Thursday, October 14, 2010

Quantity Versus Quality

Lately, I’ve been wrestling with an issue that I’m sure many bloggers face: should I try to increase the quantity of blog posts or accept a reduce number of posts in the interest of maintaining the quality (or, more specifically, the originality) of posts. Said another way: is it better to get a post up one or more times a day to drive traffic or is it better to get one really good post up less frequently?

Gosh, come to think of it, this same conundrum will soon pertain to health care delivery, too. Blogging and patient care are not too dissimilar.

When starting a blog, lots of posts placed very often helps drive blog traffic provided, of course, that the content is not just spam. Adding unique ideas or adding appropriate commentary to stories that appear on the web adds value for a reader and grows readership.

Likewise, when starting out as a new doctor you need lots of cases with good outcomes to develop a following. People have to get to know you. Volume of cases that go well builds trust amongst your peers. Early on you’ve got to get out there and develop a track record – how else will people know your talents?

And like the blog-o-sphere, as time goes on as trust is gained, friends refer friends. Things ramp up and you hit a stride and become more efficient - a well-oiled machine. It’s great.

But with this added volume come new issues. The pressures to produce more and more grows whether written or surgical. The potential to grow revenues with more volume in both fields exists.

That’s the reality in business-related ventures.

But in each of these endeavors, time remains the one constant. Eventually more of anything reaches its capacity, and whether blogger or physician, we all must make a choice: do I continue building quantity at the expense of the quality of my work? Clearly for me, the choice is no. Limits must be set lest my quality on either front suffer.

Lately, I am finding new patients are having a harder and harder time getting appointments with me. My established patients remain. Like a blog, I must make a choice - see more patients in less time, refer my established patients to others, or cut my volumes. Or maybe I should use physician "extenders" to help with me the load? Might they be like using ghostwriters?

In the years to come doctors will continue to be tasked with seeing more patients in less time with a constant pressure to reduce costs to the system (and hence, their salaries). You simply can’t add millions of more people to our health care system in our new era of “health insurance reform” and not expect that the demand for clinical care will diminish and the associated costs decline. As price pressures mount, the pressure to cut "overhead" expenses will grow and adding more expensive doctors to the system to offload the pressure-head will not be as simple as it sounds. So for now, our greatest challenge will be to see more patients in less time with less salary without affecting health care quality.

And the truth be told: like blogging, something has to give.



jimbino said...

I enjoy your posts, but they'd be a lot more interesting if you would actually solicit concerns of your respondents and then post a thoughtful reply.

I'd personally like to see you post on why the hell doctors and hospitals don't post their prices.

You know as well as I do that detailed pricing by CPT is required for payment by Medicare, Medicaid and insurance companies. Why do you doctors hide the ball from your patients?

I myself try not to do business with folks, including physicians and hospitals, who so disrespect their clients that they hide their pricing.

It's easier for me to get the pricing on a nose job in Argentina, a boob lift in Brazil, cardiac surgery in Thailand and a root-canal in Mexico, etc, than to get a quote from an American physician or dentist.

DrWes said...


Price transparency? You want price transparency?

I suspect the day will come when "CarMax pricing" rather than new car dealership pricing occurs. We simply can't afford to do otherwise.

But ours is not a free market system. Pricing today is based on obfuscation so markups can assure acceptable profit margins. Everyone between the doctor and patient are in on the game and will make sure they get their piece before you get yours.

I've written tons on this before (example here).

I'd like to think that health care reform will help, but government price controls do NOT allow lowest pricing (witness the fairly static cost of ICD's over the years - Medicare rates permit these prices to remain elevated)

Until patients themselves gain responsibility for a greater portion of the costs, change will be slow to come.

Sadly, I think that giving "free" (or nearly free) care to Americans isn't like to help things as far as cost transparency is concerned.

Dennis said...

My wife works in a Assisted Living Facility as a Medtech/CNA for $10 bucks an hour. She is just as needed as the admin folks, the cooks and LPN/RN's who get a bit more or less in salary. Yet when she gets a deep cleaning done next month at the dentist, the tech will charge $360 for two quadrants that will take about an hour. This is a perfect example of the inequity of medical pricing. Think how long and hard she will work for that procedure. Sucks.. That said... no money no honey and let your teeth fall out. Oh well...

Anonymous said...

how do you have any short term new patient slots at all? is that a new problem or an old problem that is resurfacing?

DrWes said...

Anony 06:03 -

how do you have any short term new patient slots at all? is that a new problem or an old problem that is resurfacing?

Initially, I grew new patient slots by adding more clinic. But if one adds more clinic yet only sees established patients, then the "proceduralist" will slowly see their productivity wane. Many reserve slots for new patients as a result, but this necessarily makes it harder for established patients to get an appointment.

Another way to relieve the patient volume crunch is to add doctors (hence why hospital systems are adding doctors in droves), but this is an expensive way to grow volumes and adds significantly to the cost of care delivery.

jimbino said...

I read what you wrote about CarMax pricing and the comments. It seems we all agree on the problem.

What is missing is your recognition of the fact that all that is need to rationalize our healthcare market is to REQUIRE that all healthcare practitioners post all of their prices, just as Walmart, Sears and Lowes do, and just as Medicare does.

The light of competition would then lower prices and result in very satisfied customers.

But I ask you, Dr Wes, why are you not out front publishing your prices? For all your complaining, you are part of the problem, not part of the solution.

Anonymous said...

Ummmm. Quality, quantity, costs.

I humbly submit two pieces of literature that may offer some food for thought.

Regarding "quantity". Jonathon Swift: A Modest Proposal for Preventing the Children of Poor People from Being a Burden to their Parents, or the Country, and for Making Them Beneficial to the Publick. Perhaps we can amend the title to include: Burdens to Doctors and Those Concerned with the Imposition of Taxes. (Apology to Swift for corrupting his brilliant wit.)

Regarding "costs". Adam Smith and the Wealth of Nations. That treatise prompts thought of increasing the supply of doctors. Concerns have been noted regarding doctors educated in other lands. Why not increase the number of med schools here? While this increased supply may unfortunately lower doctor incomes (see CNN list of best jobs), but it will also decrease work hours (less stress) and allow docs more time with family. I hope that will make the possibility of reduced salaries more acceptable.

I know that leaves two other big concerns unanswered: med school costs and tort reform. But what the hell do you want us to DO about 35 million (and growing) uninsured people? Yes, something has to give. We've got too many people, too many aging people, too few doctors, too much cost, too few folks that will compromise, too few who will share the burden of a civil, enlightened society. We get it. I'm looking for something more than "something has got to give" and its subtle message of fear.

DrWes said...

Anony 12:46 -

Great quality, large quantity, low cost:

pick any two.

The choice is yours.

Anonymous said...

Dr. Wes,

Are you sure you mean that - 'cause I'll take quantity (cover the 35M)and lower cost. I'm pretty sure those are the two choices that are least appetizing to you.

The government just spent about $150K on my heart and I'm still 75, have COPD, and don't feel any better. I don't blame the docs - it's nature. And I think many of the tech improvements probably aren't that much better than the ones from the last generation but they do keep those reps employed. And by the way, I loved the private room but would suffer through a miserable roommate if it meant a savings of 10% of the room bill which is an unknown amount as already discussed.

So while I'm pretty sure we have no agreement (except for the lobby waterfall), I do hope you get a chance to re-read the Swift. What a wonderful piece of satire!