Waiting room times (N/A)

[Ken Ibold]

Hey docs on the board ... a question about waiting room times. (And, please, dear readers, let's NOT use this as a piling on exercise. We all have our horror stories.)

I'm genuinely curious about why, in the medical field in general, it seems to be considered acceptable to keep patients sitting in the waiting room for an hour or more on a routine basis. Without going into details, my wife has been to four different docs in the past two weeks who have kept her waiting 1.5+ hours. She has walked out three times and, as I write this, is about to walk out on the fourth. At her hourly rate, this wasted time literally costs us hundreds of dollars each time it happens.

I understand about the "unexpected developments" issue, but this seems to be a chronic situation across a wide range of providers. Not only that, it happens at early morning appointments where delays haven't had time to stack up. So my question is, what makes it so difficult to schedule in a way that appointments can be more prompt? Please explain the dynamics here.

 

[Bill]

At her hourly rate, this wasted time literally costs us hundreds of dollars each time it happens.

I always wondered what would happen if I billed back my hours wasted waiting for late appointments. Too bad you can't, they'd get the picture quickly.

The best you can do is switch Docs. I did that, found a good internist who lives on the planet earth, runs a reasonable schedule, and gets folks in and out on time.

 

[wsuffa]

I always wondered what would happen if I billed back my hours wasted waiting for late appointments. Too bad you can't, they'd get the picture quickly.

I know someone that did. He set it down as conditions with his dentist when he started going there. And he did bill the dentist one time - and got paid. After that, no more problems with appointments.

That won't work most places. "Managed Care" a/k/a corporate socialized medicine has assured us of that.

 

[SCCutler]

I know someone that did. He set it down as conditions with his dentist when he started going there. And he did bill the dentist one time - and got paid. After that, no more problems with appointments.

That won't work most places. "Managed Care" a/k/a corporate socialized medicine has assured us of that.

This is the bottom-line.

Many practices have a dependency on patients from PPOs and Medicare, and between the substantially-discounted rates paid, the crushing administrative burden of simply getting paid by the payor, and the unfortunate reality of no-shows, the docs really have to pack the schedule to make the business model work, especially if the physician's practice is predominantly an office practice.

Yes, doctors can really rake in the bucks- but they have to rake 'em right back out the door, in some pretty stunning amounts, for overhead and variable expenses. These don't stop when patients no-show.

None of this constitutes "excuse," but it can be a good portion of "explanation."

I have been fortunate to get a physician who nearly always accommodates me with minimal wait. But, this is an exception.

===

Edit:

If you think it's bad now, wait'll we have a single-payor system, something like some presidential candidates want. Vey!

 

[wsuffa]

Edit:

If you think it's bad now, wait'll we have a single-payor system, something like some presidential candidates want. Vey!

And for a taste of that medicine, just visit a DMV office on a busy day.

 

[alaskaflyer]

I always wondered what would happen if I billed back my hours wasted waiting for late appointments. Too bad you can't, they'd get the picture quickly.

Wasn't that in a Seinfeld episode?

 

[Ken Ibold]

Yes, doctors can really rake in the bucks- but they have to rake 'em right back out the door, in some pretty stunning amounts, for overhead and variable expenses. These don't stop when patients no-show.

None of this constitutes "excuse," but it can be a good portion of "explanation."

That's the canned explanation, but I just don't buy it. If no-shows were a chronic problem, then the wait times would not be what they are because the no shows wouldn't have shown, and the delays would not exist to an appreciable degree in the early morning appointments. I mean, open the doors at 8 and keep your 8:30 appointment waiting until she walked out at 10:15? If you tried that with a client, would you expect to keep their business?

 

[alaskaflyer]

Two words: overbooked flights.

Why do the airlines do that?

 

[ejensen]

I think some try. I went for a annual checkup this morning. 8:15 appointment. Nurse called me in at 8:10 and doc was in at 8:20. It does help to be early but even PM appointment at this office it seldom more than 15 minutes. Same with my dentist. But I won't go to places that can't get you in for 3 months and then make you wait.

 

[Diana]

Well, here is my take on it from my experience working part-time at a free-standing oncology clinic owned by an oncologist. (My other part-time job is making home health visits for the local county health department, but that's a whole nother story.) Unfortunately people often have to wait in our waiting room for over an hour and I absolutely HATE that they have to wait that long sometimes. I usually apologize for their having to wait so long when I take them back and they are often mad (can't blame them) especially the ones who are newer to the practice. Usually I work to fill in if one of the regular nurses is sick, so I'm a bit slower than the regular nurses, as it takes me awhile to get my rhythm going and I have to find out where they moved stuff since the last time I worked, etc.

Ken, this is coming in spurts because I have a lot to say about this and don't want to lose this if my computer blinks.

 

[Teller1900]

I mean, open the doors at 8 and keep your 8:30 appointment waiting until she walked out at 10:15? If you tried that with a client, would you expect to keep their business?

I dunno, it seems to work for us in the airlines.

 

[Diana]

The doctor that I work for is the absolute best around and he gets a LOT of referrals. Even though he is VERY busy, he won't turn people away. So, sometimes we have to squeeze people in for that. Sometimes people run into problems with complications from their cancer or their treatment and we need to squeeze them in too.

We do not only chemotherapy in a separate chemo room in the office, but also do a lot of our own lab work and some X-rays. Drawing the blood and taking the x-rays takes time and takes up treatment rooms and sometimes you can't always predict how much time or stuff will need to be done ahead of time.

If I take someone back and need to flush their infusaport, it might only take 15 minutes to check them in, or, if the port won't cooperate, then it might take 30 minutes and I am keeping a room occupied that the next patient could have been in.

I'm on a roll here. I hope this is the kind of thing you were wanting to know. If not, stop me now.

 

[Diana]

And then there is the most important part and that is the time spent with the patient. It's hard to guess sometimes how long it will take to tell someone they have cancer (or a reoccurence of cancer) and what their options are. It takes time to talk about all that and make plans and phone calls and schedule their next stop (surgeon, radiation oncologist, hospice, our chemo treatment room, etc.) while you are still making sure they are being treated like special people with serious problems and not to be made to feel like cattle.

For instance. A few months ago, I was checking in a vibrant college professor who was just diagnosed with cancer. She was shaken with the news and was visibly shaking. I took her into the room and she started sobbing while apologizing for crying. There was a waiting room full of patients who had already waited too long...people waiting for me to check them in. What are you going to do? You prioritize. I just hugged her and hugged her and held her until she didn't need to be hugged anymore and we talked and I tried to get my work done while still talking and listening. You just can't rush people through this stuff.

 

[Diana]

And then you have to deal with all the OTHER unpredictable things. The CBC machine breaks and the girl in the lab is frantically calling the manufacturer trying to figure out how to get it going again, because we need to know how to treat the patient now...the patient who is occupying one of the rooms we need to use for the next patient.

Then there is the patient who is hard to stick and you have to get warm packs to get their veins to cooperate and THAT takes time, and then you go get the nurse back in the chemo room to stick them, but she is really busy too.

Or, the doctor is waiting for another busy doctor to call him back and that takes time.

And those poor people in the waiting room are seething out there and we are helpless to hurry any faster. And if the doctor needs to spend a lot of time with a patient, then that's fine, because the next patient who just might need that extra time might be you.

The receptionist who makes the appointment tries her best to guess about all this stuff ahead of time, but it just doesn't always work out that way. And when the doctor wants all these patients to come back on certain days or in a certain time frame, then they all need to be squeezed in.

Or, if you are a dermatologist, for example, you might have to call the patient and have him come back in to tell him that you were off on the diagnosis and it was more serious than originally thought. And that patient has to be squeezed in while others wait out there wondering why they have to wait so long.

Ken, I'm not saying it's OK for people to have to wait. I just see and experience what can happen on the other side of that door. Personally, I always take something to read any time I go for a doctor's appointment. And I wish more had that sign up in their waiting rooms about being sorry about the wait, but that you will be given the same care and time when you're with the doctor as the one who went in before you (or whatever that sign says).

I'm sure that Bruce or Gil can add better insight than I've given here. It really depends upon the particular kind of practice as to how much you might be able to predict patient time frames and scheduling.

 

[Ken Ibold]

Ken, I'm not saying it's OK for people to have to wait. I just see and experience what can happen on the other side of that door. Personally, I always take something to read any time I go for a doctor's appointment. And I wish more had that sign up in their waiting rooms about being sorry about the wait, but that you will be given the same care and time when you're with the doctor as the one who went in before you (or whatever that sign says).

Thanks, Diana.

 

[Paul Allen]

My regular doctor is usually pretty good about not keeping you waiting. It's usually 5-10 minutes at the most. I went to a urologist a couple of years ago and after 2.5 hours I walked out.

 

[alaskaflyer]

The more people walk out (with a word to the receptionist as to why), the better the waiting times will become. Doncha just love unfettered capitalism?

Squeaky wheel gets the grease. If you aren't calling them on it, you have no cause for complaining here

I wish I could find that Seinfeld scene, it was classic....

 

[RJM62]

My doc is pretty good about appointment times. The only times I wait more than 15 - 20 minutes are when something awful is going around and people drag themselves to his office sans appointment. He won't send them away, so that sometimes slows things down a bit. I can't blame him for that. I wouldn't send a sick person away, either, if I were a doctor.

Actually, my overall experience with docs and appointment times is pretty good. Earlier this year I had some medical / surgical issues and had to see a bunch of specialists. Other than one long wait for an MRI when the place was jam-packed with geriatric patients, I usually was seen pretty promptly.

BTW, I learned from that experience that the best time to schedule a radiological procedure is between 4:00 and 5:30 p.m. A lot of old folks arrive by ambulette during the day and need extra help, which slows things down; and a lot of working people who can't get time off during the day start pouring in at 5:30. The hour and a half in between is the sweet spot.

Rich

 

[Diana]

(And, please, dear readers, let's NOT use this as a piling on exercise. We all have our horror stories.)

Good luck with that one.

 

[SkyHog]

I usually don't mind having to wait in the waiting room, as I figure something important is going on behind those doors, but there were two cases where I was so upset I refused to pay, told them to sue me for the money, and the money was never collected.

1) In New Hampshire, I had a crazy allergic reaction to a chemical we were using to perform taxidermy on a deer. I went to the emergency room, literally not breathing at times for almost a minute at a time, and still waited in the waiting room for 6 hours. I keep checking, and they kept saying they were busy. To me, I could have died, and I think that not being able to breath is pretty serious.

2) I had mono a little over a year ago. There is a joyous thing that happens in mono sometimes where your lymph nodes swell, and there are lymph nodes in places I didn't even know I had places. This was resulting in the most painful cramp in my groin/legs I'd ever experienced, and I literally was crying it was so painful. I went to the emergency room at 4am, there was NO ONE in the waiting room with me, and there were about 6 doctors just sitting there, bsing with the admissions nurse. Everytime I asked what was taking so long, they told me to sit down. 2 hours later, people started coming into the waiting room, and they finally saw me.

The doctor gave me percocet, and talked down to me like I was just fishing for medicine. I explained the pain I was in, but he didn't get it. All that wait for medicine that didn't fix the problem anyways.

Anyways, the New Hampshire hospital, the Elliot Hospital, btw, decided to go after my credit for not paying. I wrote a letter, explaining the situation, and saying that I was more than willing to sue them for a lot more money than they claimed I owed, and they stopped collecting.

The mono one was a bit harder. They put it on my credit, I told them the story and the didn't care. So there's been some dispute going on right now. I will take a hit on my credit before I pay those bastards a dime.

 

[gibbons]

Ken, I'm not saying it's OK for people to have to wait. I just see and experience what can happen on the other side of that door. Personally, I always take something to read any time I go for a doctor's appointment. And I wish more had that sign up in their waiting rooms about being sorry about the wait, but that you will be given the same care and time when you're with the doctor as the one who went in before you (or whatever that sign says).

All good points Diana - really. If I ran the office as a business, however, and I had patients waiting over an hour for an appointment day after day after day, I think I might adjust my scheduling practice to take into consideration some of those issues.

See? I was nice.

 

[alaskaflyer]

All good points Diana - really. If I ran the office as a business, however, and I had patients waiting over an hour for an appointment day after day after day, I think I might adjust my scheduling practice to take into consideration some of those issues.

See? I was nice.

And that the majority continue to have long waiting times despite what most of us would agree is a no-brainer solution reveals more about the customers actions than the doctors.

 

[Diana]

See? I was nice.

Yes, you were actually very nice - really.

 

[One Short]

There are a couple of reasons why a doctor is late for the first appointment of the day. One, he may just not manage his time well. That is bad, and I don't think I would tolerate that well if it is a chronic problem. Second, the office is not the start of the work day for most docs. We have to see our hospitalized patients also. Most docs like to see them in the morning and review their treatment and make adjustments to the plan as necessary. Most times this is pretty straight forward and you can anticipate how long it is going to take. But it only takes one really sick patient to throw your schedule out the window. A specialist may get to the hospital and have several unexpected consults waiting for him to see. I hate to make people wait, so I end up wasting alot of time because I build in time for the unexpected. But I also fly a Tripacer which is all I can afford because I don't schedule up all my time.

Barb

 

[AdamZ]

Diana gave such a great explaination I think if you take it the way she put it and then superimpose the managed care system problem that Spike spoke about you will understand.

My Dad is a retired Family Doc and folks used to ask him this question all the time. His office was generally good time wise but stuff did happen. Hed say imagine your in the exam room with a patient who came in complaing of a sore throat and when your done looking in the throat and handling that situation the patient says " and oh by the way doctor my knee has really been bothering me the past few days" Whats the doc going to do tell the patient to make another appointment? No Way he/she is going to examine the patients knee. It happens all the time. Then there is the emergency that comes in. Happens quite a bit.

I represent a doc's office one patient had to wait quite a while. The staff told him they could not say when he would be seen and offered to make another appointment. He sent the Medical office a bill for his time and when they didn't pay he sued. I kicked his butt in Court. Why ? Cause he looked like a schumck. The physcian had two emergencies that day both heart attacks that occured in the office. ( don't ask me why but some folks with crushing chest pain decide its better to go to thier family MDs office than the ER). The Doc has got to tend to these emergencies. Yea that was a crazy day but add that to managed care and to the situation Diana desribed and I think you have a good view of what the problem is. I HATE waiting too but I rather wait and have the Dr. give ME all the time I need when its my turn rather than rush me out.

Here is a tool that I have started to use Ken, I think it really helps and the Doctors offices are VERY cooperative with it. About an hour before my appointment I call the Doctor's office and tell them who I am and when my appointment is. I then ask if the Doctor is running on time or is he backed up. If he is backed up I say ok so if I come in at 2:45 rather than 1:45 would I be ok? You would be surprised at how well that work. The Staff and the Doctors don't want us waiting in their waiting room either.

 

[bbchien]

I have a reputation for never being late (it's not QUITE perfect). I do underschedule a bit, and it helps. But if you cancel or miss without a day's notice, or a VERY GOOD explanation that I can believe, you pay cash upfront for the next visit before you're given the appointment, or you're GONE.

Whenever I have that rare "I'm gonna be late" the patients affected are notified immediately, at that moment, and accomadation made- see 'em that PM, or Saturday, or whichever. Emergencies do occur.

 

[kevin47881]

Bruce, that's why you're THE MAN!

 

[jhempel]

I have a reputation for never being late (it's not QUITE perfect). I do underschedule a bit, and it helps.

I wish more doctors were like this. My time is valuable too.

But if you cancel or miss without a day's notice, or a VERY GOOD explanation that I can believe, you pay cash upfront for the next visit before you're given the appointment, or you're GONE.

Fair enough..... It's a two way street.

Whenever I have that rare "I'm gonna be late" the patients affected are notified immediately, at that moment, and accomadation made- see 'em that PM, or Saturday, or whichever. Emergencies do occur.

Again, I wish more doctors ran their offices like this. You would have my business, if you were in my part of the world!

 

[ScottM]

I have a reputation for never being late (it's not QUITE perfect). I do underschedule a bit, and it helps. But if you cancel or miss without a day's notice, or a VERY GOOD explanation that I can believe, you pay cash upfront for the next visit before you're given the appointment, or you're GONE.

Whenever I have that rare "I'm gonna be late" the patients affected are notified immediately, at that moment, and accomadation made- see 'em that PM, or Saturday, or whichever. Emergencies do occur.

Fair enough, that is the way to do it.

Last summer I missed two banjo lesson. I had to call just an hour or two prior to the lessons. The reasons were fire drills at work. When I did show up my teacher said nothing and when I wrote the check I included money for two extra hours. She asked why and I told her that her time was valuable and she should not have to go without her income because my work got in the way at the last minute. She was very happy.

 

[W. Stewart]

Well, Ken asked for Doctors' responses, but mostly has just gotten responses from every else! I do think that Diana did a great job in the way of explanation, however--thanks, Diana.

Like Bruce, I am a very compulsive punctual person--people who are not drive me crazy (like my associate! Despite me telling him numerous times, he arrives at the office at 8:20 and 1:20, with patients scheduled at 8 and 1).

