“Less inclined” is not correct; the correct term is “less able.” For an example see @Mighty_Mouse’s post immediately before yours.
I do agree though, that the patient is a customer, but a very strange type of customer that may not be paying the bill, and is not able to make decisions based on cost. Services provided to the patient can be the product, though, regardless of which entity is paying.
And why can’t a customer easily go to a different cardiologist without having to pay the whole thing out of pocket?
~Max
Max_S proving once again that there is no limit to your confidence if you are profoundly ignorant. A bigger dickhead than the 9/11 truthers.
I don’t think it serves anyone to have a glut of underemployed cardiologists.
What might—just maybe—be better is to have an underlying system that was large and elastic enough to absorb some inefficiency and inelasticity in the cardiology sector. Say, a single-payer system that is willing to pay for some redudancy within the system so that patients can be treated within a reasonable time frame by people with the appropriate expertise.
Of course, such a thing still costs money, and Americans seem to have chosen to let the insurance companies dictate the terms of access to services and quality of care.
As an American/Canadian, I voted with my feet. We certainly have problems with access to care (in part due to the MUCH higher salaries available to medical professionals in the USA, enticing many Canadian doctors south). I can assure you, though, life is better without co-pays. Earlier this week I took my mom to see a doctor at a walk-in clinic, have an X-ray, and have blood drawn. It took the better part of three hours (most of that waiting for a free phlebotomist), but cost precisely $0.
I’ll tackle both of these at once.
According to the nurse I spoke to today on the phone (who cancelled my appt), it is the Nurse Practitioner (NP, the patient interface between the Cardiologist and the patient) who is apparently out (due to illness, I was led to believe). Because of that, the other nurses are having to cover her patients as well as new high-priority issues as they come up. Now, this clinic is a satellite office, where all the professionals work (and live) in the major city 90 miles away. As I understand it, the Cardiologist(s) come down one day a week. The NPs two or three days a week. Others, as needed.
So, if a NP is suddenly out, the other NPs are running ragged, and the LNs are pulling up the slack whenever they can. So, the other nurses are being spread out over the countryside, dealing with cardiac issues (prescribing medication, referring issues to remaining NPs and/or cardiologists as required). Being able to push non-essential blood draws to a later date helps relive pressure.
I am really not that put out by having to wait another 2 weeks to have my cholesterol checked. Like I said, I am not concerned about it. I am sure it’s fine.
I am tired of having the medical establishment giving the insurance companies more influence (or control) over my care than I do. It is rare that the Drs explain to me why a procedure is being recommended beyond that it’s covered by insurance. It gives me the feeling they are not telling about possible treatments simply because they are not covered by insurance.
To cover Max_S’s points, they might be valid in a free market, but the insurance companies and medical administrators have colluded to prevent free market forces from being in play. It’s not that the demand for cardiologist is inelastic, it’s that the insurance companies and medical administrators are keeping the supply of cardiologists in the area inelastic.
Pretending that a “free market” exists where it is patently obvious that none exists is the modern version of the grandfather rule.
Well, you one-upped me. Cardiologists take so long to train that even without any collusion the supply would be nearly perfectly inelastic. The other problem is that the whole supply of cardiologists do not operate on a single market - at least not for most customers. Only a subset of cardiologists are covered by any given health plan, so it really is the market itself being restricted. Because otherwise, you bet, customers would just find another cardiologist. Like we do with hairdressers or insurance agents.
~Max
If we lined up all the proctologists in the world end to end they still couldn’t reach up your ass far enough to find your head.
So the two situations are exactly the same except for the ways in which they’re completely different. Got it.
You evidently didn’t see excavating_for_a_mind’s original post that I replied to, where it was complained, why do doctors’ offices treat patients so poorly when other, hospitality services don’t? And the suggested answer was, because patients aren’t the customer, doctors’ offices don’t have to treat them deferentially with customer service.
~Max
I don’t see how you can draw that incorrect conclusion from what I wrote. It’s the post that revived the thread, and it was interesting, so of course I read it.
