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I've never had a problem across several doctors on getting a direct reply to my message. For me, there is an SLA. They explicitly state I'll receive a reply within 24 hours. That has been true across multiple health systems I've used.

Edit: In no way am I saying "American healthcare is just fine!" only that I actually have had a really good experience using messaging to communicate with my care teams.

Are you, by chance, using concierge doctors?

Negative.

Wild. I've never seen anything remotely close to an SLA with the healthcare professionals I've seen.

I don't know what is happening elsewhere I suppose. I'm a PhD clinician at a US public academic medical center and respond to patients within 24 hours even if it's to say "let me check on that...it may take a week to get the answer/letter/etc." I'm pretty sure that's the expectation for all our MD/DOs and other clinicians. We don't bill for it, and it doesn't contribute to our targets, but it just seems like it falls under a salaried expectation to me. It's for the patient.

That said--hospital management, driven by the insurance world, tries to wring as much uncompensated labor out of the medical workforce as possible. Doctors (including my MD colleagues) do not get together to limit the number of doctors available. That's baseless conspiratorial thinking that doesn't withstand a moment's scrutiny when you understand the incentives at work in American healthcare.

> Doctors (including my MD colleagues) do not get together to limit the number of doctors available.

There are limited slots each year at the accredited schools you must attend in order to acquire your role.

Nobody's accusing you of doing it - but the number of doctors is limited

Not everyone is accusing the doctors involved, but when I wrote the comment, there were numerous armchair expert opinions squarely blaming the doctors, including at least one who said that doctors limit the number of training slots available to keep their prices high. Thankfully, those perspectives have been addressed or at least outpaced by better thought out criticisms since then.

Ultimately, the number of training slots in the current system is limited by MHA and MBA administrators who see training and instruction as subservient to profits, not the doctors who make up the departments and training faculty. Or, more broadly, they are limited by the healthcare operations not being legislated in a saner way. I was just clarifying.

> I wonder if charging for these messages will make doctors more likely to respond. I wouldn't mind a modest copay for these.

How long until administration figures out that they can juice revenue by shitting up the emails to increase back-and-forth traffic?

Hah, in MyChart, my provider has started having an MA answer your emails, and then "I'll forward this to the provider". Waiting to see if I get billed for the MA's "effort".

why are you putting effort in quotes? Do you not think there is any 'effort' involved?

Why do you think someone else's 'effort' should be free?

This is an absolutist take.

No-one's saying it takes zero literal effort. Just "Should I be billed by the practice $25-30 for an MA to get my email and say "I have forwarded your question to the provider"?", and then a subsequent $100+ for the provider's response to my question.

Why should that not be part of the intrinsic baseline officework and not a billable service?

Especially when it's a 100% artificial roadblock inserted by the practice? After all, the communication portal in MyChart is "Message My Provider", not "Message An MA To Message My Provider".

> After all, the communication portal in MyChart is "Message My Provider", not "Message An MA To Message My Provider".

That is semantics, could be changed to "Message the office" but that isn't going to be the most clear title for the majority of people to understand what it is doing. It's the same as calling the office, 99.9% of offices (basically all outside of concierge/direct care) are going to be triaged by an MA/nurse first.

As far as the payment requirements I've heard of, I have never seen anyone bill just for the MA reply.

> As far as the payment requirements I've heard of, I have never seen anyone bill just for the MA reply.

My comment on this was in response to a comment positing the potential for exactly this:

> How long until administration figures out that they can juice revenue by shitting up the emails to increase back-and-forth traffic?

And then, the reply I got was basically "Well, why shouldn't they be able to do that?"

Id actually prefer this option.

Sometimes I have questions that don’t need the provider’s time, but there is no way to get ahold of anyone else in the office (the practice is part of a large hospital system and calls are answered by a call center that knows nothing)

> I wonder if charging for these messages will make doctors more likely to respond.

Physicians won't see a dime of that money unless it's through RVUs and even then it's marginal at best. The real money is in procedures.

There are some codes that can be used for asynchronous portal messages, but to be honest the AMA is still pretty broken as far as how much time we need to spend for things... the codes are 99421 (5-10 minutes over 7 days), 99422 (11-20 minutes), 99423 (21+). It is not clear to me how well these codes are actually paid for by private insurance. In a wRVU system a PCP may get paid like $5-13 for the first code, $15-30 for the 2nd, $24-44 for the 3rd. This is a lot less than a visit... and you must spend the minimum 5 minutes on the portal message or you are billing it fraudulently. I can cover an in person level 4 visit (99214) in 5 minutes in some cases, which pays something like $100.

If there are codes like this why don’t all doctors use them already?

While waiting 6 weeks for an appointment with a specialist and suffering in pain, my mom diagnosed herself, created a treatment plan, ordered prescription pills from some Chinese site, and started treating her condition herself. She cancelled her appointment because she was feeling much better.

This is terrible advice.

It isn't advice

> I wonder if charging for these messages will make doctors more likely to respond.

Why would it do that? If they get money for messages sent (rather than messages sent by doctors) then some flunky can send a message and you can still be billed. Given how this sounds like a profit center, and doctors are cost centers (imagine if they needed to send more messages... now they have to pay more doctors!), I figure physicians will be kept far away from any such system.

If we plot out perverse incentives as a space, I believe that our fate will be to trek through every possible point in that landscape such that we eventually see every single one. This means you will eventually get universal healthcare, most likely as the very last of those perverse incentives.

Interesting point. That could make for some awkward conversations if the patient thinks messages were coming from their doctor but then the director had no memory of the messages. It would also seem fraudulent to have messages signed by the doctor when it wasn’t actually sent by that doctor.

I think it’s much more likely that doctors will end up sending AI-autocompleted messages that take very little time to complete but seem like took much longer.

I have not used a medical messaging system, but if it's anything like the messages my bank or my insurance company sends on their own systems then these will look much more like text messages and less like emails. No place to "sign". No need to risk it looking like fraud. As for awkward conversations, I'd be shocked if many people don't experience circumstances where their doctors act as if they don't remember previous in-person conversations. They're seeing 25 patients a day for 3 minutes at a time after all.

The standard will evolve to something like clinic staff sending the messages which will be overseen/supervised by a medical doctor (who won't be involved in composing the messages or spend any time looking at them before or after they are sent). We'll see trials where the doctor who was supposed to be keeping an eye on the messages wasn't, and some flunky kills a patient by suggesting that drinking used engine oil will cure the sniffles. Keep in mind that the messages can be sent from anywhere too, technically no need to keep that onshore. May eventually get legislation that would guarantee that, but only after a wild west period that lasts a few years.

The medical messaging systems I've used all have "from" fields with the person's name and title. It's important because I take messages from the doctor much more seriously than the messages from the nurses.