Overheard "You're there to make money, not to talk," in clinical

lillymom · Apr 8, 2011

Maybe I'm young and naive, and I know I have no experience in healthcare (other than clinical), but I just think that's incredibly sad that all these people (nurses and doctors) who supposedly care about people and want to help let CEOs and insurance companies run the way they work. Ultimately you're there to help people get better and I understand that some patients talk your ear off just to do so, but even from a "business perspective" if you provide good thorough "customer service" the patients will come back and that will result in "more money"...right? I'm not trying to criticize anyone whose been in the field I'm learning what healthcare is truly all about, and it's unfortunate.

A lot of the physician practices in my area are hospital owned because they are unable to make it one their own financially. There are a lot of Medicare/Medicaid pt's in my area and the reimbursment is lower with these companies and we also have a free program for pt's who are ineligible for any other insurance and don't make enough to pay for insurance and their health care needs. This takes a toll on the doctor's offices and they end up contracting with the local hospital system. If they do not see a certain amount of pt.'s per day they fire them even if they are great MD's and they have lots of routine pt's.

Unfortunately this is they way healthcare is especially when big money is involved. If you want to keep your job you have to get them in and out 15 mins or less. They will also make the MD's decline to adress a situation if they are just coming in for a well check. For example a child comes is for a well child check and they have flu symptoms they will tell the pt's family we can either do the WCC or a sick visit you decide!

dudette10, MSN, RN · Apr 8, 2011

For example a child comes is for a well child check and they have flu symptoms they will tell the pt's family we can either do the WCC or a sick visit you decide!

This, as I'm sure you understand, is the fault of the system. The MD/NP/PA probably wouldn't get paid for both types of care if they happened at the same appointment. It is also in keeping with what the doctor I mentioned in a PP post said. He explained something about two separate outpatient procedures done on the same day. It can't be done and actually expect to get paid for both, although having both done on the same day during the same visit would NOT adversely affect the patient's health. So, overall, more is charged for the two procedures done separately than both procedures done together. Ridiculous.

We as future healthcare professionals are told to individualize care, but hospitals and MDs are under pressure to fit guidelines that are "one size fits all with x diagnosis." IT SUCKS! If someone reading this doesn't understand what a DRG is, look it up.

To the poster above who thinks it's bad form to let insurance companies/Medicare/Medicaid run the way you work...take a look at the examples in this post. What can be done? Become an activist and change it. MDs and hospitals cannot give away their services for free.

Abraham Lincoln once said, "A lawyer's time and advice are his stock and trade." That goes for healthcare professionals, too. If the system is set up so that proper compensation for time and advice is not paid, the system needs to be changed.

ImThatGuy, BSN, RN · Apr 9, 2011

Maybe I'm young and naive, and I know I have no experience in healthcare (other than clinical), but I just think that's incredibly sad that all these people (nurses and doctors) who supposedly care about people and want to help let CEOs and insurance companies run the way they work. Ultimately you're there to help people get better and I understand that some patients talk your ear off just to do so, but even from a "business perspective" if you provide good thorough "customer service" the patients will come back and that will result in "more money"...right? I'm not trying to criticize anyone whose been in the field I'm learning what healthcare is truly all about, and it's unfortunate.

At the end of the day would you rather have the best roof over your head and tastiest meal on the table you can have, or would you rather have made someone feel more comfy?

Fool.in.the.Rain · Apr 9, 2011

At the end of the day would you rather have the best roof over your head and tastiest meal on the table you can have, or would you rather have made someone feel more comfy?

Wow...

Tricia76 · Apr 9, 2011

At the end of the day would you rather have the best roof over your head and tastiest meal on the table you can have, or would you rather have made someone feel more comfy?

Hmm is all I can say to that!

Fool.in.the.Rain · Apr 9, 2011

At the end of the day would you rather have the best roof over your head and tastiest meal on the table you can have, or would you rather have made someone feel more comfy?

What a total bummer.

suanna · Apr 9, 2011

At the end of the day would you rather have the best roof over your head and tastiest meal on the table you can have, or would you rather have made someone feel more comfy?

