Does your physician offer weekend hours?

It is better having discussion with physicians hourly in weekend to better know their problems.

A business is a business is a ... Yeah, I know. We risk patient/customer satisfaction if we don't keep to our published hours. OTOH, it is not unusual for small businesses to alter their hours on short notice because of extenuating circumstances. I can't count the number of times I've visited a small business and discovered that the place was closed because the owner was on vacation. It is not at all unusual for restaurants and small specialty stores to do that. We're not exactly a small business in that sense, but on the weekends when there are only 3-4 people in the building (each of whom is critical to running the place) it sure FEELS like a small business.

By coincidence, this week I've been dealing with a complex medical problem that is usually handled by a specialist but the specialist has closed his office temporarily/unexpectedly for an unknown amount of time because of a family emergency. It's been awkward for me and for the patient. My office isn't the only one facing challenges like this.

As I noted in the OP, there were no appointments involved yesterday. Our weekend hours are strictly unscheduled walk-in patients. There is a hospital ER 2 blocks away and an urgent care center a short distance away that keeps longer hours than we do. During the week we always have multiple providers scheduled, but on the weekends when only one person is scheduled to work things get more complex. This is the 1st time a physician illness has put us in a position where nobody was reasonably available in the 3-4 years we've been doing the weekend clinic, but I'm sure it won't be the last.

We have had some interesting back-and-forth dialog within our group around how to manage unforeseen events. You mentioned being open regardless of weather. I understand your perspective, and I once chastised my preacher for canceling church because of a few inches of snow one Sunday, but there is a reason we occasionally close the office in really severe weather. Most of our weekday business is scheduled patient care, and many of the patients have impaired mobility. Around here things can get pretty nasty during ice storms, much worse than the snowstorms I remember dealing with when I lived in Colorado. That means our parking lot can be dangerously slick after an ice storm, despite our efforts to scrape and salt the surface. We actually had an employee sustain a severe leg fracture from a fall in the parking lot a few years back. But guess who shows up for their appointments? When things are really nasty, the young folks miss their appointments (and rarely call to cancel - they just don't show up) but the OLD folks who can't walk right, who have no business getting out in dangerous conditions, KEEP their appointments. That leaves us with a dilemma. If we try to open up with short staff (our staff often act just like the young patients, though they they do at least call in) all we see are patients who are risking injury to come in. It doesn't make sense. I know, I'm indulging in stereotypes (and all generalizations are false) but it does create a difficult situation. We don't close often for weather - I think the last time was winter before last - but sometimes it looks like the right thing to do.

You seem to have some ambivalence in your attitude: Compare Would I expect you, your sick coworker who was originally scheduled, or anyone else to work if the are ill? vs More than once have I worked with a low grade fever or had attacks of diarrhea between customers. Employers who force employees to work when they are ill are NOT doing themselves OR their customers any favors. Sick people spread disease, and they don't get all that much work done. I don't like working with insufficient nursing staff, and I don't like covering for sick partners but it is FAR better to suck it up and deal with employee absences than it is to spread disease.

BTW: Regarding refunds for missed appointments - No, we don't offer payments if the doctor misses an appointment. Then again, we almost never charge patients for missed appointments unless the patient has a history of multiple missed appointments. It is against policy for our providers to change their schedule with less than a week's notice. Exceptions are mostly related to personal or family illness. If a doctor is ill we do our best to re-schedule the patient, but if the patient cannot be contacted in time we offer them a choice between being seen by somebody else or re-scheduling.

There's no good solution. Doctors do get sick despite their best efforts. Family members do have medical emergencies. Patients are unhappy when that kind of thing happens but most of them are fairly understanding. The most difficult situations involve complex patients who work for employers that have punitive policies regarding any kind of work absence, but I don't know how to fix that situation.

... working community outreach, I was ON CALL 24/7 whether I was on the "official" on call list for that week or not. An example : I was supposed to present my youngest sister (18 years my junior) for her confirmation and had to bow out at the church because of an emergency call. That job could involve life or death situations so you had no choice but to show up when called.

