What Went Wrong?

It’s been a very slow week in my office.  Today we almost pitched a no-hitter, having only one patient come in toward the end of the day.  Overall, we’ve been quiet in nearly every way – few phone calls, few patients stopping by, few appointments, few secure messages.

What’s wrong?

That was a trick question.  This is exactly what should be happening when things are going right.  My patients are happy.  My patients don’t need me now.  My patients are satisfied with my care.  This would be a problem in most offices, as revenue depends on people having problems, having questions about their care, or anything else that would fill the schedule.  In practices like mine, however, this is what we want; after all, I am paid just as much for an empty office as a full one.

The hardest thing about weeks like this (which seem to happen in June and July) is to fill our time with tasks (other than going on Facebook, playing Candy Crush Saga, or having a happy hour with the staff).  These slow times are not the norm, especially as my number of patients nears 600.  Some days are quite full.  I had one day a few months ago where I actually had more than 10 patients come in for appointments!

Seriously, that’s busy around here.  I used to see between 25 and 30 patients on normal days, and sometimes ended up seeing more than 40 (once saw over 60).  So my current definition of a “busy day” is quite laughable in comparison.  Remember, however, that I am not limiting care to office visits.  It doesn’t matter to me if patients’ problems are handled in the office, via messaging, or on the phone, as long as it is good care.  Office visits are just one form of communication.

Prior to leaving my old practice, I kept tabs of what percentage of visits actually required the patient to be physically in the office.  3/4 of the visits weren’t necessary.  Of the remaining 1/4, a small percentage of the actual visit required face-to-face time.  So now that I am out of the gravitational pull of obligate office visits, I give care however it will work best.  I love it.  My staff loves it.  My patients really love it.

Still, on these slow days we are challenged to do the tasks we can’t do when we are “busy.”  Those tasks aim at two main goals: to improve the quality of care we give and to make our system more efficient (so those busy days aren’t as busy).  The nice thing is that I can do that task with Van Morrison playing loudly in my office.

So yay for boredom!  Yay for healthy patients!  Yay for a job that doesn’t encourage me to have sick patients and to spend as little time with patients as possible!  Yay for Van Morrison!

Rob Lamberts is a physician in private practice in the southeastern united states.


Categories: Uncategorized

6 replies »

  1. “This is exactly what should be happening when things are going right. My patients are happy. My patients don’t need me now. My patients are satisfied with my care. I am paid just as much for an empty office as a full one.”

    What a great con game doc. Do you really think this model is keeping patients more healthy than other models? Are these formally sick patients you’ve cured with this billing model? I don’t know, I hardly ever see a doc, nor do I pay a monthly fee to keep my place in line.

  2. Rob,
    I’m a long-time fan; however, this fired me up.

    Many docs use patient email, telephone, even video visits. Most PCPs do everything possible to provide quality service when and where patients want it.

    Despite the digital deployment, patient demand (not a game) is crushing primary care doctors. When you say you’ve nothing to do, it’s so far from what most physicians experience that I wonder about your sensitivity.

    Indeed, concierge medicine is great — if your patients can afford it. But it’s not technology that is keeping you idle. At a fraction of the volume of most physicians I’m sure you’ve lots of time to blog.

    Take care, before posting, my friend.

  3. go to doctorlamberts.org for the fees (between $30 and 60 per month). No fees for visits. Insurance doesn’t cover visits (because I don’t charge for them). I’d say my uninsured population has grown, but overall the same % are healthy vs unhealthy.

  4. Hi Rob,
    It sounds like your patient’s are happy. Roughly how much are your monthly fees and do your patients get any reimbursement from their insurance companies for it? Has your patient population changed since you switched practices (i.e. more or less healthy)?

  5. I comfortably have about 600, and am honestly not certain of the cap. It depends what we do to become more efficient in processes. All of those patients pay the monthly fee (obviously), but I don’t know what percentage of the folks out there would be willing. But the growth is currently very steady and positive, and our attrition rate is very low, so hopefully once they’ve experienced it, they see the value in the monthly fee.

  6. Rob,

    How many patients do you think you can comfortably handle with this model and what percentage of potential patients do you think would be both able and willing to pay the subscription fee assuming they fully understand how the model works and what it’s benefits are?