Me- I'd vote for the best roof, and tastiest meal. I am neither a charity nor a volunteer. I provide a valuable service to my patients and expect to be compensated fairly well for my skills. Yes, when I have the time I will spend a few extra minutes with some chit-chat. Fortunately I'm paid by the hour, not but the visit, so if I have the time after my vital interventions, I'll spend as much time as I can providing the hand holding you may need. Unfortunately docs are largely paid by the visit- so a 20 minute conversation complaining about the quality of the hospital food, the new treatment you read about in the tabloids, the rash your second cousins back-side.... are all money out of the doctors pocket. I've known few doctors that were not willing to spend as much time as was needed with thier patient when reviewing the problem at hand, but patients many times are just lonely and need an ear to bend for a while. They need to call a friend or ask for the clergy on call to meet those needs. The doctors, and many times the nurse, may be hearing about how cute someones granddaughter is at the expence of someone who needs urgent, skilled, health care intervention. If docs (and nurses)charged by the minute- with insurance covering only the first 10 minutes, I wonder how many of your patients would be willing to pull out the mastercard to chat with thier licenced care givers about whatever is on thier mind today. That is the reality of a medical practice in the USA. It's worse, from what I hear in other countries.

futureRN_Anastasia · Apr 13, 2011

I had clinical Saturday on Mother/Baby postpartum and I was in the nursery for most of the day. I overheard a resident talking to her attending about how she was more comfortable in the hospital setting, but in the clinic she couldn't get patients to stop talking and asking questions. Word for word this is what I heard her attending say to her, "You'll learn how to make them be quiet, you're there to make money not talk." :angthts:
Seriously?! I about flipped when I heard this because I for one have really crappy health insurance and I'm about to get my yearly check-up and I've been making a short list of things to ask my doctor while I'm there. As crappy as this economy I fully understand that patients are going to be asking more questions while at their appointment to get their money's worth. It just really upset and offended me to hear an attending say that. I was curious what other people's take on doctors were as nurses or nursing students.

And that is exactly the reason, why for my second pregnancy (first ended in miscarriage unfortunately) I went to midwife's office, and not to an obstetrician. I like asking questions.

Anxious Patient · Apr 13, 2011

As a patient who has had doctors start an appointment by hovering at the door, with one hand on the doorknob, I'm glad there is Dr. Google for backup.

BarbaraNP · Apr 16, 2011

As an NP who teaches others about having their own businesses and practices, I'd like to chime in here.

While working as an RN (and later as an NP) being paid an hourly wage, or even when on salary, I never worried about the overhead cost of seeing patients. Now, as a practice owner, I understand the reality all too well that time truly does equal money. Unfortunately, not everyone understands this reality.

Stop for a moment and consider the overhead (ie, cost to run the business) of any practice, hospital, community clinic. Overhead include (and are not limited to): lease/mortgage; salaries and taxes (often the highest/2nd highest expenditure); utilities (heat/air, water, sewer, garbage); phone and internet access; liability and business insurances; licenses; housekeeping; office supplies; medical supplies; lab costs, including those utilized for POC); billing personnel or billing service (quite high usually); professional services such as the CPA and attorney and a myriad of other costs...before the practice owner ever gets a dime.

Now look at the other side of the equation: a practice owner only makes money when patients are seen (unless you are seeing pts under a capitated plan as was explained by dudette10). There are several ways to look at this: cost per patient, cost per day, break even points.

For example, (using made up round numbers to make this easy). If the overhead cost per month is $5,000 (this would be a very small office), and your average reimbursement is $40.00 (it's often lower than this for Medicare/Medicaid), then the practice (and often the practice owner) does not make any money until 125 pts are seen that month. However, just because the patients are seen, does not guarantee that the practice will get paid. I am only half joking when I say that insurance companies are not in business to pay your claims.

There are many more variables that go into this, but I write this to give an example of what every practice owner must consider. As nurses and nurse practitioners who are employed, we would do well to learn a bit about the business of healthcare.

No one can provide services for free. Even if you volunteered your time entirely, someone has to pay for the cost of providing the service. There is no such thing as free health care. Period. Someone is paying.

And as a professional, don't you deserve to be paid?

nor902 · Apr 16, 2011

It is funny you should say this. I am a nurse in a physicians office. There is nothing worse than a patient who comes once a year with a list of 40 problems. Our appointmets are in 15 minute slots. Why do they only come once a year you may ask, especially with all these problems? They do not want to have to pay a copay or they are too busy!If you ever wonder why you have a long wait in a physicians office-wonder no more.

~Mi Vida Loca~RN, ASN, RN · Apr 16, 2011

Maybe the appointments should last longer then 15 mins. As much as they cost, it surely seems reasonable. A lot of people probably only come once a year because 1) it's called a yearly physical for a reason. 2) It's not cheap, especially if you have to pay out of your pocket. I used to have to get med checks every 3 months. I was in the room for maybe 3 mins with the doc and 10 mins total. Cost me over 200 dollars. Add to that the labs I have to go get done, another 250 dollars. I have Ins. now thankfully, but I certainly understand where people are coming from. If patients become afraid to speak up, things get missed and bad things happen. Then people are annoyed at them for not saying anything.

Sure there will always be those few patients no matter where you are in life that go on and on. There are always "annoying" people everywhere, every field you go too. I have had nurses talk to me more than I talked, gotta love a yappy nurse when I came in for a migraine and just want to be in a quiet dark room until they give me a shot. :rolleyes: