You wake up today and you are sick. You do not want to go to work. The problem is that your boss is already mad at you for calling off three times in the past 2 months and you need a note if you want to keep your job.
So what can you do? Yes, you call your Doctor's office wanting to be seen this morning so you can get back to being at home - and yes being sick, but at least you can watch TV all day. You find out that your Doctor is (!gasp) on vacation this week and not available. If you are lucky you are given the option of seeing a colleague of hers today or, if you do not mind waiting, seeing her next week (when you will be probably be feeling better and may or may not still have a job) (By the way, this is the same job that that pays for Insurance that pays for your healthcare to see the same Doctor you were going to see - all for at a fraction of the real cost!).
If you would like to learn more of American-style healthcare economics - Follow me on the jump....
Most primary care physicians in the U.S. get paid by seeing patients. If a physician is solely officed-based (as many of us are choosing this for lifestyle reasons) she gets paid by how many office visits she manages to squeeze in a day and by the COMPLEXITY factor of each visit. So, for example, a head cold visit from a regular patient who simply needs a note for work gets her X dollars. A new patient complicated visit from an obese Diabetic who was discharged from the hospital the day before gets her 2X dollars. How would she rather fill her schedule for the day? You bet 2X is greater than X - so it is a no-brainer for her.
"How cruel!", you say. After all of those countless visits over the years when she is getting to know you and your family, your pet's name, the kids' birthday parties. LIAR. She is not there when you need her. Sadly, however true- She is trying to make ends meet. She is concerned about getting a raise this year. The new family addition soon - Babies dont raise themselves she thinks. "And, those future college costs!". She is simply trying to provide.
Last year she made $160,000 for seeing 3,500 different patients for 4,000 visits for a grand total 4,500 RVU's. She made $35.56 per RVU. She would have taken home to her Man homemaker $32 dollars for your visit for the Doctor's note. If she saw only headcolds all day every day, she would make far less than her $160K/year that she is used to. In fact, she would make only $128,160/yr if she only saw sickly "I do not want to go work today" individuals like yourself.
Aren't you now feeling guilty now along with feeling sick?
A "Relative Value Unit" standard is an industry conconcted weighted medical difficulty statistical number (i.e., 1 headcold sick visit = 0.9 RVU, my sick diabetic example = 1.4 RVU). Trust me although these are decimal differences, they add up quickly over the course of the day, the week and yes, the year.
As many of you know, Doctors do not get paid by answering questions from phone calls, emails or even messenger pigeons. Doctors do not get paid from filling out your DISABILITY forms. Doctors do not get paid by providing you good care, bad care, or no care. We get paid the same regardless whether you do well or don't, whether you live or die.
In fact, The cynical amongst us (CERTAINLY NOT ME) would wrongly conclude - that the cold turned into that meningitis turned into that sepsis turned into that ICU intubation with the 21 day in-hospital stay turned into 30 day rehab recovery would actually be good for business. Please do not think this way.
But, I digress..
The point is Doctors get paid when your COPAY gets handed over and then they stop getting paid again until you are out of that EXAMINING room. Here is your hat, this is my hurry.
So HEAVEN's please, I will write your note, but - no office visit pleasantries today for the sake of my Baby's infant FORMULA!
As you see, in my example, if your Doctor would like to get a raise this year for a NEW BABY on the way - from 160k to 170K / yr - an extra $10,000 need, she would need to increase her yearly RVU productivity to 4,781 from 4,500. Assuming she works 240 weekdays a year (on average), she would have to see an extra 1.17 RVU visits per day. Remember there are only 8 hours of a typical working day.
Sorry, your head cold (at 0.9 RVU) just doesn't cut it. BE SICKER NEXT TIME.
Now if you had fever, a touch of pneumonia or perhaps even the flu, and needed an extra blood pressure check or a cool "RAPID FLU thing in your nose that tickles or hurts or both" -during your visit - NOW WE ARE TALKING.
With tongue firmly in cheek - I await your replies.
Editor's Note.
FYI - Be kind. I do spend the time - although my wife has our first little one on the way. I do worry about Infant Formula. I do worry about a new crib. I do worry about future College. More importantly, I worry most about the future of our for-profit Health care. Moral of my story - Stay healthy.