I’m a little more than an hour into my second three-hour office session of the day. I’m running about 30 minutes behind schedule, which isn’t too bad considering I’m double-booked. In between patients, someone from the front office staff tells me that my new patient got lost and is an hour late.

We have a 15-minute grace-period policy for lateness, but this patient is complaining of pelvic pain and spotting with a recent positive pregnancy test.  I tell the staff to squeeze her in between returning obstetric patients. I know this will put me further behind schedule, but I don’t think the patient should wait another day to be seen. 

The next patient I see is an annual exam. She is young and healthy, so the visit should be straightforward and quick. But while reviewing her history, she mentions some small painless bumps that she noticed last week. When I do her exam, it is clear that she has genital warts. When I tell her this she begins to cry hysterically. We spend the next twenty minutes discussing the HPV virus, treatment for the warts, vaccination and the best way to address this with her partner. 

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When I walk into the next exam room, a return obstetrics visit slotted for 15 minutes, my pregnant patient at 30 weeks gestation and her husband are very upset. They’ve waited an hour past their appointment time to see me. After reassuring them that this is not the norm, I spend at least 25 minutes answering their questions about labor, creating a birth plan and breastfeeding, as well as listening to fetal heart tones and doing a “belly check.”

I try not to make my patients wait, but there are days this like this where every patient encounter takes twice as long as it should. Sometimes it is due to some unforeseen complication during a routine visit or someone who needs a little extra education or emotional support. Sometimes I’m just overbooked. But I understand the value of time, and do not feel that my time is any more valuable than that of my patient’s. Even when I’m running behind, I try to ensure that no one feels rushed.   

I know that I’m not the only provider in the office who provides this type of care. I have midwife and physician colleagues alike who focus on quality over quantity. I’m happy to work in an environment where this is the norm, and seems to be valued by patients. But in this time when the focus is shifting to bottom lines and budget cuts, how long will patient satisfaction trump profit?  Is there a way to make money while not shortchanging the patient?

During my next performance evaluation, my relative value units (RVUs) will not reflect the quality of my work, only the amount of money I am generating during my office sessions. There will be nothing that measures my time spent comforting the woman with a newly diagnosed STI, or discussing pain management alternatives for labor with a nervous couple. There will be no acknowledgement of the days that I leave hours late because I want to make sure each patient receives the care they need. But my patients know, and they continue to see me for their care. At the end of even the longest day, that can be a morale booster.

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.