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re: Translation: I add on a bunch of services that the patient hasn't requested, and then I charge them for those services. )))

Is that so? You mean you regularly get charged for two office visits when you've only had one?

The Van Vleck quote is about continuity of care--treating a patient instead of an illness. Family medicine. Opportunity to screen a patient for other problems, like, why does this patient catch so many colds?

These clinics are good mostly for minor acuity, which is great. I'm glad they exist.

But if your doc charges by the question--I'd sure like to see how he gets paid for that with the rules the way they are. Bills are not coded that way.

Doctors, like most professionals, charge for their time on an hourly basis. Most doctors, though, set up their bills so you are just charged a flat rate for an office visit; however, that fee is based on an estimated time that he'll spend with each patient and then calculated out to determine what he wants (or needs) to earn.

Thus, when the doctor is spending more time with each patient (performing services that the patient doesn't request), then the fee for the visit needs to be higher so the doctor can continue to cover his nut.

Don't think your time with the doctor is free. It's not.

The Van Vleck quote is about continuity of care--treating a patient instead of an illness. Family medicine. Opportunity to screen a patient for other problems, like, why does this patient catch so many colds?

P.S.: That's not really what this doctor is saying. Read what he says again:

"'When I see a kid for a sore throat, I get to go through their chart. If they have a little bit of scoliosis I might check their spine. I will check their immunization record. We go over the record, and we try to go over what's going on besides the sore throat, or besides the ear infection.'"

I've got scoliosis. When I go to a doctor for a sore throat, I don't want him checking my back. I want a prescription for an antibiotic. Checking a patient for back trouble has NOTHING to do with why he has a sore throat--it's merely a way to run up the bill.

"Oh, so you've got a sore throat, huh? Great...say, I see you haven't had your Typhus fever immunization this year....Hmmm. What, you say you're not going to be aboard an 18th Century British sailing ship and don't need it? Well, you never know. Let's just get you set up with Typhus fever, huh? Great...that'll be $100. Thanks for stopping by!"