It’s About Time…….MY Time

In a small private obstetrics and gynecology practice, I used to think I would see a limited number of patients, and I would not see a very wide variety of medical conditions. I thought I would mostly see happy things — women who wanted to be pregnant (and I could help them); women who wanted to avoid pregnancy and just live their lives (and I could help them too!) and women who had symptoms throughout the reproductive spectrum (that I could help them get relief from.) In reality, it has not been exactly what I thought it would be. I do many exams that are supposed to be “Preventative”, or “annual physicals”, but rarely do I see anyone who comes simply for a preventative visit or a check-up. Almost everyone has a problem. Or three. I can see why patients become very frustrated with a medical system that usually slots a maximum of 15 minutes for visits, no matter what the age and no matter what the ailment(s). In the five years I have been in my own solo private practice, I have seen people who have been diagnosed with various cancers and pre-cancers, others who have multiple (sometimes unrelated) medical problems that have yet to be properly diagnosed, countless women who have menopausal symptoms making their quality of life horrible, and so many pregnant women with high risk complications that it would be impossible to evaluate and treat them properly in a fifteen minute spot.

This puts me in a dilemma of course. Since I own my own practice, I have set my own office appointment templates for how long I spend with each patient. New patients are seen for 45 minutes to an hour, annual visits and consultations are 30 minutes, and shorter visits, like for a problem, can usually be 15 minutes. The dilemma is with the insurance companies. Getting them to pay me appropriately for my time is next to impossible. On any given day, I have office staff on the computer and on the phone, trying desperately to get insurance companies to pay me for the care of the patients that have paid them -often large premiums — to be on their panel of insured patients. Insurance companies are constantly denying me payment for the amount of time that I need to spend with patients to appropriately take care of their problems.

Just this week, I saw a pregnant patient in the second trimester (21 weeks) who came in to the office with what she thought might be ruptured membranes (broken…