One of the telemedicine companies I work for sends their providers a monthly scorecard detailing their patient satisfactions scores and prescribing rates.
I did an experiment to try to see if I could half my prescribing rate and maintain/improve my patient satisfaction scores. I can’t share with you the beautiful screenshot of last month’s survey results but I’ll paint you a verbal picture.
Satisfaction scores: 95% → 96%
Prescribing rates: 83% → 58%.
Telemedicine Prescribing Rates
It’s common to see a ton of medications being prescribed on telemedicine platforms which likely has to do with patients calling in for seemingly obvious diagnoses which just need a medication to manage.
On this particular telemedicine platform the average physician has a 92% prescribing rate – 9/10 visits end with a non-OTC prescription.
The last time I got a report I had a prescribing rate of 83% with N=200 with the average physician having N=70.
This time I brought my telemedicine prescribing rates down to 58%. That’s a big improvement from last month.
Quite a few patients call in for medication refills so it’s a bit silly to include these individuals in the calculation as this telemedicine company has decided to do.
That said, there are a lot of medication refill requests which shouldn’t be refilled because the patient hasn’t done the proper lab monitoring. The examples I recall recently were metformin and furosemide refill requests which I had to deny.
By far the most frequent medication prescribed by telemedicine doctors appear to be antibiotics. There are a lot of azithromycin and ciprofloxacin prescriptions – perhaps the 2 most scrutinized antibiotics.
Antibiotic stewardship is necessary not because we want to protect patients or to decrease antibiotics resistance – that’s what we tell the med students. Patients sadly could care less and have little respect for the physician authority figure.
The point of antibiotics stewardship is so that as physicians we don’t lose the right to prescribe antibiotics.
A day could come when broad-spectrum antibiotics may have to be discussed with an ID doctor before being prescribed or even worse, having to run it by the CDC.
Soon after that telemedicine prescribing will be so strictly monitored that every other lawsuit will come from unnecessary antibiotic prescribing through an online platform.
I enjoy my $250/hour and for the sake of being able to continue to enjoy this delightfully simple income potential I urge my fellow physicians to aim for lower antibiotics prescribing rates.
Patient Satisfaction Scores
My goal was to improve my patient satisfaction scores which, in the previous month, was at 95%.
The average telemedicine physician at this company achieves patient satisfaction scores of 88% in the good/outstanding range.
The goal for this company is to have a 90% satisfaction rate.
This past month I experimented with lowering my telemedicine prescribing rates and managed to simultaneously achieve patient satisfaction scores of 96%.
High Patient Satisfaction Scores
I have always had the highest patient satisfaction scores regardless of what idiotic method was used to measure such scores.
As such a high-achieving clinician I know exactly what it takes to get these high scores – kissing the patient’s ass. I would love to think that’s it’s forming a genuine bond and displaying empathy but it’s not.
Kissing That Ass
My empathy is that I don’t want you as the patient to be harmed by a medication that you don’t need. I don’t want you to have excessively high hopes that a certain condition will resolve overnight.
2 days of cough and congestion and no fever and no blood in the mucus and no history of PNA and an otherwise healthy person … do you know where the empathy is in there? The fact that I managed to tease out all those questions.
At that point I should be able to tell you that based on what you have told me your symptoms are caused by a virus or seasonal allergies and all you need is xyz. You can ask me how to go about administering xyz but we’re not arguing about the fucking diagnosis.
Turning a No Into Something Positive
The fucked up thing is that I am now having to justify to this person why they don’t need antibiotics – why they don’t need a 10-day course of azithromycin because “that’s what helped me last time”.
Maybe other physicians feel differently but I always feel that I am the one entering the patient’s office and not the other way around. I’m in the hot-seat and I’m going to have to justify every that comes out of my mouth.
Kiss that ass. Kiss it good. Because when these scores come then it goes straight into your resume folder. It’s money in the bank if you know what to do with it.
Why Bother Optimizing Scores?
The utility of optimizing such metrics will be different from person to person.
This telemedicine company won’t get rid of you even if you have 80% patient satisfaction scores or 75%. Nor will they hassle you even if you have a 99% prescribing rates.
I’m not a maternal or paternal physician. I consider myself a more holistic physician. I put a lot of effort into researching the medications I prescribe and am aware of the complications for patients on long-term antibiotics especially when they already have family histories of cancers, diabetes, or IBD.
