Why Doctors Fail

\"genius\"We are not geniuses.  We are not anywhere near at our full potential.  We see so many areas where we could improve.  Yet, for some reason our practice is considered very well-run.  We are frustrated at our shortcomings, but patients are thrilled by our strengths.
This afternoon, I walked into the exam room 45 minutes late.  I got a late start when my first few patients didn\’t get put back until 20 minutes late.  That frustrated me.  Then I got even further behind when my patients kept asking questions and adding problems for me to think about (the nerve of them!).  So when I walked into the exam room and immediately apologized to the woman in the exam room.  I was frustrated.

She paused, then smirked, then said \”This is about as fast as I have been seen at any doctor\’s office.  I usually have to wait almost two hours.\”

Two hours?  Have you ever a grocery store and had to wait two hours to check out?  Would you wait two hours to get your oil changed?  Would you be impressed if your date showed up two hours late?

Not all doctors are so bad at customer service; but the reputation is definitely well-accepted.  Lawyers and accountants have reception areas, hotels have lobbies, and doctors have waiting rooms.  Is it a coincidence that we call those we care for patients?

So why is it so hard on PCP\’s to make a living?  They have an incredibly marketable skill – one that is in short supply and highly valued.  Yet few are happy with their income.  Whose fault is this?  Is it the insurance companies\’?  Is it the government\’s?  While I think these entities play an important part in the struggle of the PCP, I think that there is something else.  Why would physicians in my practice be able to earn more than 90% of PCP\’s?  Is it that we are so good, or that the bar is simply low?

The job of physician requires very little long-term planning.  A doctor thinks very little about the patient when they are not face to face with them.  Decisions are made, the encounter is over, and the doctor goes on to the next room.  Strategy and planning – two things that are very important for business – are really not something most doctors do much of.  When I see a patient, I react to what is in front of me.  I look at the blood pressure, listen to today\’s story, and make a plan with what I have.  Rarely do I go back and research the best approach to the problem.  Rarely do I spend more than 15 minutes thinking about a specific patient\’s problem.  It just isn\’t in the nature of the job.

Running an office is takes a totally different set of skills.  It takes research, planning, consistency, patience, and dedication to a goal to make a successful business.  If you react to every situation that is in front of you in business, you change constantly and never get to a goal.  The payment system in the past was so favorable that doctors could make a good living despite running the business side poorly.

\"planning\"from www.despair.com

Our practice got lucky.  If I was in charge of our practice, we would be constantly changing and never finishing tasks.  We would have big plans, but get lost in the details.  If my partner were in charge, we would be so stuck in details that we would never even see the goal.  If my other partner was in charge, we would be all about building relationships and avoid tough confrontations necessary to succeed.  Somehow, however, the three of us work in a way that covers the bases.  We trust each other too – which is essential.  I didn\’t hire the other two physicians because of these traits; it was just good fortune.

So what\’s the point?  Being smart is not enough if you want to run a business.  Being proactive smart is far more important than being reactive smart.  Being patient and sticking with a task is far more important than being creative and quickly solving problems.  Business problems take a long time to solve, and I really wonder if most doctors have the patience for that.  For the small practice to succeed, doctors need better business skills than ever before.  What it takes, however, is not more book knowledge; it takes knowing your strengths and finding people to help where you are weak.

Can most docs do this?  I have my doubts.

20 thoughts on “Why Doctors Fail”

  1. The pediatric surgeon I work with always told me that getting doctors to work together in business is like herding cats. You are in fact lucky to work with partners who recognize eachother’s strengths and weaknesses. I also think that the egos carried by many MDs inhibits their capacity as businesspeople Interesting thoughts.

  2. The pediatric surgeon I work with always told me that getting doctors to work together in business is like herding cats. You are in fact lucky to work with partners who recognize eachother’s strengths and weaknesses. I also think that the egos carried by many MDs inhibits their capacity as businesspeople Interesting thoughts.

  3. i know i’m a poor administrator. i just want to do what i’m trained to do and leave the rest. it causes a fair amount of chaos. your points are well taken.

  4. i know i’m a poor administrator. i just want to do what i’m trained to do and leave the rest. it causes a fair amount of chaos. your points are well taken.

  5. This is quite possibly why larger (3 or 4 GPs) practices in the UK often have a practice manager, who is a manager and not a medic, is so the doctors can concentrate on doctoring and not practice management.

  6. This is quite possibly why larger (3 or 4 GPs) practices in the UK often have a practice manager, who is a manager and not a medic, is so the doctors can concentrate on doctoring and not practice management.

