Hello Reader,
Eight weeks ago, I was at my doctor's office and I noticed something.
Another doctor had left the practice. Again.
So I asked my doctor: "Why do doctors keep leaving?"
She sighed. "There are a few things, Beth, but top of the list? The new health insurance is terrible."
I blinked. "Wait—DOCTORS are struggling with terrible health insurance?"
"Yes." She replied. "And some are leaving medicine entirely because of RVUs."
"RVU's? Uh-oh." I thought.
Now, I know about RVU's but I'm betting you don't. I know because a couple of years ago, I did a year-long certification in Applied Compassion Training through Stanford Medicine (CCARES) to help me in the patient care work I do with dialysis centers.
But when I first learned about the RVU system during my research for my capstone project, I was shocked. Doctors were having to punch a clock?
Yes. And here it was in action at my appointment. The doctor I was meeting with had to push a button each time before she entered an exam room and push it again as she left.
Her time with patients is being tracked. Measured. Monitored.
She told me: “I hate this system. Most of us do. But we don’t have a choice anymore.”
A few weeks later I had an appointment with an NP, who was part of a different hospital system and decided to ask her about RVU's. Yup. RUV's were there too. She confirmed: "I have to clock in when I enter your room and clock out when I leave. The system tracks how long I spend with each patient. If I spend too much time with someone, I have to write a justification note explaining why."
I sat there processing this. These are two different practitioners, two different systems, same reality.
Those RVU's I learned about in my research, they weren't the rare practice. They were everywhere.
Today, I want to pull back the curtain on what's really happening in healthcare—not to make you angry, not to blame, but to empower you to take command of your own healthcare.
Because once you understand the system, you can work WITH it instead of being frustrated BY it.
THE SYSTEM YOUR DOCTOR IS WORKING UNDER
What Are RVUs? (And Why Should You Care)
Most doctors today—57.8% to be exact—are no longer independent practitioners. They’re employees of hospitals, health systems, or corporate entities.
And like any employees, their productivity is measured.
Enter the RVU: Relative Value Unit.
Here’s how it works:
Every single thing your doctor does is assigned a value: - Quick follow-up visit: 0.70 RVUs - Complex visit with exam: 1.92 RVUs
- New patient comprehensive visit: 3.17 RVUs - Procedure like a colonoscopy: 4.67 RVUs
Often your doctor’s compensation depends on RVU's.
In many systems doctors have a base salary and then a bonus based on productivity, which heavily relies on RVU's.
A doctor spending an hour with ONE complex patient earns about 3 RVUs.
That same hour, they could do multiple simple appointments and earn 5-6 RVUs.
The Time Tracking Reality
In many hospital-employed practices (and this is becoming standard), doctors are tracked in ways that would shock you:
Electronic Health Records (EHRs) now monitor: - How long doctors spend with each patient - How long they spend documenting - How many patients they see per hour - How their productivity compares to their peers
In some systems, doctors literally: - Click a button entering the exam room (timestamp recorded) - Click a button leaving the exam room (timestamp recorded) - Get flagged if they’re spending “too long” with patients - Have to write justification notes explaining extended visits
And here’s the reality: In our predominate system, the end-user is not the patient. The end-user (entity to be pleased) is the insurance company.
Most doctors HATE this system.
They went to medical school to help people, not to maximize RVUs.
But running an independent practice has become nearly impossible.
WHY INDEPENDENT PRACTICE IS DISAPPEARING
Why are doctors selling their practices?
When surveyed, doctors cite:
- Inadequate payment from insurance (Medicare physician payment has DROPPED 29% since 2001, adjusted for inflation)
- Crushing administrative burden (staff just to deal with insurance paperwork and prior authorizations)
- Cannot compete with hospital systems (hospitals can negotiate better rates)
- Cost of running a practice (EHR systems, compliance, billing specialists, coding experts)
Translation: It’s not that doctors don’t WANT to be in control of how much time they spend with their patients. It’s that the system makes it practically impossible to do so. I can tell you that years ago I tried to help my husband with insurance billing in his practice. It was such a labyrinth and so frustrating that I quit!
WHAT THIS MEANS FOR YOU (THE REALITY CHECK)
Here’s what I need you to understand:
You cannot go into a doctor’s appointment expecting to: - Figure things out together - Have the doctor explain everything from scratch - Get comprehensive education during the visit - Make complex decisions on the spot - Ask about every symptom and concern without prioritization
Why? Because your doctor likely has: - 15-20 minutes scheduled for your visit - A system monitoring how long they’re spending with you - Pressure to see a certain number of patients per day - RVU targets they need to meet - Notes to write after you leave (which also get time-tracked)
This isn’t because they don’t care. It’s because the system is designed for volume, not depth.
And here’s the hard truth: Waiting for the healthcare system to fix itself is not a strategy.
TAKING COMMAND OF YOUR HEALTHCARE
If doctors can’t change the system, and we can’t change the system, what CAN we do?
We can change how WE show up.
Think about it like this: If you have a 15-minute meeting with the CEO of a major company, would you: - Show up unprepared? - Expect them to explain basic concepts to you? - Try to cover 10 different topics? - Make important decisions without any prior research?
