What is Going On With Our Private Medical Providers?
By Dr. Rolando M. Ochoa D.B.A.
According to an article in CommunityLiteracy.org by
Edmund Duncan dated May 2022, there are
approximately 76,000 licensed medical doctors in
Florida where I live. The population of Florida as
of 2022 is estimated to be 22,085,563 which produces
us a ratio of approximately 3.44 medical doctors per
1,000 persons.
In the U.S. there are approximately 985,000 licensed
medical doctors. The U.S. population today is
estimated to be 338,359,137 which gives us a ratio
of approximately 2.91 medical doctors per 1,000
persons. However, these ratios do not tell the whole
story when we factor in age.
The average age in Florida is approximately 43 today
while the average age in the U.S. is approximately
39. Given that older persons tend to need more
medical care, it could be concluded that Florida’s
doctor/population ratio is much lower considering
that those persons over 65 in Florida account for
approximately 21% while in the U.S. is only 17%. The
logical conclusion is Florida does not have enough
medical doctors
For the last almost two years, due to the Covid 19
pandemic, medical providers were forced to function
in an unconventional environment. Infections,
shutdowns, restrictions, staff shortages, supply
shortages, tele-consultations, and many other
factors required that these providers changed how
they delivered medical services. These necessary
changes had a larger impact on private medical
practices.
Now that we are almost done with the pandemic (some
have said that the pandemic is over), many private
medical practice providers are finding it hard to
revert to their normal routines. The shortage of
medical doctors, the shortage of staff, the lack of
proper training given to the new staff, the
continued use of certain pandemic restrictions—such
as requiring patients and staff to wear masks —and
other events, have caused for the quality of the
service to deteriorate to even lower levels than
before the pandemic.
Mutual health providers, Clinics, Urgent Care
facilities, Emergency Rooms, and Hospitals were also
affected but not as much. Many of these entities now
seem to be functioning better. I think is because
they are managed by professional managers and not
the doctors. I will expand on this later on in the
article.
Like my
family and me, I am sure that the reader can
probably recount stories about negative or
unpleasant experiences encountered when visiting a
private medical practice facility. We all put up
with them out of respect and fear of upsetting the
doctor and/or the medical staff if we vociferously
complain. We clearly know our health and well-being
is in their hands. In our case, most of these
negative experiences came from the staff not the
doctors. However, in my opinion, there is a general
lack of proper leadership and guidance of the
private medical practice staff.
The following comments and recommendations reflect
my knowledge of leadership and management, not only
because I was a leader and manager for many decades
in the banking industry, but also due to my
research, education, and professorship on these
topics.
Medical doctors spent many years getting their
professional schooling. Medical doctors also need to
have strong dedication to their profession in order
to endure the hardships of their education and the
fact they must continue to take classes and
re-certification tests throughout all their careers.
Most, if not all, have the medical knowledge to be
effective providers and many with years of
professional experience, have accumulated even more
knowledge. They deserve our respect and admiration
as medical doctors.
Because of their ongoing strong devotion to their
profession, many will unfortunately neglect the
supervision and leadership needed for the office
staff. The medical doctors rely on an office manager
who is not normally a principal of the practice and
a private medical practice cannot survive without
making a profit no matter how good the medical
doctor is.
The dilemma, therefore, is that individuals with a
strong medical vocation do not normally have
business-savvy. Contributing to this issue is the
fact their training there clear absence or
insufficiency of classes in business, leadership
classes, and administration. Many doctors, not only
have very little knowledge about how to run the
business side of the practice, but also have a
dislike doing that task. Therein is part of the
problem.
There is a saying in Spanish that describe the need
for the business owner to be, not only knowledgeable
about their trade, but also directly involve with
the organizing, supervising, recruiting, and
customer service of that business.
“El
Ojo del Amo, Engorda al Caballo,”
loosely translated means. “The Eye of the Owner,
Fattens the Horse.” The office manager, who is not
normally part of the ownership, is thus not as
committed as the owner of that business. A doctor,
therefore, is also normally “too busy” to worry
about what happens other than the medical part of
the practice.
A private medical practice has many different
function or departments. They all must be organized
in the most efficient manner and all departments
must be supervised constantly and monitored. There
are many different styles of leadership and all are
valid when used properly. If a manager has a very
experienced staff, then that manager will not need a
very close supervision. Conversely if you have a
very inexperienced staff, you need to make sure it
is very close supervised. Correcting subordinates
when they make a mistake, is one of the best forms
of training for success.
