Tiverton Primary Care
821 Main Rd
Tiverton, RI 02878
+1 401 6251001
+1 401 6251584
Or use our contact form.
We are open during the following hours:
Monday 9am to 5pm
Tuesday 9am to 8pm
Wednesday 9am to 4pm (Patients seen at PrimaCARE in Fall River)
Thursday 7am to 4pm
Friday 9am to noon
Saturday (every other) 6am to 1pm
ALL PHONE CALLS AND APPTS SHOULD BE MADE THRU TIVERTON OFFICE (EVEN PTS SEEN ON WEDNESDAY IN FALL RIVER)
To Our Patients:
We need to talk...
Patients do sometimes complain about waiting too long to be seen. We have been accused of overbooking or not caring or valuing the time of our patients. But that is not the case at all. In fact, we go to great lengths to be the best primary care practice that we can and do the best for our patients. We have lots of priorities each day in the office, and although we sympathize with the frustration of waiting, running exactly on time is important but cannot be the top priority.
I do want to explain the problems running exactly on time in a primary care practice and strategies that we use to try to reduce waiting.
It is unfortunate that booking for a primary care practice is not an exact science. We have been trying to perfect our schedule for 30 years. We learned years ago that we cannot predict how long each patient will be in the office. Some patients are here for routine followup. Some have one medical problem. Some have 6 chronic problems. Some patients are here for one urgent sick issue; others have an acute mental health issue or other complicated issues. Some are here for a physical/prevention visit; others just need forms completed. (Dr. Cummings even does some housecalls after regular office hours for some established patients who can no longer get to the office.) We do our best to accomodate everyone.
As a full-service Family Practice, we do not only focus on Primary Care and Prevention, but we also manage acute and urgent problems. We want to be the first stop for our patients for their health needs. In addition to routine visits , we offer sick visits for urgent problems. Many other practices do not adjust their schedules to accomodate their patients with urgent problems, but we believe that comprehensive care involves not only providing prevention, such as physicals, or maintenance of chronic health issues, but also dealing right away with acute problems as they come up.
We also are proud to offer some services that are not readily available elsewhere. In addition to offering comprehensive medical care, Dr. Cummings uses Osteopathic Manipulative Therapy for musculoskeletal issues. Additionally, we do perform minor skin procedures, and schedule those at the end of the day as they may take longer, and we want to minimize the impact on patient flow.
Many specialists are dealing with one body system and can get through office visits more efficiently. In Family Practice, we do not have that luxury. We do try to give value to the services that we provide. In addition to face-to-face care, we do a lot behind the scenes, such as coordinating care, reviewing and dealing with abnormal labs, coordinating referrals, dealing with insurance problems such as formularies and authorizations, not to mention financial issues etc etc etc..
Phone calls especially are a challenge. There are times that Dr. Cummings is fielding up to 20 calls during the day. We coordinate care with other doctors, including radiologists, get calls from VNA, nursing homes, pharmacies, Emergency Rooms, reviewers for prior authorizations etc. We do review labs after hours and try to make phone calls at nite, but some abnormal labs or xrays cannot wait and need to be managed right away.
Much of the phone calls and behind-the-scenes work is uncompensated. To run an efficient office, our overhead is high, and it costs the practice $50,000 per month just for expenses (staff, rent, insurance, computers etc.) The office visits are what pays the bills. All visits are important to coordinate care, review medications, as well as making sure that we are doing a good job preventing illness and providing chronic care. And the office visits are how we are reimbursed for the care that we provide in person and behind the scenes.
Much of our job is not only to see patients face-to-face in the office. People frequently see Dr. Cummings' car here at nite and weekends. We spend time doing extensive documentation, following up on labs and XRays, complete forms and other paperwork for insurance companies. We have lots of regulations that complicate life, such as the requirement to use the Electronic Medical Record. The doctor averages working 50-60 hours per week to get it all done. But that is part of the job. We do put our full effort into running the practice, and are proud of the care that we provide.
One issue that also complicates the practice is "no-shows." We try to minimize no-shows by calling for reminders before the visit, but we still can have as much as 10-15% of the scheduled visits missed by patients who do not show. When we have lots of no-shows, that makes it difficult to afford the multiple staff members who do the behind-the-scenes work, and we have to struggle to see enough patients to afford the overhead for this busy full service practice. Some days, there are more no-shows, and consequently the schedule runs on time. Other days, everyone shows up with complex issues, but we take care of the needs of all those patients, because that is what we do.