Of course not.
You’d come PREPARED. You’d be FOCUSED. You’d make every minute count.
Your health is more important than any business meeting. So why would you prepare any less?
YOUR NEW APPROACH: THE COMMANDER’S HEALTHCARE STRATEGY
Here’s the simple version. Three steps:
BEFORE: Do Your Homework
Look up your condition or symptoms (Mayo Clinic, Cleveland Clinic, NIH)
Write down your top 3 questions (most important first)
Know your numbers (check your patient portal for recent test results)
That’s it. Don’t overcomplicate it.
DURING: Have an Informed Conversation
Let me give you a real example from my own life.
My LDL cholesterol came back high. My doctor suggested starting a statin.
But I knew my numbers had always been like this: High LDL, very high HDL, very low triglycerides.
I had done my homework before my appointment. Here’s what I found:
Research shows that people with my specific profile (high LDL but also high HDL and low triglycerides) don’t get significant benefit from statins.
I also looked into: - Statin side effects (muscle pain, liver issues, potential cognitive effects) - Additional tests that could give a fuller picture (like ApoB levels) - What really predicts heart disease risk (it’s not just LDL)
I’m not anti-medication. But I wanted to make sure I wasn’t putting myself at risk needlessly.
So I was ready to have an informed conversation. I said:
“I did some research on my cholesterol profile. Given that my HDL is very high and my triglycerides are very low, I read that statins may not provide significant benefit for someone with my specific numbers. Would it make sense to run an ApoB test and get a calcium score test to get a more complete picture of my actual cardiovascular risk before starting medication?”
We ran the additional tests.
They showed I was NOT at high risk.
Statins weren’t necessary.
That’s the power of doing your homework.
Not to argue with your doctor. Not to refuse treatment. But to have an INFORMED CONVERSATION that leads to the RIGHT treatment for YOU.
AFTER: Follow Through
Use your patient portal to review test results
Message your doctor if you have follow-up questions
Track how you respond to any treatments
Schedule follow-ups before leaving the office
Simple. Doable. Effective.
WHAT IF 15 MINUTES ISN’T ENOUGH?
For complex or multiple health issues:
Request longer appointments: - New patient visits (45-60 minutes) - Annual wellness visits (often covered by insurance) - Complex care management visits (for multiple chronic conditions)
Ask for them. They exist.
Use specialists strategically:
Your primary care doctor is a generalist. For chronic or complex conditions, specialists can spend more focused time.
Consider concierge or direct primary care:
Yes, there’s usually an annual fee ($1,500-3,000+), but you get 30-60 minute appointments and direct access to your doctor. For complex health issues, it can be worth it.
The point: If you need more than 15 minutes, there ARE options. You just have to ask.
THE MINDSET SHIFT
Here’s what I want you to take away from this.
You are the CEO of your own health.
Your doctor is a highly trained consultant who has 15 minutes to provide expert guidance.
Would you walk into a CEO meeting unprepared?
No.
You’d come prepared. You’d be organized. You’d maximize every minute.
Your health deserves the same level of professionalism.
WHY THIS MATTERS MORE AFTER 40
For women over 40 dealing with: - Perimenopause/menopause (complex, often dismissed) - Multiple health concerns (they accumulate with age) - Chronic conditions (often requiring ongoing management) - Preventive care (becomes more critical)
You CANNOT afford to wing it in a 15-minute appointment.
The doctors who dismiss women’s symptoms? Sometimes they’re just overwhelmed by the system and trying to meet RVU targets.
The doctors who don’t take time to explain? They literally might not HAVE time within the constraints they’re working under.
This is not an excuse. But it IS the reality.
And the Commanders who navigate this best?
They come prepared. They advocate for themselves. They understand the system. And they work strategically within it to get the care they deserve.
YOUR ACTION PLAN THIS WEEK
Before your next doctor’s appointment:
☐ Check your patient portal - review your recent test results
☐ Write down your TOP 3 questions or concerns
☐ Do 15 minutes of research on your main issue
☐ Think about what outcome you want from this visit
That’s it. Four simple steps.
Don’t overthink it. Just come more prepared than you did last time.
BEFORE I GO…
I know this newsletter might feel discouraging.
“Wait, Beth, you’re telling me the healthcare system is broken AND I have to do all this extra work?”
Yes. I am.
But here’s what I’m also telling you:
You have more power than you think.
Every woman in our community who: - Shows up prepared - Advocates for herself - Makes every minute count - Takes command of her own health
…is sending a message to the system that we expect better. We demand better. We DESERVE better.
You can’t control the RVU system.
You can’t control time tracking.
You can’t control insurance reimbursement rates.
But you CAN control how YOU show up.
And when you show up as a Commander—prepared, focused, empowered—you get better care. Period.
Your doctor will appreciate you. Your outcomes will improve. And you’ll stop feeling frustrated by a system you now understand how to navigate.
That’s power. That’s taking command.
Welcome to your next chapter of healthcare. You’re not just a patient anymore.
You’re the CEO of your own health.
You’ve got this.
With strength, determination, and absolute belief in your power,
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