Sunday, February 3, 2013

Same Day Doctor Appointments? Read the Fine Print

Cleveland and northeast Ohio are not hospitable to private practice medicine.  I should know.  I’m one of them.  Private practice is fading as health care reform suffocates it by design.  When this occurs, the public will have lost physicians who, in my view, have practiced patient advocacy and service at a higher level than our employed counterparts.  Keep in mind that the first half of my professional career was spent as an employed physician and the latter half as a private practitioner.  So, I know the advantages and drawbacks of each model first hand. Of course, there are employed physicians who are outstanding doctors and private practitioners who are not, but I maintain that a physician who owns his business has a stronger incentive to provide excellent service to patients and to referring physicians.  This just makes sense.  Don’t we find that when we shop or dine out or stay at a Bed and Breakfast that there is a different level of service from those who own these businesses?  If a store closes at 5:00 pm and you arrive at the locked door at 5:05, would your chances of gaining entry inside be greater if the boss were there rather than an employee?  Get the point?

I recognize and have expressed in this blog that there are advantages to the employed physician model which eliminates and reduces conflicts of interest that confront those of us who practice in the private arena.  However, doctors on salary and the institutions that employ them face their own unique conflicts and challenges that can interfere with their healing mission.  Fee-for-service medicine leads to over-utilization while models that restrain costs may restrict care, access and service to patients. 

One service that our small gastroenterology practice offers is rapid access for patients who need or desire an expeditious appointment.  This is tough for sprawling and expansive group practices, as we have in our neighborhood, to duplicate.  Yet they try.  The big dog medical institution in town is now advertising that they guarantee a same day appointment to any patient who desires it.  Sounds good so far.  I wondered how they could pull this off since it’s a vexing task for me even to reach these docs on the phone, let alone try to arrange a timely appointment for one of my patients.  Here’s the sleight of hand.  Sure, the institution will grant the patient an appointment, but it’s not with his doctor and may even be across town in a satellite location.  Is this what most of us have in mind for a same day appointment?  While it’s a tricky marketing ploy, it’s a poor play at customer service.  These patients would do better to present to a local urgent care, which offers a same day visit with a doctor who is likely less than 10 minutes away.

Years from now, when we are all enjoying Cadillac care at Chevrolet prices, where will I be?   Private practice will be long gone, but my skills will still be useful.  I’m hoping I can land a position as a docent in the Fee-for-Service wing in the Museum of Medical History.   I’ll be paid on salary, of course, like doctors will be everywhere. 


  1. Well stated and sadly true. I do think there will always be a need for those to provide care outside the rigid government imposed systems such as ACOs and the like. Whether it is concierge care or a fee for service model there will be those courageous enough to provide this service. I urge interested readers to read Dr. Perednia's book Overhauling America's Healthcare Machine. Although I disagree with most of his "solutions" it clearly describes the problems. Priceless by John Goodman offers many reasonable market solutions that increase patient power and autonomy but I fear that none of these will be adopted until our current system implodes. In the meantime, we must inform and maintain whatever is best for our patients.

  2. Appreciate your comment, Dan. I believe this is your inaugural comment. I hope it won't be your valedictory one. Can you put a timeline on the implosion that you forecast?

  3. This is neither my first nor last comment.
    I think we will see continued legal challenges to Obamacare and implosion over the next 5-10 years if this disaster that is Obamacare persists.
    By the way I am now working on Open Wide and Say Moo by Dr. Fogoros. I urge all readers to view the debate which can be found videoed here: