The elderly gentleman is about to leave the urologist’s office after getting his treatment for impotence. He goes to the secretary and asks her why the fellow who just left was given a prescription for Viagra and he got Popsicle sticks and duct tape. “Oh, that gentleman has fee-for-service insurance and you have the HMO coverage.”

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One of the most disheartening aspects of bedside manner is how quickly loyalty goes out the window when the patient has to pay a few dollars more for your service than for the provider who belongs to their HMO. It’s not hard to understand how patients are willing to leave your practice if the out-of-pocket expense is considerable. After all, for many patients, coming up with hundreds of dollars to pay your bill is motivation enough to switch to a doctor whose bedside manner doesn’t compare to yours. When they leave your practice to save a few dollars by using a network provider, you have a right to feel betrayed.

As much as you may wish to think HMO’s will not affect you, it can happen. There was a time when doctors believed their patients would never leave them for medical plans that forced them to see foreign practitioners with language barriers and doctors with no bedside manner, but they were sadly mistaken.

Some doctors gravitate toward fields offering cosmetic procedures that today seem immune to managed health care. They may also fall to market forces one day. Already, patients go to other countries to have breast augmentation and other elective procedures. Clinics in most every country offer cosmetic procedures at discounted fees. Foreign doctors can be more competitive because costs are less, and they don’t have the regulation and threat of lawsuits found in America.

Remember, many patients assume every practitioner is competent. They think the procedures done at a discount mill are going to be the same as at your office.

 You have a few choices when dealing with managed care. You can join every plan on the market and schedule a hundred patients each day, you can strive for the boutique office and limit your practice to those who want to pay your fees, or you can accept managed care plans that allow you to provide decent care without seeing too many patients.

 Many young practitioners feel compelled to join every HMO in order to build a practice. That may be your reality, and in time your practice should grow exponentially. But try to avoid the trappings that prevent you from providing exceptional professional care, cause burnout, and never let you develop your full potential toward a great bedside manner. Once you live a lifestyle based on working excessive hours, it can be difficult to give up.

As you find yourself seeing more patients than is reasonable, reassess the benefits of bringing in an associate or of dropping the less fruitful plans, thus allowing you to grow a practice more suited to your personality and desire to live a balanced life. You can’t have any semblance of bedside manner, nor can you provide optimal care, if you have to see too many patients.