Customer service is very important in all
businesses, but more so in a private medical
practice. A satisfied customer/patient keeps coming
back and refers others to the business. A
dissatisfied customer/patient, likely will not come
back and seldom refers another person. A customer
complaint, however, does give the business the
opportunity to correct the situation and satisfied
the customer. Indeed, dissatisfaction can be a
successful training tool. If I had a private medical
practice, I would insist all patient/customer
complaints come directly to me. This is a practice I
implemented when I was a bank branch manager.
The customer feels better already talking to the top
person in charge. Also, because the top person
normally has the decision power, a correction can be
made then and there. Another benefit is that the
procedure could be fixed or person provoking the
complaint could be counselled, on the spot and
counseling or adjustments be undertaken, so it not
to happen again.
Let me relate here a few of the problems my family
and I have had with private medical practices in the
past few months:
A)
Telephone calling the office for an appointment or
any other matter is most of the time impossible. No
human ever answers the phone. You get a computerized
voice mail system with multiple options. Most of the
time you have to leave a message and that message is
seldom returned promptly or at all.
B)
If you are lucky enough to get an appointment, it is
normally several weeks in the future no matter what
your medical condition is. The person answering the
phone or the one who finally calls you back is
probably the least experienced staff member at the
practice and has no authority to make exceptions or
accommodations of any kind.
C)
When you get to the office for the appointment, you
will likely have to fill in considerable paperwork
even if you are a long-time patient. These multiple
forms are normally very repetitious and you have to
write the same basic information in all the forms
instead of having one main form with attachments for
all the variations. Some offices give you an iPad
for you to enter the information, but some older
patients have a hard time using technology.
D)
When you have a procedure done by another doctor or
medical facility, the results sent to your doctor
are not reported to you on a timely manner. Many
times, the patient has to call the office to get the
results instead of being called directly with those
results.
E)
You may get a call that your appointment was
cancelled without a proper explanation as to why and
never with an apology. Yet if the patient does not
show up or cancels the appointment the same day,
that patient has to pay a fee. Why isn’t there a fee
or credit paid to the patient when the doctor
cancels the appointment? We recently experienced a
medical doctor who cancelled the last three
appointments and only gave the new one for three
months in the future. No apologies were given. It is
simply what it is!
F)
When you go in for the preliminary phase, the
medical assistant takes your vitals and asks you
questions that you might rather only discuss with
the doctor. After finished that initial phase, you
often wait there for a while with no apology. It is
understood that a medical visit sometimes takes
longer than expected. Sometimes that is the
patient’s fault because he or she talks too much,
but other times the delay is the doctor’s fault for
talking too much talking about things unrelated to
the visit. Let me give you an example:
I used to take my late father to a specialist
very often. We had to wait for at least two hours
after the scheduled time, but we did because this
doctor was very good and had helped many members of
our family regain their health including my father.
When we finally got in to see the doctor, the
consultation took less than five minutes, but then
the doctor would call several members of his staff
and asked my father, who was a comedian, to tell
stories and jokes for 20 minutes or so. My father
had a good time, but those waiting to see the same
doctor did not.
G)
The doctor only looks at a computer terminal and
never at you. The doctor asks you how do you feel
and you give your own diagnostic instead of the
doctor telling you what is wrong. Many times, only
the computer program gives the diagnosis. There is
very little physical examination.
H)
Sometimes after your visit with the doctor, you need
to see another person in the office to schedule a
procedure schedule or something else. That person
also makes you wait with no apology.
If you complain about the wait, you normally
get an “attitude” response and the appointment is
delayed further as a reprisal, I believe.
Some of the possible solutions:
(1)
Proper analysis and adjustments to the office
procedures
(2)
Proper and complete training of all staff
(3)
More direct supervision and better corrections
(4)
More accountability for errors and complaints
(5)
More positive reinforcement (maybe a bonus, salary
increase, lunch, etc.) when a staff member does aa
excellent job and the patient offers a compliment
(6)
Better control of the time spent with each patient
(7)
More acknowledgement of the patient when he or she
has to wait by offering an apology
(8)
Realizing the patient’s time is as valuable as the
doctor’s
(9)
Assure that all telephone messages are answered with
the hour
(10)
Make sure the patient is promptly called when a
third-party report is received from a procedure the
doctor ordered
(11)
Prioritize appointments based on medical need and
not call time
(12)
Minimize appointment cancellations by the doctor and
offer a discount or waive the co-payment for
rescheduling
(13)
Make all forms more patient friendly and less
repetitive
(14)
Make sure faxes and emails from other doctors or the
patient are acknowledged and dealt with quickly and
fully
I am sure that there are many more you could add to
these problems and solutions. I would love to hear
them.