My feelings about medical services and their responsibilities are shaped by my experiences... should a small office be able to close? Of course it should.

I just found your phrasing of wanting to know a Non-Medical point of view interesting when compared to how the retail world works. The majority of retail workers are under threat of losing their jobs if they do not perform. Really... no exaggeration... they can lose their jobs for not showing up just once. They can lose their jobs due to the complaints of a petulant, spoiled customer who has an ax to grind. I often think that highly trained professionals of all types of work often forget the expectations retail workers operate under. Is it reasonable that an office could close due to illness ? Sure it is. Would it be tolerated at a Circuit City, Tweeters, Best Buy, etc. ? Not one bit... those companies would call in staff from the next nearest store and sack the original staff if they all called off because of a little thing like the flu or a cold.

Bottom line is if you own your own business, you can close when ever you want. If someone else owns the business, then you bow to their demands.

Our office has a mix of physicians and nurse practitioners. Nurse practitioners (NPs) and Physician Assistants (PAs) can see patients, make diagnoses and prescribe treatments under the supervision of physicians. They are frequently called "mid-level providers" and the combination of physicians plus mid-levels is frequently descried as "health care providers", though "health care provider" is also sometimes used to include other disciplines.

In a lot of medical offices around here people refer to "providers" instead of talking about physicians + NPs + PAs.

i'm not sure if we have the same here in israel, i know that our local clinic (doctor twice a week and a nurse 5 days a week 3-6 hours daily)
wont give out anything stronger than aspirin or acamol, without a prescription


i've asked a nurse friend if we have the same system here

jonah

,.

My sons and I had a dentist's appointment for checkups. We had been going to this dental clinic for years. We showed up and it had been closed. I had to call all over the place to find out where our records had been sent.

Diana

that physicians in the US reached success when they could open their own practice and a partnership was more often started between brothers, father and son, or some other relative. The offices didn't have trained nursing staff other than maybe an LPN. If so, she was also the secretary. Physicians kept their own ledgers and did their own billing. When folks didn't pay, there wasn't an aggressive effort made to go after them. They were just refused further service at some point. Doctors were bad business people and, while they still made above average income, you didn't see them living opulently.

All of that has changed and much has to do with government regulation and insurance....including malpractice. Many group practices are more like mini-HMOs employing 1/2 dozen andmore physicians and a large staff of nurses, schedulers, etc. Billing is out-sourced. Many group practices have limited laboratory services as well though these are regulated based on the complexity of the testing performed. Oncology practices that do on-site treatment will have a considerable investment in laboratory equipment and qualified staff. All of this must get expensive and it's a far cry from the old days of doctors making house calls where they could really do little more than just make a presence.

I'm afraid that government involvement in just about anything eventually results in at least a quasi- takeover of it. We've seen it before. Look at education, for example....even charity. Government regulation already has deep penetration into the availability and quality of health and medical care and absolutely controls the rate of medical advancement here. I can't say it's all been bad but it does complicate life and take away personal choices....at least for people who still want to make them.

I can't speak from personal experience here, but one of my older med school profs said that when he was young (he grew up during the depression and trained during the WW II era) doctors expected to earn above average incomes, drive above average cars, and pay for their children to go to moderately priced colleges but medicine was not regarded as an especially high paying profession. During his lifetime he saw all of those expectations change. What drove the change? Ironically, it may have been Medicare.

There was a time when care for the elderly was not reliably reimbursed because the elderly didn't have much money and we didn't have much to offer anyway. Then, with technological change, a lot of progress was made. Although most US physicians opposed Medicare, the emergence of Medicare at a time when there was rapid technological change and when (I'm told) insurance in general was less common than it is now, meant that physician income derived from elder care substantially increased. Later, as the government encountered MAJOR increases in Medicare expenditures the Feds had to gradually decrease Medicare reimbursement. These days Medicare is one of the worst insurance plans in terms of payment, coverage, bureaucracy, ... but that was not always the case.

