Waiting for the doctor


Category : Medical Rants

This past weekend I had lunch with one of my golf buddies and his father. The conversation veered towards health and illness, and finally doctor’s appointments. They both “attacked” me because they hated waiting in doctor’s offices.

I have had several comments on this blog about how doctors made them wait. After all the patient’s time is valuable also.

How do we solve the appointment problem? First we must understand why it occurs.

First, few practices have considered or embraced Queue theory. The first problem is that scheduling systems do not consider that visits are not neatly packaged.

By far the biggest problem is how we (physicians) get paid. We are paid by the visit, not by the amount of time spent. Therefore, our best efficiency occurs when we always have someone in the queue. An empty queue is a lost opportunity.

The way we pay physicians encourages waiting – not explicitly, but implicitly.

Ask any physician and they will tell you that they try to stay on schedule, but …

1. The second patient of the day was much sicker, or more complex than expected.
2. A hospitalized patient crashed, so I was late getting to the office.
3. The third patient of the day was 15 minutes late, throwing my entire schedule off.
4. A patient called in acutely ill and I had to squeeze them into the schedule – throwing my entire schedule off.

These are not random or unusual occurrences. I suspect my colleagues will add more reasons to this list.

As long as we are paid per visit rather than for our time, we will have this problem. Usually patients have no choice, because there are few good alternatives. These problems are common to most physicians.

For many specialties, we do not have enough physicians – so the “competitor” will not be any better.

The father and son are lawyers. I explained the difference in medicine and law (or accountants) in this fashion. If I have a 10 a.m. lawyer appointment, the lawyer might assume that it will take 1 hour. He/she will not schedule someone else for 11 a.m., just in case – because the lawyer always has other tasks to fill in the time between appointments. Physicians only make money when we are seeing patients. Thus we try to squeeze as many as feasible into our day.

Waiting for the doctor sucks. So does waiting to get your car repaired. Note the similarity here. We do not have enough auto service places, so the demand outstrips the supply. Auto repair shops cannot make money unless they are working on a car – so they do not plan their day around the customers convenience.

If your time is valuable, you should find a cash only or retainer practice. We do need a better method of providing high quality service to patients. Only by rejecting our current system will we solve the queue problem.

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Comments (20)

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.

Maybe, I’m in the minority, but I’ve never had a problem waiting for the doctor. To me, a bit of the wait is just part of seeing the doctor. Sure there are times when the wait is longer than I would like, but I’ve always tempered that with the idea that we’re talking about people’s health and I would rather wait a few minutes to see the doc than feel rushed and not fully cared for when I’m actually in front of the doc. As for your auto-repair comparison, makes sense to me. Thanks.



The problem is not waiting minutes, but hours. Optimizing the queue is certainly a fair issue. The problem arises when a small number of doctors feel their patients owe them an hour or more for financial gain or ego gratification. I had one doctor tell me “How are people suppose to know I am a good doctor if they do not have to wait?”

In searching for my current doctor timeliness of appointments was an issue. One of the nurses is ex-military and they run a tight schedule. On your first visit it is made clear that if you expect to be seen on time, you will arrive early enough to have all the paper work completed at the time of your appointment. I have never had to wait an unreasonable amount of time at this office.

He also has a person answer the phone during office hours. That saves an incredible amount of time for patients as simple questions, or scheduling problems, are solved immediately.

Steve Lucas

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.

I don’t want to be negative…

BUT this is one of the many, many issues that people complain about with respect to drs.

However you guys keep a pretty tight wrap on this and many other issues that result in patient unhappiness. We, the patients, don’t understand the root of the problem. We assume you guys are being jerks and are greedy.

Somehow you guys need to better advertise that many of the problems drs face in health care effect patient happiness. You can post this stuff on your individual blogs night and day but here you are preaching to the choir.

How about small articles on the office website discussing why patients may have to wait, why you can’t always come to the phone, why a specialist isn’t always the best choice and so on.

marketing is lacking and if you truley want to move to an open market you have to consder it.

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

I think that most patients expect to wait at least 30 to 45 minutes when making a trip to the doctors’ office. And to me, there is no problem with waiting that length of time.

My frustration begins when the waiting room begins to stack up, and the nurse calls me in to see the doctor, puts me in the patient observation room, then the doctor pops in for 3 or 4 minutes between waits of 30 to 45 minutes.

