In God We Trust

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.