Fri, Apr 18 2014
Joan Eisenstodt didn’t have a stopwatch when she went to see an ear-nose-and-throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes.
“He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone,” said the 66-year-old Washington, D.C., consultant, who was suffering from an acute sinus infection.
When she started protesting the doctor’s choice of medication, “He just cut me off totally,” she said. “I’ve never been in and out from a visit faster.”
These days, stories like Eisenstodt’s are increasingly common. Patients – and physicians – say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements.
It’s not unusual for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they’ve been asked to see patients every 11 minutes.
And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care — some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems.
“Doctors have one eye on the patient and one eye on the clock,” said David J. Rothman, who studies the history of medicine at Columbia University’s College of Physicians and Surgeons.
By all accounts, short visits take a toll on the doctor-patient relationship, which is considered a key ingredient of good care, and may represent a missed opportunity for getting patients more actively involved in their own health. There is less of a dialogue between patient and doctor, studies show, increasing the odds patients will leave the office frustrated.
Shorter visits also increase the likelihood the patient will leave with a prescription for medication, rather than for behavioral change -- like trying to lose a few pounds, or going to the gym.
Physicians don’t like to be rushed either, but for primary care physicians, time is, quite literally, money. Unlike specialists, they don’t do procedures like biopsies or colonoscopies, which generate revenue, but instead, are still paid mostly per visit, with only minor adjustments for those that go longer.
And many doctors may face greater financial pressure as many insurers offering new plans through the health law’s exchanges pay them even less, offering instead to send them large numbers of patients.
This fee-for-service payment model, which still dominates U.S. health care, rewards doctors who see patients in bulk, said Dr. Reid B. Blackwelder, president of the American Academy of Family Physicians, who practices in Kingsport, Tenn.