I thought she acknowledged the point I was trying to make from the outset.
I agree that getting rescheduled is annoying, though. Just a couple weeks ago my PCP had to cancel on my annual visit, which they wanted to rescheduled three months later with another doctor in the system. Seeing as I then moved to a different city… will probably end up going with a different doctor.
~Max
It’s not the re-scheduling, or that it’s annoying. It’s the conformation that, as the one with the complaint who is seeking the addressing thereof, has no authority over their treatment.
Like I tried to imply above, it’s not that the timing in inconvenient, it’s that the major impetus is not how to let the market provide what is best for the patient, but what is best for the practice. I had a blood draw last week to check my A1C. It would have been trivial matter to roll the cardiologist’s blood test into the one my GP wanted. They are even on the same practice group. But, both offices would have lost money from the insurance, since they get paid per draw. Patient comfort be damned.
Patient comfort vs Max_S’s employer (or parent, I’m not sure) making another $100?
Why do you hate the free market? Are you a communist?
It probably wouldn’t have been trivial, as they probably aren’t set up to coordinate. What would be trivial, and what i still think you should request, is to get that blood draw done at another place, like qwest, that has capacity to see you when they schedule you.
I solved the cardiologist conundrum myself.
At one time I didn’t have a cardiologist. Then I had unstable angina and needed a stent, so I found a cardiologist.
After the stent I was symptom free . I went to a scheduled postoperative visit where even the receptionist was shocked to find that my insurance copay for the visit was more expensive than what they’d charge me if I was uninsured.
At the visit the cardiologist asked how I was doing and I told him I was well. Ten seconds of auscultation of my chest and I paid the lady and went home.
I decided I no longer needed/could afford a cardiologist and have been fine since.
So there’s still Covid going around and my patients are getting sick. Luckily I can prescribe Paxlovid. The government isn’t providing it for free anymore but most insurances cover it, don’t they? It’s got to be cheaper than the prolonged ICU visits it will prevent. Besides, my patient has three insurances: Medicare, a part D for medications and another supplemental to cover additional medications. So I’ll just prescribe it for him and his wife. Just a quick check first out of curiosity to see what the cost would be for an uninsured patient.
OK, so Pfizer charges the government about $500-600 for a five day course. So that would be crazy expensive. The cost to the public is $1390. A quick check of GoodRx shows the cheapest price in this area is over $1400. Good thing they have insurance. I’ll just enter their orders in and wait for my system to tell me their actual costs which are…….$1975. Yes, they need to come up with $4000 if they want to try to stay out of the hospital.
Now off to check for assistance plans. Pfizer has an assistance plan which is only for commercial insurance, not Medicare or Medicaid. But wait, they have a plan that helps with Medicare that expired in December 2023, or maybe 2024. They seem confused. All I have to do is get the patient to sign up- between 8AM and 6PM Monday through Friday and once they have processed the paperwork they will ship the patient the medication, which needs to be started within 5 days and it’s already been 2 and I really really hate this part of the job and that’s before we even start calling pharmacies to see if anybody has it in stock.
OK, I’ve done more research and apparently there is a Medicare and Medicaid option until the end of the year. And I was wrong about the call times. They are apparently open Saturdays but not Sundays and you actually have to call before 3PM EST. And they will overnight it to you, but we are still talking a 48 hour delay. Also it looks like they may have to shell out the $4000 then wait to be reimbursed.
And I still hate this system.
Holy shit. I can afford that. But I’m glad i declined when my doctor suggested i should take paxlovid. That would have really pissed me off. And while i was pretty unhappy for a couple of days when I had covid, i don’t think paxlovid would have made me $2000 happier.
And i live in a well-supplied urban area and the “finding the pills” part wouldn’t have been too bad. And staying out of the hospital would, of course, be worth $2000, but i was never sick enough to consider hospitalization. Yeah, you don’t know in advance. I’m glad i don’t have your job, at least for stuff like that.
My dad in the US is on paxlovid now. He’s at high enough risk that the cost is worth it, but holy hell, that’s infuriating.