Kaiser Permanente.....yikes!!

[RySerr21]

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last friday i went to ask the doc ive been shadowing for a LOR, and he invited me in to eat lunch with them....im not sure what the deal was but it was like Kasier Permanente Bash-Fest 2008. they successfully convinced me to never ever work there....ever.

the cardiologist apparently used to work there, and one of their colleagues who just went over to kaiser already put in her two week notice b/c she cant take it anymore. she was talkin about how she was harassed like every day about how much time she spent with her patients. if it was ever more than 10 minutes she was in serioussss trouble. if a patiet had more problems than the 10 minutes allowed for, you have to tell the patient to schedule another appointment and come back later!!! she talked about how at the end of the month they printed out these sheets that had all the docs and how many x rays, mris, CTs, etc. that they ordered and if you were higher than the average you got totally flamed for it. she also talked about how everything you do is questioned, every single time. shed have a patient come in with a lymph node the size of a grape fruit, she'd order a biopsy and then get yelled at b/c it apparently isn't necessary.

i mean i understand that if a doc is ordering unecessary tests all of the time, something should be done about it. but what are you supposed to if a lot of patients that you see need additional tests done???? just not order it and tell them "sorry im already passed my quota for the month?" I just hope that when I am practicing medicine it is as far away from that as possible. The thing that gets me the most is the 10 min. time constraint. The DOs i've shadowed who have their own practice take anywehre from 15-25 min a patient! Sometimes they are quick and over within 10, but thats b/c the examination was complete and there was no other reason to be there!!

the complaints went on and on and on. it was a bit overwhelming!



p.s. i love when people trying to convince doctors to buy or endorse something come with lunches from Togo's or Subway or whatever it may be.....soooo awesome.

 

[endocardium]

Ah, yes, the joys of working for an HMO. 👎

 

[brianmartin]

The easy thing to do is "blame the HMO."

What you have to think about is why do we have such a push towards more efficiency. Well, of course efficiency is valued, but it becomes much MORE valued when you have incredible demand and poor supply. Fewer and fewer medical students are going into primary care because of the Medicare reimbursement structure. Time spent with patients is not highly reimbursed, only the nature of the visit and what tests/procedures get done.

Talk to any private practice family physician and they will tell you the same thing, they have to become volume practices and see patients for only 10 minutes too. The problem is the screwed up reimbursement system, not "Kaiser." That's why Kaiser started using NP's and PA's to do primary care, because it is now obvious they can handle the vast majority of cases.

Private practice doctors also have statistics gathered on them, and the groups voluntarily do this. It's not only at "Kaiser". I think your post makes it sound like Kaiser is some evil HMO when the fact is, these issues are systemic, related to how Medicare indirectly controls how doctors practice by tweaking the pay rates.

BTW, ordering unnecessary tests has been (and currently is) a problem. Only a small percentage of doctors are guilty of this but it does happen.