Shrinking Staff Levels Can Lead to Unhappy Patients

Dr Skin has been in practice for 30 years. He has a very busy practice. Like many practitioners, he has aspects of his practice he loves and others he does not.

Two years ago, he decided that he could no longer deal with the hassles of running an office and he sold the practice to a private equity (PE) interest. 

David J. Goldberg, MD, JD, director of Skin Laser & Surgery Specialists of New York and New Jersey, past director of Mohs and laser research at Icahn School of Medicine at Mount Sinai, and adjunct professor of law at Fordham University School of Law in New York, New York.

With the deal done, he believed he could relax and still practice dermatology. He soon realized otherwise. During the first 6 months after the integration, the PE firm cut his office staff in half. Many of his patients began to complain of long delays in the waiting room. In speaking with other practitioners who had sold to PE firms, he found some who had added staff, whereas others had seen staff levels sharply reduced.

In a recent medical malpractice case, the patient sued Dr Skin over a scar caused by a procedure. The case was evaluated according to the standard medical malpractice process. Did Dr Skin breach a reasonable duty? Was there a nexus between that breach and resultant damages? 

One of the disturbing aspects of the case was how angry the patient was about the communication skills of Dr Skin’s staff. More than once, the aggrieved plaintiff complained about how long she would have to wait to see her dermatologist. She said that if the staff had only communicated better, she might never have initiated a lawsuit. Dr Skin learned that, although he wants to keep his patients happy, he no longer has control over the hired staff.

Recently, one of his patients who is an information technology (IT) specialist became angry when Dr Skin was late for a scheduled appointment. The IT specialist calculated his hourly wage and billed his doctor for the time he had to wait. Dr Skin chose to pay the bill. Was this a smart move? 

Many doctors use cash, gifts, and/or credit for future appointments to compensate patients for time spent in the waiting room. Most dermatologists are not drinking coffee or scrolling social media while their patients lose valuable time in the waiting room. More commonly they are seeing other patients who demand and need additional time. With a reduced staff, it is more difficult to move patients in and out of rooms. Complex clinical dermatologic questions rarely can be answered in 5 minutes. These unpredictable interruptions have a cascading effect.

Many doctors’ offices notify patients if the doctor is behind schedule. Some offices provide patients with pagers so they do not feel confined to the waiting room. Patients appreciate these courtesies, and such methods often sidestep any anger patients otherwise may have because of long wait times.

Most patients understand that if they are kept waiting it is because the doctor is dealing with patients before them. They rightly assume that if their problems are complex the doctor will also take the appropriate time to deal with their problems. Because of that, of course, the next patient may be delayed.

With the complications of today’s dermatology practice and the varied approaches to running such practices (private equity, university, or small privately owned practices), issues such as these will only increase. The broader issue here for Dr Skin and all dermatologists is the concept of establishing proactive communication. This helps to build the very core of the patient-physician relationship. By dealing with this proactively, Dr Skin is unlikely to receive many bills from patients for their time.