  7. I once waited 45 minutes in a doctor’s lobby before walking up and asking how much longer it was likely to be. The response was more than an hour. Just to clarify, I asked whether they meant *another* hour, on top of what I’d already waited – yup, they did.
    I asked why they hadn’t told me when I got there. They were confused, and said it wouldn’t have made any difference, because it still would have been a 2-hour wait. I told them that *of course* it would have made a difference, I’d have left and gone back to WORK for more than an hour, and come BACK 2 hours later, but that having already sat there for 45 minutes, I really couldn’t take the time to do that and they’d have to cancel my appointment (it was a routine appt., not an urgent issue). They were confused, and started to argue about the doctor’s time being important…. I told them that if they didn’t understand that my time was important enough to warrant a simple, courteous warning that they were running *that* late, then I’d be finding a doctor that realized that his/her patients were people, too.

  8. I once waited 45 minutes in a doctor’s lobby before walking up and asking how much longer it was likely to be. The response was more than an hour. Just to clarify, I asked whether they meant *another* hour, on top of what I’d already waited – yup, they did.
    I asked why they hadn’t told me when I got there. They were confused, and said it wouldn’t have made any difference, because it still would have been a 2-hour wait. I told them that *of course* it would have made a difference, I’d have left and gone back to WORK for more than an hour, and come BACK 2 hours later, but that having already sat there for 45 minutes, I really couldn’t take the time to do that and they’d have to cancel my appointment (it was a routine appt., not an urgent issue). They were confused, and started to argue about the doctor’s time being important…. I told them that if they didn’t understand that my time was important enough to warrant a simple, courteous warning that they were running *that* late, then I’d be finding a doctor that realized that his/her patients were people, too.

  9. Yes, I’ll wait a long time once, up to an hour, as long as the receptionist lets me know how long it will be, on the principle that it could be an aberration. I’ll even wait a second time, although I’ll discuss it with the receptionist (and with the doctor, if necessary). A third time will be the last time — if I have any choice of doctors, I will leave after half an hour, and find another. If I were an hour behind with my clients, I would soon have no clients. I respect my clients’ time, and I expect a doctor’s office to respect mine.
    There’s no reason why a doctor’s office can’t run approximately on time, the same as any other business. Certainly there are emergencies, or unexpectedly complicated cases, and that can mess up a schedule on occasion. But doctors and receptionists have to agree that the schedule should be realistic. Once a practice is established, and it becomes clear how long each doctor typically takes with a patient, it should be easy to figure out how many patients a doctor can usually see, realistically, in a given number of office hours. If an office consistently makes too many appointments for the time available, so patients always have to wait, and if no effort on my part can keep me from having to wait a long time, I presume the doctor is busy enough, and doesn’t need my business.

    I used to have an ophthalmologist whose office scheduled all morning patients for 10 AM, and all afternoon patients for 1 PM. On top of that, they always scheduled too many patients. Not knowing this, you might arrive at 1 PM and not leave until after 5. The doctors were really excellent, but I’m not going there any more.

  10. Yes, I’ll wait a long time once, up to an hour, as long as the receptionist lets me know how long it will be, on the principle that it could be an aberration. I’ll even wait a second time, although I’ll discuss it with the receptionist (and with the doctor, if necessary). A third time will be the last time — if I have any choice of doctors, I will leave after half an hour, and find another. If I were an hour behind with my clients, I would soon have no clients. I respect my clients’ time, and I expect a doctor’s office to respect mine.
    There’s no reason why a doctor’s office can’t run approximately on time, the same as any other business. Certainly there are emergencies, or unexpectedly complicated cases, and that can mess up a schedule on occasion. But doctors and receptionists have to agree that the schedule should be realistic. Once a practice is established, and it becomes clear how long each doctor typically takes with a patient, it should be easy to figure out how many patients a doctor can usually see, realistically, in a given number of office hours. If an office consistently makes too many appointments for the time available, so patients always have to wait, and if no effort on my part can keep me from having to wait a long time, I presume the doctor is busy enough, and doesn’t need my business.

    I used to have an ophthalmologist whose office scheduled all morning patients for 10 AM, and all afternoon patients for 1 PM. On top of that, they always scheduled too many patients. Not knowing this, you might arrive at 1 PM and not leave until after 5. The doctors were really excellent, but I’m not going there any more.

