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Friday, August 19, 2011

The Council Has Spoken!! This Week's Watcher's Council Results


The Council has spoken, the votes have been cast, and the results are in for this week, carved eternally in the Akashic records of cyberspace.

One thing we've always taken for granted here in America is the availability of doctors and being able to see them in a timely manner. As this week's thought provoking winner, Working for Free: The Economics of Being a Primary Care Physician by the Razor reveals, if present trends continue, that maybe a thing of the past - especially if ObamaCare isn't repealed. Here's a slice:

Assume a business day of 8 hours. For each hour a family/primary care physician can see 3 patients at 20 minutes each. During each 20 minute visit a doctor has to review a patient’s history, listen to the patient’s complaint or reason for the visit, make a clinical diagnosis on how to best treat the patient’s problem, and assess the patient for signs of any other disease process. All this must be carefully notated in the patient’s chart to track progress and to document the visit for insurance purposes and in rare cases, legal actions.

So the doctor sees 24 patient’s in a day. Assume each patient’s insurance is billed $100 for the visit. Of that $100 the doctor’s practice expects to receive (including patient co-pays) $50. 50% of that $50 is kept by the practice to pay for overhead (medical assistants, receptionists, nurse practitioners, building costs etc). That leaves the doctor $25 per patient.

3 patients an hour means $75 hour, and that equals at 2000 hours a year, $150,000. This is a good wage by most standards. The problem is that doctors don’t work 2000 hours.

As well as seeing 24 patients, the doctor is responsible for managing physician assistants and nurse practitioners. He or she is ultimately responsible for the treatments made by these mid-levels and can be held accountable by the medical board and in court for any mistakes they make. This usually means monitoring what the mid-levels are doing, reviewing their charts, and assisting with their treatment options. This supervision is completely unpaid; the doctor is not reimbursed for his or her time.

Throughout the day test and lab results from current patients arrive on the doctor’s desk. S/he must review these and sign-off on them, adjusting medications or marking for follow-ups as needed. This work is unpaid.

Each refill request made by a patient must be reviewed and signed off by the doctor. He or she is not paid for this work.

20 minutes is not enough time to adequately document a patient’s chart. A doctor will often make quick notes during the patient visit and complete the chart after visiting hours. Charts for those with complex problems and chronic conditions can take upwards of 30-60 minutes to document each visit – all done for free.


In our non-Council category, the winner was a superb piece by Terry Glavin – The Final Nail In The Coffin Of The Pakistani Pantomime? submitted by Simply Jews. It outlines the misconceptions about the war in AfPak and especially about our 'ally' Pakistan that have cost us dearly in blood and treasure.


Here are this week’s full results:

Council Winners



Non-Council Winners



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