So, for the patient’s sake, it’s good to practice antibiotic stewardship.
But the patient doesn’t care so why should you? It’s a valid argument and I haven’t found the answer to it. But you have to be able to sleep well at night – make sure you can do that regardless of what you do.
Your resume won’t be harmed even if you have shitty patient satisfaction scores or high prescribing rates. Most medical groups won’t know to ask nor have the capacity to check.
However, when you have these scores neatly printed out with an N=500 then it’s a pretty impressive thing to hand to your interviewer. It says “I know I’m the right person for this job because my numbers prove it.”
Will management notice your stellar scores? Yes, guaranteed they will notice. Will they do anything about it? Probably not. Not because they don’t care but because they have 100 fires to put out and don’t have the luxury to pat you on your back.
It does provide you with bargaining power, however. Knowing when to capitalize on this is important.
After a few months of working for a particular telemedicine company where your patient satisfaction scores and your prescribing rates are erection inducing, it might might be a good time to email the CMO and ask, based on your stellar performance, if another position besides clinical medicine is available for you in the organization.
Saying No & Satisfaction Scores
Without a doubt, it’s much easier to get higher patient satisfaction scores by always saying yes to the patient. Let the overprotective mother think that little Jimmy is the most important guy in the world and that you’d prescribe him anything to make him feel better.
If you’re a surgeon you’re only good if you can do a surgery for a patient. If you’re a PC then you’re only good if you can prescribe a medication while offering the least resistance to the patient.
In order to dissociate the relationship between satisfaction scores and prescribing rates you must inject a 3rd factor – ass kissing. Lots of it. The juicy kind.
Ass kissing isn’t taught in medical school, not in residency, and not even in your medical group’s bullshit empathy courses.
Ass kissing is something you learn on the job. Look for the doctor with the most callused lips. I feel bad for the doctors who refuse to drop down to my level because it makes their job harder.
Purse those lips ladies and gentlemen. Create a -5 psi of pressure. Squeeze the buccinator. Finish by batting your eyelashes. Expel emesis in the wastebasket.
Capitalizing On These Scores
I will aim to repeat these number for 1 more month and then I’ll be chasing in my chips.
If you are looking to advance your career then you’re either looking to add something new to your resume or learn something new.
Perhaps you’re interested in a leadership role or just want to do less clinical work and achieve a higher salary.
“I’ve been a telemedicine provider on your platform for the past 6 months and I have attached my most recent patient satisfaction scores and prescribing rates.
“You can see that I am a high-performing clinician and I hope this demonstrates my dedication to our patient population and to the organization.
“I would like to meet with you to discuss some work opportunities outside of my current role. I am interested in furthering my career and learning more about the organization.”
Maybe you love clinical work and aren’t looking for career advancement but don’t want to get paid 20 measly dollars per patient.
“Please see attached my performance on your platform over the past few months. I believe these numbers demonstrate my commitment to patient care and to the mission of your organization.
“I am writing you to discuss options to increase my remuneration for my clinical work. I am passionate about clinical medicine but want to be able to dedicate more of my resources to your company.
“Please let me know when we can meet to discuss potential opportunities.”
Sure, you’ll get some no’s but don’t stop. Get creative. At first they will say that all clinicians will get paid the same amount – “it’s our algorithm, we can’t change it”.
That’s fine. You’re willing to see their complex cases. You’re willing to see patients at less desirable times, etc. Be flexible. Open up the communication channels and don’t give in until you get some sort of a raise.
Calling Your Bluff
If you are working for several telemedicine companies and are performing well in all of them then use them against each other but be willing to have them call your bluff.
“I am being offered by company X to take on more shifts and the volume allows me a better income. However I would prefer to stay with your company. Is there a way I could get a higher income per patient or per hour and that way dedicate my time solely to you guys?”
“If I can’t get paid a higher wage could we settle on a few employment benefits while I remain a per diem with you? I would be interested in having my medical licenses, a laptop, a cell phone, and my health insurance expenses covered by your medical group.”
You’re not being cocky. You’re being honest and you are demonstrating that you value your skills. Sure, a large corporate medical group like Kaiser Permanente won’t care to differentiate between you and the other doctor who can’t even wash her face before coming into work. But these highly competitive telemedicine companies can’t afford attrition of good talent.
Be willing to cut back your hours on their platform if they don’t care to work with you. Take the same effort and energy and place it in another company. Eventually it will pay off.