Primary care is a difficult practice. We try to accomodate everyone who comes in the door. Some patients are straightforward, low risk, not many medications. But, to be honest, MOST of our patients are not easy, some have multiple problems, some have complex social issues, and some have difficult personalities or take a long time to describe or work through their issues. All of this can complicate the visit, and this often happens multiple times per day. Unfortunately, we cannot predict who will be easy and who will be difficult, and we certainly cannot predict to schedule in advance to compensate for patients who need more time, so we end up averaging out the schedule. We actually do a pretty good job of it so that we can get most of the needs of our patients completed by the end of the day.
It needs to be remembered that the medical practice of Family Medicine is not like running a store. We do not sell products or just give out prescriptions. Also, we are not a walk-in center or urgent clinic that deals with one problem. Family Medicine actually involves MANAGING the health care of the patients of our practice. We focus on prevention; we deal with acute and chronic issues; we coordinate with other providers. And we are dealing with life and death issues, so we often check and double check everything that we do to ensure high degree of safety.
In order to provide high quality care, our philosophy is that we take as long with each patient as they need. Some patients need 10 minutes, some need 45 mins. That is the nature of primary care; it is not predictable. We do, however, set up the schedule to maximize our efficiency while also accomodating our patients. We know that urgent visits do not take as long as physicals, so we do dedicate several visits each day for urgent issues (sick visits limited to one problem) and do not schedule them until one day before.
Not all doctors run late; there are local doctors who always run exactly on time. Most of our patients don't want to see those doctors. Some doctors will only let patients talk about one complaint. Some don't offer sick visits or rush through the visit with their hand on the doorknob. But Dr. Cummings has some patients travel to see us from Boston, Providence, Cape Cod. They come because they feel they get quality service that they cannot get in other places. It is ironic that many of the ones who complain most about the waiting time are the ones who live locally in Tiverton or nearby.
To accomodate our patients with jobs or other commitments, we do have variable appointment times available. On Tuesdays, we work until 8pm. On Thursday, we start at 7am. Every other Saturday, we work 6am to 2 pm. Some hours here are less busy than others. We notice that some of the patients who complain the most want to be seen in the middle of the day. But that leaves more chance that there may have been emergenices or other complications before that visit. Some patients have found that there is less wait time if they schedule their appointments to be seen first when we open or right after the lunch break. Others choose to schedule most of their visits with our Nurse Practitioner, Cody Zygmont, who tends to run more on time during the day.
(Speaking of the "lunch break," that really is just a gap that we leave in the schedule mid-day. We use that time to catch up if I am behind seeing the morning patients. We generally try to eat something between patients. Dr. Cummings has not taken a break to sit down or go out to lunch in many many years.)
Believe it or not, we do have some days that we run right on time. That is how primary care works. Some weeks, the schedule is fairly light. Other times, especially when viruses are rampant, the schedule is packed. But there are many other variables that can affect the schedule also. (Sometimes it only takes one patient with a very complicated problem to impact the schedule for the whole day.) As an Osteopathic physician, Dr. Cummings does use Osteopathic Manipulative Medicine to treat musculoskeletal problems. That is an effective way to deal with pain, but again, it is time consuming.
In conclusion, our role is not just to dole out health related services. We are not an urgent care center to deal with sick episodes. We do not just give out prescriptions for medications. Our role is actually much more complex. We MANAGE all your healthcare needs, from medical problems to mental health issues. We focus on prevention, work to maintain quality of life, decrease risk factors while also handling day-to-day urgent issues as well.
If everyone would always show for visits and promise just to stay for 10 minutes, then there would never be a problem running late. (We would even get time for lunch.) But no one wants a doctor like that. And that is not how we want to practice. Our practice does get high marks for being thorough. The staff is helpful, and we go to measures to help with many issues including accomodating sick visits, completing forms, coordinating care with other providers. But all these things take time, and we need to remind everyone that "you cannot have it all." We prefer to offer higher level of service, and the compromise for good access to quality care is that there are times that a wait is required.
We have to admit that we feel badly if we keep patients waiting for an hour beyond the time of their scheduled visit. But up to an hour is considered the price of getting high quality primary care. If this is not acceptable, please don't harrass our staff. This just may not be the right practice for everyone. We offer much more than other convenient settings (such as a walk-in center), but some patients may decide that they are not willing to make the time and effort or commitment for the services that we provide. In that case, there is no hard feelings if a patient decides to transfer. However, by continuing to engage our services as your primary care provider, you can be assured that if and when the occasion arises that you need us to deal with a complicated or urgent problem, we will be available to spend the time and effort to take the best care of you here at Tiverton Primary Care Associates.