By Barbara Bronson Gray, RN, MN
A couple of months ago I wrote about the increasingly common frustration of having to wait a long time to see the doctor. The piece was picked up by another website and provoked a lot of discussion. Some of the comments were especially interesting -- and revealing.
My point was basically that physicians owe it to patients to organize their schedules so that, barring an extreme emergency, people don't have to wait more than 15 to 30 minutes at the max to be seen. I said that physicians who routinely expect their patients to wait for more than 30 minutes are being disrespectful of their time. And for many, especially those who are ill or especially anxious, a long wait can be physically and mentally tortuous.
We have the technology now to roughly estimate how long a visit will take, build in a little breathing room, plan for an unexpected urgent need from an unscheduled handful of patients, and, at the very least, communicate with patients by phone, email or text message if they should come a little later to avoid a long wait.
Many physicians said that the long waits they force their patients to endure are necessary in order for them to earn a decent income. To me, this doesn't make sense, because a schedule full of people who've waited to see you earns you no more money than a schedule that has run on time. In fact, you're likely to get home a lot later if you're a physician with a full waiting room at 5 p.m.
There is a science to effective scheduling. I think a lot of physicians could do better if they put more thought into what is driving the problem and what the alternatives might be.
Here are some of the most interesting comments:
Perceived Financial Pressure
"Unfortunately, the hospitals and universities who own PCP [primary care physician] practices like mine still give me a 15 minute per patient schedule to work with... and that's not up to me. And my salary is 30K below that average for a family doc... and I had over $170,000 of loans when I started practice, that's more than my mortgage."
"In primary care you have two options: One, you can see loads of patients, some of whom have emergencies and cause you to get behind, or, two, you can go out of business."
“Those of us in family medicine who, through the goodness of our hearts, take all comers are given a VW budget, a budget not of our choosing, I assure you. Mark my words, in a few years you'll be lucky to get to see a doc at all. So sit down, open the magazine and count your blessings. Or leave. Your choice. You won't be missed. There are plenty more patients who would love to take your place in my waiting room.”
"The problem is that to maintain his salary, the doctor has to see too many patients. The only way the doctor could stay close to on time would be to start clinic much earlier and/or end clinic much later. Though certainly possible, one of the assumptions above is that the doctor would like to be home for dinner at a reasonable time. You might be able to fix things a little bit with more flexible scheduling/process improvement, etc. but only by a tiny bit."
“The problem is too many patients. The reason why there are of too many patients is that primary care physicians are not adequately reimbursed for the services rendered. Most hairdressers get reimbursed better than primary care physicians. And hairdressers have lower overhead (don't need to hire an extra employee simply to do billing) and don't have to pay malpractice insurance. No amount of scheduling techniques, built-in breaks in the schedule, or improvements in process will solve the problem of too many patients, unless reimbursements to primary care are increased. "
The Need for Better Scheduling Systems
"I was at [a medical facility] last week and saw first-hand how they manage schedules. They track when patients arrive, when they're put in a room, when the staff comes and goes, and the overall scores for satisfaction. They've standardized much of the work, including how to resupply the room so that they've cut the time down without hurting quality. By tracking and improving process, they know when they're ahead or behind and can add to the schedule or ask someone to come later (better the one than the many) and keep satisfaction high.”
"I hate waiting so I decided when I set up my own practice (I'm a rheumatologist) that I would not keep patients waiting. We schedule appointment times more generously and do not double-book. We also leave some breaks to allow catch-up for the inevitable problems that demand more time and attention. Being busy and having medical ‘emergencies’ is relatively predictable or at least, can be anticipated."
All in all, food for thought the next time you’re passing time in your doctor’s waiting room.
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Barbara Bronson Gray is an award-winning writer and a nationally recognized health expert. She's a regular contributor to HealthDay.com, preparedpatientforum.com and thirdage.com. Barbara has worked in hospitals, as a nurse and as an administrator, led a major healthcare magazine, created a website for WebMD, and served as a leader of global communications for Amgen, the world's largest biotech company. She continues to write and speak about healthcare and has a communications consultancy. Follow her on Twitter: @bbgrayrn.