In light of my recent decision to leave my practice in a big health network and transition to a new, better delivery model of healthcare (direct primary care), I recently decided to take inventory of how my time was spent in the “fee-for-service” realm of medicine while I still had the chance. For those of you not familiar with this terminology, the industry term “fee-for-service” could essentially be a replacement for the layman’s term “traditional doctor visit.” The “traditional doctor visit” that we’ve all come to accept and hate looks something like this:

·  Arrive 10 minutes early for appointment as asked to do

·  Fill out useless paperwork and questionnaires during this time (10 minutes)

·  Wait in waiting room until you’re called back for your appointment (15 minutes)

·  Nurse rooms you, which consists of questions, vital signs, medication review, etc (10 minutes)

·  Wait for doctor to arrive (20 minutes)

·  Doctor arrives 45 minutes after your scheduled appointment time

·  Doctor types on computer while only listening to half of what you’re saying (5 minutes)

·  Doctor leaves and you wait to be checked out (10 minutes)

·  Nurse arrives to finish check out process and schedule next appointment (10 minutes)

The grand total here equals 1 hour and 20 minutes spent in the doctor’s office, with a total of 5 minutes with the doctor where you only received partial attention.

All of that you already knew and unfortunately, you have probably experienced something similar or worse. But what you probably don’t know is what happens behind the scenes. I’m sure many of you have sat in the exam room thinking, “How long have I been here now? What on earth is she doing that is taking so long?” Trust me, I get it. I recently documented the first 90 minutes of my day in the “fee-for-service” world to show you the answer to this common question. And, to demonstrate why the doctor is always late.

7:30 AM –First appointment

7:35 AM – Patient #1 arrives late

7:42 AM – Check-in process complete

7:46 AM – Patient #2 arrives

7:50 AM – Patient #2 appointment time

7:52 AM – Patient #1 rooming completed with vital signs, med review, concerns, etc.

7:52 AM – I enter the room of patient #1 to commence follow-up visit. After scouring the medical record looking for the MRI that should have been completed but I couldn’t locate, I find out from the patient that it was completed at an outside facility.

7:53 AM – Check-in process complete for patient #2

7:56 AM – I leave the room of patient #1 and ask staff to have MRI result faxed to our office from outside facility. This then takes away from the time that my nurse had planned to use to room patient #2.

7:56 AM – I start reviewing the case for patient #2 while waiting on MRI results for patient #1

8:00 AM – Patient #3 arrives for their appointment

8:02 AM – Rooming complete for patient #2

8:03 AM – 2nd request sent for faxed MRI results as we still haven’t received them

8:04 AM – I finish reviewing the case for patient #2 and simultaneously the MRI results for patient #1 come through the fax machine successfully diverting my attention back to patient #1

8:08 AM – Finish reviewing MRI results for patient #1 and enter back into the room with patient #1

8:10 AM – Patient #3 appointment time

8:12 AM – Finish appointment with patient #1

8:15 AM – Complete documentation and billing for patient #1-- I’m extremely efficient at this process and most doctors would need much more time.

8:18 AM – Check-out process complete for patient #1

8:16 AM – Patient #4 arrives

8:17 AM – Enter room for patient #2 (27 minutes after their appointment time)

8:25 AM – Rooming process complete for patient #3

8:30 AM – Finish with patient #2 after spending 13 minutes with them but could have definitely spent more time in the room if it weren’t for time constraints

8:30 AM – Patient #4 appointment time

8:35 AM – Check-out process complete for patient #2

8:37 AM – Finish documenting patient #2, refill my coffee, and take a bathroom break

8:43 AM – Patient #4 rooming complete

8:38-8:47 AM – Unscheduled patient unexpectedly dropped by the office and “needed” to talk to the doctor. Also addressed 2 urgent phone messages.

8:53 AM – Finish reviewing case for patient #3 and enter the room (53 minutes after they arrived at the office)

8:54 AM – Enter the room with patient #3

9:02 AM – Finish with patient #3

9:07 AM – Documentation and billing complete for patient #3

9:08 AM – Check-out process complete for patient #3

9:14 AM – Finish reviewing case for patient #4 and enter the room (57 minutes after they arrived at the office)

9:20 AM – Finish with patient #4

9:27 AM – Check-out process complete for patient #4

Each patient’s time was spent in this manner:

Patient #1 – 43 minutes at office, 8 minutes of face-to-face time with doctor

Patient #2 – 49 minutes at office, 13 minutes of face-to-face time with doctor

Patient #3 – 68 minutes at office, 8 minutes of face-to-face with doctor

Patient #4 – 71 minutes at office, 6 minutes of face-to-face with doctor

Ready for the kicker? My appointments are spaced out every 20 minutes which is a lot for a doctor. I’ve consistently fought back against resistance when asked to shorten my appointment time slots. Most doctors have time slots for patients that are spaced every 10 or 15 minutes. Now, maybe you can understand why the doctor is typing his documentation (and only half listening to you) for the visit while you’re expressing your medical concerns that you may have waited 3 weeks until you could get an appointment to express. It’s the one mechanism that the doctor has at their disposable to make a feeble effort to keep a schedule in the midst of the chaos.

Luckily, there is a better way in the emerging world of direct primary care medicine, a new model that utilizes a membership fee in order to see patients without billing insurance. When you don’t bill insurance, you can operate more efficiently and spend much more time with patients, providing superior quality of care. Let’s look at a sample schedule at my new practice, Simplicity Health Direct Primary Care.

8:30 AM – Dr. Opperman arrives at office and prepares for patient #1’s appointment

9:00 AM – Patient #1 arrives for their appointment

9:05 AM – Patient rooming complete-- no insurance check in needed and no useless surveys, forms, or questionnaires

9:06 AM – Dr. Opperman enters room with patient #1

9:40 AM – Dr. Opperman finishes appointment with patient #1

9:50 AM – Patient #1 check-out process completed with their labs drawn in the office and their prescriptions filled for them and ready to go.

9:40 – 9:55 AM – Dr. Opperman reviews the most up-to-date literature for patient #1’s condition. Dr. Opperman also personally calls and speaks with a specialist regarding patient #1.

9:57 AM – Documentation for patient #1 complete. Only pertinent documentation that is useful for patient care is required since meaningless insurance requirements for coding and billing aren’t needed.

10 AM – Begin reviewing case for patient #2’s appointment at 10:30 AM

10:15 AM – Finish reviewing the most up-to-date literature for patient #2’s condition

10:15 AM – 10:25 AM – Personally call patients to wish them a happy birthday and see if they have any medical concerns. You only get one birthday per year, we can’t let a medical concern get in the way of your special day!

10:25 AM – Patient #2 arrives and waits 0 minutes for their appointment

Patient # 1’s visit can be broken down like this: 50 minutes spent in the office, with 34 minutes of face-to-face time with doctor. Patient #1 also does not need to take more time to drive to and wait at the lab or the pharmacy because that was all taken care of in the office during that 50-minute time frame.

As you can see, the “fee-for-service” model that currently dominates modern patient care is exhausting for both patients and physicians. Mandatory extra steps that are put in place by insurance companies and big health networks act like hurdles and often end up slowing down doctors rather than truly enriching patient care. Patients are left wasting time, mindlessly thumbing through magazines or scrolling their social media wondering, with heavy sighs, “How much longer is this going to take?” With Simplicity Health Direct Primary Care, all of this goes away. We provide top-notch care that is always straight-forward and simple.