One of the great things about sleep medicine is that I don’t have to over- schedule like most primary care doctors have to. If I have some down time during the day, I can still be productive by reading sleep studies. My patients usually don’t have to wait much.

Amen!

Good post, once again, on an important topic. I tend to run 30 minutes late by the time I get to my last appointment in the morning, unless I have a no-show or cancellation. I try to always apologize and/or explain, and most patients are accepting, and many gracious about it. I think patients know it may be their turn some-day to get an extra long visit with me.

Dr. Bob is right; as we have to book 15-minute follow-ups to earn a living from our practices, doctors will either be habitually late, or do a superficial and inadequate job caring for complex patients.

in the NHS in the UK doctors, well GPs anyway, are paid by the number of people on their books not by the number of visits those people make to the clinic

and the waiting is a lot worse than anywhere else in the world

the patients dont pay directly its done through the taxes

the normal commecial reality of the docs having to keep their patients happy does not exist, and the ability for patients to go elsewhere is very limited

its the worst of all situations, the waiting rooms are dirty, the receptionists are rude, its impossible to get through on the phone, we pay a fortune for the service, and yes we wait hours and hours, no late or weekend appointments

so i think queues are more to do with poor medical practise than anything to do with the way docs are paid

Interesting you compare it to the auto shop.

I am responsible for our four cars, so I see a lot of the dealership. In the scheme of things they operate pretty efficiently. They may not pay anybody a Dr.’s wage, but they’ve got plenty of bodies on the payroll so I know keeping overhead utilized is a priority. I think the government is right when they say it costs .44 a mile to operate a car!

The auto shop makes appointments, you can drop your car off ahead of time or they’ll take you to the bus stop so you can still get to work.

Three nights a week they are open until 9:30 at night. They’re also around on Saturday by appointment.

You get an estimate up front and they let you know if that’s going to change. The work is guaranteed within limits.

The Honda place gives you a stopwatch when you come to pick your car up. If they aren’t back with your car in X minutes the watch is yours.

Detroit did business their way until the 1970s. Then another business model came to town via the Japanese. Now Detroit is in DC, hat in hand, looking for accommodation.

Seems like history might repeat itself with health care?

This is a great post, and great reference to queue theory and the implications for the management of waiting in medical practices.

It would seem that in healthcare there should be a more binding ethical obligation to the “customer” who is waiting, as compared with other industries where queue theory appears to be more of an objective management puzzle than an ethical consideration (I mean, someone standing in line at Wal-Mart to spend their discretionary income certainly requires less compassion than a sick patient waiting to receive needed healthcare from their physician).

This said, no matter how compassionate we are about the fact that patients are waiting, it’s always going to happen, and no amount of queue management is going to eliminate this reality.

I think that an area of understanding that deserves attention in addressing the problem of waiting in medical offices has to do more with the psychology of waiting than the theory of queues. The perception associated with waiting has much to do with the expectation of the person doing the waiting, and not only to do with the mere passing of time (a patient that expects a 20 minute wait and only waits 10 minutes is going to feel pretty good, whereas a patient that expects a 2 minute wait and gets the same 10 will undoubtedly be upset).

In his article, “The Psychology of Waiting Lines,” David Maister presents factors that affect the psychological impact of the waiting individual, which is where many gains can be made in the management of patients waiting for outpatient medical care: http://davidmaister.com/articles/5/52/

Maister’s article is a great read, and a great reference.

Tannus Quatre PT, MBA
Practice Consultant
Vantage Clinical Solutions, Inc.
http://www.VantageClinicalSolutions.com

Today I had a dr appt. at 11 am. (I had to wait 2 months to get the appt.) When I arrived I told the receptionist that I had another appt across town at 12 pm and would need to be on my way by 11:45. She said there was ONE patient ahead of me. At 11:30 I asked the receptionist how much longer would it be since I would need to leave soon for my next appt and I would like to see the dr for at least a FEW MINUTES. She said the nurse had my chart and it would be another minute. After a few minutes they called me back into the room. I told the nurse I would have to leave in a few minutes and did not know if I could wait much longer. She said I could wait a few more minutes and see if the dr showed up or I could rebook the appt. I said I would wait 5 minutes (that would leave me a whole 5 minutes with the dr.). Finally at 11:45 I walked out of the room and told the nurse I had to leave for my next appt. She said she could get me in next Mon. at 1:30 right after the drs lunch so there would be nobody ahead of me. (Funny I could get an appt so soon, since I had to wait 2 months for this one). I took the next appt and left. I encourage more people to WALK OUT. If the doc is late, leave. Go to a walk in clinic if you have to.

I would like to bill the doc for my wasted time. I have a very BUSY life with many things to do. I have very little sick leave, so in order to go to these appts. I WORKED overtime to earn the FLEX TIME for this appointment. My time is valuable and I also have clients that depend on me to do my work in a timely manner so that they can start their projects. In order to attend the next “appointment” I will have to work more FLEX TIME.

The person who said they didn’t mind waiting must not have much going on in their life since they don’t have anything better to do with their time than wait and wait and wait for a so called “appointment”.

I take my husband to the doctor. We used to go every month and I talked the doctor into letting us come every two months because of the long waits. We have waited up to four and a half hours before to be seen! Usually it’s two to three hours.
Usually my husband gets up and leaves and I have to reschedule.
I found out not long ago from one of the receptionist who used to work there that the doctor set his income level at ten thousand dollars a day or more! He told them to double book in the week if he starts lacking that amount. He was already overloaded but to double that was plain greedy and ridiculous.
We haven’t switched doctors because it’s hard to find one taking new patients on Medicare.
I do not know where to report this behavior. Some doctors of course will say they do it because of “no shows” and whatever but believe me when you walk in this doctors office and see twenty-two people booked for ten-thirty, it plain greed and it makes us both actually SICK to go to the doctor.

Face the facts, we live in a world with 9+ billion people. This means longer waiting time, longer lines at the store, more traffic jams on the highway. Until we decrease world population (which is unlikely) we all will have to wait & wait & wait….

I work in a Neurologist office. And I have to say there definitely are doctors who overbook for greed. However in my office the patients are always extremely complex and time consuming. We allow 30 minutes for an established patient and 1 hour for a new patient. We generally only schedule 12-15 patients a day. The doctor I work for pays himself only slightly more than me.  Since he allows so much time for each patient most insurance companies will not pay what they call "prolonged service" charges because they don't think patients need that much time.  The patients usually end up getting the bill for these extra charges, but the doctor does not pursue these payments and we never send a patients bill to collections. 
Also a patient who has a particularly severe problem, or much trouble understanding their care may take much longer than the scheduled time.  This puts the other patients behind. We try to explain to the patients when we are behind, and why. But a majority of people still get mad and leave and do not come back.  This leads to even fewer patients on our schedule and even less payments from insurance companies.  We tend to run at least 2 months behind on our office rent, and me and my staff sometimes have to wait days, fingers crossed for a check from the insurance companies just to get our paycheck.  This is what happens to doctors who value patient care more than trying to "work the system" to make more money.  I completely understand why doctors overbook appointments and make people wait.  In the current system it is the only way to insure that you'll stay in business.  We are currently trying to sell our practice to a hospital because we do not believe the business can last another year.