The latest issue of Family Practice Medicine has an article on patient satisfaction scores.
I remember my first patient satisfaction score VIVIDLY.
I am in my first family medicine job in Alamosa, Colorado. I receive a 21 page handout with multiple graphs about my patient satisfaction scores. I am horrified because I score 30% overall. I am more horrified by the score than the information that I will not receive the bonus.
I go to my PA (physician’s assistant). He too has scored 30%. We are clearly complete failures as medical providers.
Then I go to my partner who has been there for over 20 years.
She snorts. “Look at the number of patients.”
“What?” I say. I look.
My score is based on interviews with three patients. Yes, you read that correctly. THREE PEOPLE.
And I have 21 pages of graphs in color based on three people.
I am annoyed and creative. I talk to the Physicians Assistant and we plan. I call the CFO.
“My PA and I think we should resign.”
“We scored 30% on the patient satisfaction. We have never scored that low on anything in our lives before. We are failures as medical people. We are going to go work for the post office.”
“NO! It’s not that important! It is only three patients! You are not failures!”
“Three patients?” I ask.
“Yes, just three.”
“And you based a bonus on three patients? And sent me 21 pages of colored graphs based on three patients?”
“I think we should discuss the bonus further….”
I did not get the bonus. It was a total set up and I am not sure that ANYONE got that bonus. Much of the maximum “earning potential” advertised was impossible for any one person to get. You would have to work around the clock. They got out of paying us by having multiple bonuses that each required a lot of extra work…. They were experts in cheating the employed physicians. That became pretty clear and I was 5th senior physician out of 15 in two years, because ten physicians got right out of there. I lasted three years, barely. I knew I would not last when an excellent partner refused her second year of $50,000 in federal rural underserved loan repayment to quit AND stayed in the Valley working in the emergency room. I called the CEO: “Doesn’t this get your attention?”
“She just didn’t fit in.”
“Yes, well, I don’t think anyone will.” I asked my senior partner how she stayed. “You pick your turf and you guard it!” said my partner. I thought, you know, I hope that medicine is not that grim everywhere.
Unfortunately I think that it IS that grim and getting grimmer. Remember that in the end, it is we the people who vote who control the US medical system. If we vote to privatize Medicare, we will destroy it. Right now 1 in 5 doctors and 1 in 4 nurses want to leave medicine. Covid-19 has accelerated the destruction of the US medical non-system, as my fellow Mad as Hell Doctor calls it. We need Medicare for all, a shut down of US health insurance companies, and to have money going to healthcare rather than to paying employees $100,000 or more per year to try to get prior authorizations from over 500 different insurance companies all with different rules, multiple insurance plans and different computer websites. Right now I have specialists in four different local systems. The only person who has read everyone’s clinic notes is ME because it is nearly impossible to get them to communicate with each other. Two of them use the EPIC electronic medical record but consider the patient information “proprietary” and I have to call to get them to release the notes to each other. Is this something that we think helps people’s health? I don’t think so. I have trouble with the system in spite of being a physician and I HATE going to my local healthcare organization. Vote the system down and tell your congresspeople that you too want Medicare For All and single payer.
Physicians for a National Healthcare Program: https://pnhp.org/
Healthcare Now: https://www.healthcare-now.org/
I have had people say, but think of all the people out of work when we shut down insurance companies. Yes AND think of the freedom to start small businesses if we no longer have to fear the huge cost of insurance: Medicare for all!
I think you are on target for all the points.
Staff shortages are not all the fault of covid fatigue. There was lots of stress before covid came along; covid just knocked the pins from under a reeling system.
I am old enough to remember when HMO meant health maintenance organization and not health management organization. It seems to me that about that time the rot really started setting in. All of my providers, God Bless them, are on the edge of leaving for somewhere else, I’ve had to change practices this year, and everyone complains about the new notes system, and everyone seems desperately overworked. But the bloody customer survey lands in my mail after every visit. And having been victimized by them elsewhere I religiously fill them out with extra comments. You have to support those who support you.
One of my partners at the next job found that anyone could log on and fill out a patient satisfaction scare for any provider. She announced at the next meeting that she’d given five of us 10/10 scores. I thought that was pretty creative too.
I also panned one visit. It is supposed to be confidential. But an administrative person said something about me panning a visit in a meeting. I said, um, did you just violate HIPAA? yep, she did.