Peculiar Muse

“Why Don’t More Doctors Discuss Vaccines With Their Patients?” That is the question being asked on one of my favorite reads, the Wall Street Journal’s health blog. The author, Ms. Laura Landro, goes on to point out:

…high level of…failure by many physicians to discuss vaccines with their patients, let alone administer the ones recommended by the CDC…
For doctors, it often comes down to costs….

The article raises a very valid point – there truly is a need for doctors to address the issue of adult vaccines more often. I disagree however, about the “it often comes down to costs”. Actually, I do agree that is comes down to costs, but not in the way Ms. Landro seems to mean it. As in, the implication that doctors don’t discuss vaccines more often because they don’t get paid enough for them. Here’s another perspective from a within a physician’s office.

(This perspective is based on my own short, and now concluded, experience as a provider of primary care, and more extensive experience of some of my colleagues who provide such care every day).

Consider a typical office of a primary care physician (PCP). On an average, a PCP makes about $150,ooo a year. That’s the income of an internist – a physician trained in internal medicine. Family practitioners typically would make a little less, solo practitioners, even less. A PCP’s office typically would also have 3-4 staffers including nurses.

In this typical office of a PCP, now consider a typical day. To be able to make the above mentioned amount of money and hence, to be able to pay the staffers and the cost of the business, the appointment book is crammed with the names of 25 – 30 patients. Average time per patient? About 16 minutes. That’s assuming an 8 hour work day, with every single minute spent in only patient care related activity.

That does not mean 16 minutes actually spent in the room, with the patient. These 16 minutes also include the time spent in reviewing recent blood test results &/or other tests, reviewing medications, writing prescriptions, dictating or electronically updating the patient’s chart, and ‘coding’ correctly each time, every time. Did Mr. X recently see a specialist? What were the specialist’s recommendations? Add to this the ever present occasion of having to justify a test or treatment to a person at the insurance company who may have no idea what it is for, and frankly doesn’t care.

16 minutes! For all this. A 16 minute cycle for every patient. 25 to 30 times a day, all day.

I am not surprised that adult vaccines are not discussed as often as some would like. But I strongly disagree that a PCP – who’s busy making sure that Mr. X’s blood pressure and cholesterol are controlled without destroying the kidney and liver in the process, and that Ms. Y gets her mammogram and colonoscopy – that this PCP does not bother to discuss vaccines because the payment is too low.

I think it has something to do with the fact that this doctor has to see 30 patients in an average day to avoid going under – and taking 3 or 4 people with him.

I think it has something to do with the current state of healthcare in the USA.