The problem, though, is that specialists seem to have a very wide range of opinions on what constitutes a 'full' clinic. I have seen specialists insist on 30, 45, and 60 minute appointments. Half days of admin. Full days of admin. Additional half days for collaterals. They are all ''full' in the sense that they book every appoinent they have, but is that really full? Should that kid really have been waiting those six weeks? Or should you have have more appointments?
I don't know your schedule at all and I'm only 90% sure I even know your specialty, so no judgement. However when a military subspecialisty rejects my patient because they are full and tells me thar I should be able to handle it I hope that means they are staying later at work than I am.
Yeah, no way to know for sure. For me, at the duty station where I was rejecting certain consults, full meant 15 minute new patient, 10 minute follow up or post-op. 30 minute lunch (if I was lucky, usually seeing consults at that time). I had zero admin time and I was in charge of 4 officers, 4 NCOs, and 5-6 GS employees. That's how I ran my clinics in the Army, and that's how I run my clinics now that I'm out. There are definitely lazy providers who see far fewer patients than they can see. That's just DoD medicine. Or, really, any single payer medical system. I've also been placed where the PCP was seeing 10-12 patients/day (or even fewer for some mid-levels).
But, if you're going to get upset with how much work other people are doing, you're going to have a bad time in the military. I used to get livid when I couldn't schedule more than 5-6 cases in an OR day because no one wanted to work before 7 or after 3pm. (I routinely schedule 12-14 now). No matter how hard I worked, they wouldn't do any more than that. But scheduling more cases didn't help either, and getting upset about it didn't help either.
I agree that they should be busy if they're denying consults. What "busy" means is pretty amorphous, however. For some people that just means being more stressed out. For others, it means having a constant flow or work (which doesn't necessarily mean that they're working efficiently). For others it's a literal number of patients, but that isn't directly correlated either. I could also ask why a psychiatrist or an internist needs 30 minute new patient appointments, but the answer is that they're often fielding far more complaints than I am and many times in sicker patients. So it's apples and oranges. I could also ask why I get more RVUs/time interval (more productivity) by FAR for a tonsillectomy than I do for a wide local excision of a cancer with a neck dissection. Also not really fair.
Maybe the specialists stay later than you or maybe they don't. That is more of an efficiency question. No judgement there because I don't know how you work at all, but I've worked with guys who see 35 patients in a day and leave work at 4:30, and I've seen guys who see 35 patients are are writing notes until 7pm. I never felt like the guy leaving at 4:30 ought to see patients until 7 because the other guy can't get his work done on time.
It also used to irritate me when other services had "post-call days," when I never did and never have. So that's something to take into consideration as well, if we're talking about how hard any specific person is working. How much call are they taking? I was on call every single day, 365 days/year at my first duty station. I'd get a minimum of 3-5 calls per day on a light day on top of all the scheduled stuff I had to do. I had a call sharing agreement, so I was only on call every other night, but I had to go to work the next day and see a full clinic or work a full OR no matter if I was in the ER for three hours suturing up a face or if I got a full night's sleep. The general surgeons were far busier than I was. The Internists took call, but they almost never cross covered and it was a 12 bed hospital with 5 active beds, and usually a census of about 3. So that's not really fair either, is it? Plus, because I could only do half as many cases in an OR day in the military (on a good day), that meant I spent twice as much time in the OR, at which point I couldn't see patients. It took my at least 2 (if not three) OR days per week to do in the Army what I can do in a single day in my ASC (and I get out earlier here too). So, in that sense, the Army is also robbing you of your specialist's time, and that's also not really fair.
Ultimately, I hear what you're saying. If a provider is lazy, that's a problem and I'm 100% on your side there. Honestly, one of the biggest (top three for sure) reasons I got OUT of the military was that I couldn't stand the laziness. Those guys ought to be hounded. Severely. If you know for sure your specialists are lazy, run that up the flag pole. Believe me when I say that the military tracks that kind of thing. Every year someone from the command suite would come by and let me know how I compared from an RVU perspective with my civilian counterparts. If there's a major discrepancy, they know about it. If you're just upset that they're getting out of work earlier than you, well, that's something to think about pre-residency.