  11. “There’s no reason a doctor’s office can’t run approximately on time.”
    Actually, that is an over-statement. Some types of practice certainly can keep on-time because their visit types are more predictable (dermatology). Our practice schedules patients every 15 minutes, regardless of the reason (except for a few we know will be longer, we schedule for 30). On average, this works out fine, but there are days when everyone has hard things they want me to talk about – and I can’t ignore them. On those days, I run up to 60 minutes late.

    Really, my patients have a choice: do they want a doctor who is always on time, or do they want a doctor who will take the time needed with each patient to take care of whatever is needed? I cannot cut people off if they need me. There is no way my office staff can figure this out (believe me, we have tried).

    That being said, most days I do much better, and so when I am running overtime, my patients assume I have a good reason. This is one of the perks of being well-established.

    OB/GYN’s have very good reasons – babies being born – to not run on-time. The gist of this is that there are some good reasons, but there is also simple mismanagement. I think man doctor’s offices are blaming the latter on the former.

  12. “There’s no reason a doctor’s office can’t run approximately on time.”
    Actually, that is an over-statement. Some types of practice certainly can keep on-time because their visit types are more predictable (dermatology). Our practice schedules patients every 15 minutes, regardless of the reason (except for a few we know will be longer, we schedule for 30). On average, this works out fine, but there are days when everyone has hard things they want me to talk about – and I can’t ignore them. On those days, I run up to 60 minutes late.

    Really, my patients have a choice: do they want a doctor who is always on time, or do they want a doctor who will take the time needed with each patient to take care of whatever is needed? I cannot cut people off if they need me. There is no way my office staff can figure this out (believe me, we have tried).

    That being said, most days I do much better, and so when I am running overtime, my patients assume I have a good reason. This is one of the perks of being well-established.

    OB/GYN’s have very good reasons – babies being born – to not run on-time. The gist of this is that there are some good reasons, but there is also simple mismanagement. I think man doctor’s offices are blaming the latter on the former.

  13. Well Rob, the doctor I used to go to frequently ran late, sometimes up to 1 hour late. There was what most of the patients regarded as a good reason for this. He was forced to schedule 6 minutes for an appointment, and just refused to let the time he actually spent with patients be that short unless that was genuinely all they needed.So I’d endorse our argument above; if the patient needs more time than was scheduled, take it!

  14. Well Rob, the doctor I used to go to frequently ran late, sometimes up to 1 hour late. There was what most of the patients regarded as a good reason for this. He was forced to schedule 6 minutes for an appointment, and just refused to let the time he actually spent with patients be that short unless that was genuinely all they needed.So I’d endorse our argument above; if the patient needs more time than was scheduled, take it!

  15. Really, my patients have a choice: do they want a doctor who is always on time, or do they want a doctor who will take the time needed with each patient to take care of whatever is needed? I’d like a 3rd choice – a doctor with front desk staff that lets me know when I check in (before taking my money) that the doctor is running late, with a rough idea of *how* late. That way I have a choice of waiting, rescheduling my appointment, or leaving to run another errand and coming back at the pushed-back time.

  16. Really, my patients have a choice: do they want a doctor who is always on time, or do they want a doctor who will take the time needed with each patient to take care of whatever is needed? I’d like a 3rd choice – a doctor with front desk staff that lets me know when I check in (before taking my money) that the doctor is running late, with a rough idea of *how* late. That way I have a choice of waiting, rescheduling my appointment, or leaving to run another errand and coming back at the pushed-back time.

  17. I run on time and I leave time for my patients. I generally book based on the worse case scenario. So many times I am done before my next patient arrives. It cuts into my paycheck but everyone should be allotted the same respect for their time! My biggest issues occur when a new patient arrives 10 minutes late for their appointment and they still have paperwork to fill out. Emergency patients can run me 15 minutes behind and when my staff or I explain this to the next patient they or more than satisfied to wait. I usually catch up within a patient or two. If you cant keep up with respect to time higher another doctor. Your arrogant if you think your so good patients understand why you run late. IMO.

  18. I run on time and I leave time for my patients. I generally book based on the worse case scenario. So many times I am done before my next patient arrives. It cuts into my paycheck but everyone should be allotted the same respect for their time! My biggest issues occur when a new patient arrives 10 minutes late for their appointment and they still have paperwork to fill out. Emergency patients can run me 15 minutes behind and when my staff or I explain this to the next patient they or more than satisfied to wait. I usually catch up within a patient or two. If you cant keep up with respect to time higher another doctor. Your arrogant if you think your so good patients understand why you run late. IMO.

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