Although Medicare does not run my practice, the rules surrounding Medicare drive many of the decisions we make about how to run the practice. The result is that a lot of things about the practice are driven by Medicare rules. Also, many insurance companies follow Medicare's lead in coverage decisions. And people wonder why the vast majority of doctors are opposed to a single payer government system?

In many ways, the government already has FAR too much influence over health care decisions but I don't see an good way around that.

A common joke about a single payer government health insurance system is that it would offer coverage with all the compassion of the IRS and all the efficiency of the Post Office. That's probably unfair to the USPS. Maybe we should say it would offer all the efficiency of the Italian Postal Service.

regarding medicare. My work carries me into medical facilities and deals with laboratory instrumentation. Lab services are well known to be profit centers and a few doctors purchase some laboratory instrumentation. I noticed that, in the past, many such purchases were made by smaller inner-city practices that saw mostly Medicare patients. In fact, I'd see signs saying something to the effect of "Medicare Welcome". Knowing a bit of the reimbursement schedule, I had to suspect that some doctors had taken the time to learn how to "milk" the system....and who could blame them. For the most part, the QC practices in these laboratories was horrible, if present at all. Along came CLIA and a mad scramble to either conform or be shut down. These small physicians office labs seem to have all but dried up. What remains is a few oncology and other specialty practices that need results while patients are still on site. Lab Corp, Quest, and others operate more as "concessions" in some offices and will provide phlebotomy and courier services more as a convenience than a producer of income. I'm not sure how accurate these observations are but it seems that the presence of implementing Medicare and then getting some of it fixed has had a dramatic impact on health care as a business.

Anybody doing chemistries and such needs to take excellent care of the equipment and follow appropriate cleaning/maintenance/QC etc. The good news about CLIA is that all labs SHOULD be doing a better job to protect themselves. The bad news is that some of the CLIA standards are bizarre and some of the proficiency testing is a joke.

Our office doesn't do a lot of tests. We have a Coulter, we do simple microscopy, FSBS, monospots and a few other kit tests that are mostly waived. Keeping everything ship shape for CLIA is a pain but it's just one of those things we have to do. My lab tech is so obsessive-compulsive that she would have a stroke if she found any significant problems in the maintenance records and so on. I don't mean that as a criticism. OCD is not a bad thing in some situations. We can't run high complexity labs under CLIA (No pathologist and no PhD techs in our office) and I really don't want to go there anyway. Being lab director of a moderate complexity lab is bad enough.

You are probably right about Medicare and lab profitability. Although Medicare reimbursement for office visits is pitiful, my impression is that the reimbursement rate for clinical labs isn't too bad. It used to be that the big boys would compete for office business by lowballing the wholesale cost of labs that we bill to 3rd party insurance so they could get our Medicare business. I think that is less true now.

We had a local Dr. just down the street. He pretty much took care of everyone as a GP. We got our immunizations shots, colds/flu medicine or scripts, etc.. To me every medical Dr. is compared to that one person. He really wasn't the nicest guy but wasn't an a-hole neither, I just guess he was harried. When friends and I talk about old times, if we delve into our medical past, his name comes up and warmly too. He's the best thing since sliced bread.

Now for the current world. Well, I can say I was treated well and all that for recent maladies. The experience was pleasant as can be, but you felt you were a factory, a nice factory but you were another clog in the machinery. Paperwork, paperwork is something that got shown to me after the diagnosis, so you take it from there. After awhile, I became keenly aware I should follow my instincts and be aware of all that's be done to me. I guess anyone should but I get the feeling, if I wasn't that well(mental) or assure of my surrounding just how I would be treated. Not in a bad way, but just "what happened here" review of treatment being done. Even after being explained to, that medical jargon can fly over your head. Anyways, its nice to be among the living. -----Willy

that a Government take over is likely if the Government is covering any more than 1/4 of the populace, so long as Insurance Companies maintain their responsibilities with the patients they have. However, should the Insurance Industry start to dump all the expensive patients into the Public system, then the Government may be forced to respond.

Rob