Out of an hour and a half in of being in the patient observation room, I actually see the doctor for about 5 minutes.

If the doctor is not ready to see the patient, they should leave the patient in the waiting room where it is usually more comfortable than sitting stripped down on a rolled out piece of paper.

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?

I think it would be preferable if PCP’s, who are basically selling their time, were paid based on time spent with the patient. Lab tests and prescriptions would, of course, be billed separately. The rate could be, say, $300 per hour with a $50 minimum or whatever is needed to cover practice expenses and generate a respectable income. I wonder how many PCP’s could bill this way as an alternative to the current insurance based system, at least for their non-Medicare and Medicaid patients.

From a patient perspective, the most infuriating aspect of waiting is not knowing how long the wait will be. It comes across as arrogance and a total lack of respect for the value of my time. The receptionist should be able to offer a reasonable estimate of the wait time. I might want to go for a walk or get a snack if the wait is going to be more than 30 minutes. A beeper could be offered to alert me that my turn is coming within, say, 15 minutes. I know that emergencies occur and some waiting is unavoidable. However, I sometimes get the impression that many doctors never heard of the concept of customer service. They might consider trying to treat their patients the way they would like to be treated if their positions were reversed.

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.

I always see my patients on time if it is at all possible. If I have kept a patient waiting I will explain why this occurred and I will also apologize. I think all patients are owed this courtesy.

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”.

Today I had a yearly GYN Appt. the Dr. I have been going to for years and even deliverd my youngest daughter. One of my children got severe tummy pains and threw up all over, 20 mins before I had to leave. She then continued to get sick and cry. I had no choice but to clean it up and by the time I got done comforting and cleaning it was obviously to late. I NEVER miss my APPTs. I always show to be sitting there way past my appt time. Yet when my phone rang and I answered to say I was sorry but I couldn’t help it, I was advised I might be billed for not giving them 24 hours. I guess I should schedule my daughters sickness’ better.. This is just sad how we patients have to be talked to anymore!

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.

Most of the specialists I have tried make patients wait at least 30 min, and it is usually an hour before you only see the doctor for 5 min. A physician would need to be a telepath to give truly good medical care in such a short time. I really hate going to these doctors and avoid them as much as possible. This probably will lead to less than optimal medical care.

I also have one doctor that runs a fairly tight ship. The pratice uses online forms that can be downloaded and completed at home (you get a much more thorough and accurate response) before the visit. If a patient is more than 15 min late, they have to reschedule. The doctors ask a lot of questions to make sure they understand everything happening in a patient’s life in order to give complete medical care. They only schedule in the morning and use the afternoon for open appointments (it’s always busy). I have never had to wait more than 15 minutes in that waiting room, and this practice is the only one I enjoy going to visit.

I can certainly understand the physician’s office getting behind when emergencies happen, yes these things are part of life. What I do not understand is the total disregard everyone in a physician’s practice has for the patient’s time. Not all patients have sick time to make up time lost due to office visits. The very least an office manager can do is inform the patient walking in for an appointment that visits are running behind schedule and how far behind. A patient can then make an informed decision about whether to wait or reschedule. If there is a delay first thing in the morning, telephone calls to scheduled patients would be appropriate so time away from work (and money out of paychecks) would be minimized.

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….

What galls me about this practice of making patients wait (to receive an average of 6 minutes of the doctor’s time for a $60+ fee- wherein most patients are allowed to speak for an average of 17 seconds before being cut off) is the arrogance that many doctors have about their inability to manage time effectively. After all, no one would wait three hours in a restaurant for a sandwich, and that profession is certainly rife with unexpected complications. To complain of the queue system and being paid per patient seen is a ridiculous conceit. Hairdressers are paid per client, so are those in any number of professions, yet schedules are kept on time. To add insult to injury here is the fact that most doctors make a minimum of $80,000 per year. Perhaps it would be wise for these arrogant, thoughtless individuals to recognize that a medical degree is not license to disrespect people. After all, isn’t the hippocratic oath thus: First, do no harm.

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.

[…] The doctor will see you — eventually: Why our current health care system promotes scheduling inefficiency and long waiting-room times. Waiting for the doctor. […]

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