to hava nagila. I remember attempting to learn an elaborate schottische complete with the bowing and curtseying, before a Virginia reel.

The Cashpay fellow sounds a bit like the hoops and bells and whistles of an elaborate Baroque court dance, perhaps a a passacaglia with the expensive real silk gowns and ostrich feathers, and gold-embellished fat little curly-haired cherubs and cabbage roses painted on the ceiling whereas Ibee's sounds more real, just a real, with not not that much reeling.

Anonymous said...

I don't see the problem with making an appointment for a 15-30 minute phone call - we do it all the time. It's a big chunk of time, as you said. Scheduling it just makes sense. But not paying you for it, or letting you charge Mr Rich for it? Demanding your time for free?

Mad Jack said...

I have no insurance. I'm a cash customer. Three years ago COBRA ran out and I started trying to find health insurance. The lowest quote for catastrophic insurance coverage was over $1000 per month. What's three time twelve? 36?

So in that time I've spend less than a grand on health care, all told. That's over the past three years.

Anonymous said...

My former PCP went to the concierge plan too. It turned out that she had decided to do that or just retire. So I was going to get a new doctor one way or another - and my new one is just as awesome.

Anonymous said...

Marvelous post, Grumpy.

Lin said...

Nice, so he believes his time is worth more than yours since he won't do the phone call without charging the patient but you're expected to do it for free. What an ass.

Oh man, I feel for those of you who had to change Drs due to them going cashpay only. I also have multiple medical issues and changing Drs is horrible. My current primary (internist) I've had multiple ups and downs with, but started realizing that the downs were all a result of her office staff... So now I really like her, but her office staff are morons, and I REALLY don't want to try to start over with a new Dr! Its really hard to find a good primary that will coordinate the care with so many specialists. My last one, who I started seeing because I moved here, I left because she seemed terrified to treat me. She was ok with coordinating the specialists... But she seemed to refuse to treat anything herself, it was specialists for EVERYTHING. Thats no good. I really hate having to see so many specialists, but I've resigned myself to it. When I turned 18 I LOVED my Dr because she allowed me to drop all of my specialists and handled my case mostly alone for years. When she would go on maternity leave it was horrible, because those covering wouldn't do anything for me and just wanted to refer off. But as the health conditions progressed I gave in that I had to be followed by the specialists. And my biggest health concern is a genetic disorder thats rare and pretty much affects every bodily system... So generally every new Dr knows nearly nothing about it and has never had a patient with it before. That makes new Drs particularly hellish.

gin4407 said...

You took the high road...kudos!

Anonymous said...

Normally I like the pseudonyms you give people, but I think you missed the boat on this one. Dr. Dick or Dr. Asshole would've been my first choices.

Unknown said...

Dr. Cashpay's wanting to waste Dr. Grumpy's time like that is obnoxious, but the posters above who "loved" their PCP as long as they were accepting their insurance's crappy rates, then get self righteous when asked to pitch in for the PCP's time and effort are pretty obnoxious, too. I know a local FP who I always thought was a selfish, negligent asshole. When I ran into him at a meeting a few months ago he seemed oddly interested in his patients, and, it turned out, he'd gone to a concierge model and wasn't seeing 45 patients a day anymore. And I see a lot of patients who seem to be getting crappy care from doc's who I know have their hearts in the right place, and it's because they have to move them through at lightening pace if they want to keep taking Medicare.

Grumpy, M.D. said...

I have nothing against him making money. It's his attitude toward other doctors that I find irritating.

pretzel said...

+1 to Unknown's comment above. I graduate from residency in < 7 months and I'm ready to retire from my specialty to avoid having to see 20+ patients a day. Patient care should not resemble a factory assembly line. No one told me in medical school that quantity would be the main priority. I'm pretty sure this is the main reason for both physician burnout and patient anger toward doctors.

 
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