I do have the advantage of being an ophthalmologist, so I do not have hospital rounds before office hours. I run a very efficient practice, and do my best to keep things running smoothly--I am very aware of wait times, and I get uptight when we are behind. Ophthalmology practices do have the disadvantage of having to dilate patients, though, so we might keep patients waiting TWICE each (dilated) visit: once at the outset, then once again after the dilating drops are instilled, so there is double the chance of being kept waiting. On the front of the chart's charge sheet, we write the appointment time, the arrival time, the time the patient was dilated, and I use all the above to determine which patient to see next.

I cannot fully explain why at some practices waits are so long, nor can I apologize for them. At my practice, I have worked very hard on my appointment template. One can only see so many patients in a day, so that number (of regularly scheduled appointments) is tightly regulated. Of course, this causes the wait to GET an appointment to lengthen out to several months. I cannot control the number of work-in (urgent/emergent) patients, though. We do not turn anyone away. I might keep the work-in patients waiting an hour or two, as I see the regularly scheduled patients preferentially, unless the emergency patient is truly in pain. Like somebody posted, though, the doctor cannot control the patient's complaints/findings: often someone gets a certain type of appointment for a professed certain type of problem but then burdens the doctor with numerous OTHER complaints/problems once there. Or, when I do go in to see the work-in urgent/emergent patient: things like new onset double vision just take a lot of time. Or, if something truly odd happens in, and I have to spend a bit of time on the phone.

Of course, when an appointment is not available for several months, this causes other problems. All too often, people will "back door" the system: they might call for an appointment. My phone person will ask if this is for routine examination, or if there is a problem (trying to judge the urgency of the situation, plus we have different types of appointments for different types of problems). Very frequently, the patient says "routine, no real problem", but when told that the next appointment is three months, then all of a sudden "oh wait. . .there IS a problem . .yada, yada".

For people who do not like to wait, tell the front office, and ask what the best time for an appointment is that reduces the wait time. At my office, I KNOW that I will be on time at 8:00 and 1:00 (and I schedule several quick type appointments then), but I am often behind by 10:00 or 3:30. Of course, many of an ophthalmologist's patients are elderly, so they don't like 8:00 AM appointments. Adam's suggestion of calling an hour or so before your time is a good one, too. Bring a book!

Someone posted that doctors book heavily to make a lot of money. I cannot begin to express to you that, while doctors make a reasonable living, we are really the schmucks of the world. For the most part, doctors are truly caring people who have spent years being educated and do their best to do good for the world. We have no control over anything, but are at the mercy of the government (CMS and other regulatory bodies) and insurance companies, etc--we simply collect what they SAY we can collect. Office expenses and headaches are enough to do you in. We do not hit any financial homeruns, unlike people in business or law. Personally, I cannot wait for retirement.

Wells
Ophthalmologist, or "Eye MD"

 

[bbchien]

We have no control over anything, but are at the mercy of the government (CMS and other regulatory bodies) and insurance companies, etc--we simply collect what they SAY we can collect. Office expenses and headaches are enough to do you in. We do not hit any financial homeruns, unlike people in business or law. Personally, I cannot wait for retirement. Wells Ophthalmologist, or "Eye MD"

I second this one.

 

[SCCutler]

I second this one.

Not all doctors make folks wait.

Not all lawyers are rich.

Believe me on this one.

Or, ask Adam.

 

[Teller1900]

You would have my business, if you were in my part of the world!

Second.

 

[W. Stewart]

Not all doctors make folks wait.

Not all lawyers are rich.

Believe me on this one.

Or, ask Adam.

Well, if you are an attorney, at least you can bill for your time (phone calls, reviewing documents, etc). We only get to charge for the particular level E/M code pertaining to what transpired in a patient visit.

This weekend I spent four HOURS trying to get caught up with dictations and reviewing records I had requested. We do this stuff just to be providing quality care! (No pay for this)

Wells

 

[SCCutler]

Well, if you are an attorney, at least you can bill for your time (phone calls, reviewing documents, etc). We only get to charge for the particular level E/M code pertaining to what transpired in a patient visit.

This weekend I spent four HOURS trying to get caught up with dictations and reviewing records I had requested. We do this stuff just to be providing quality care! (No pay for this)

Wells

Sounds a great deal like proper file documentation. If I could bill for all the time I work, it would be a grand thing. If I could collect for all the time I bill it would be a grand thing.

Only truly rich lawyers are (1) big-time PI / med-mal / plaintiffs' lawyers; (2) big firm partners; and (3) high-end divorce lawyers. Small-firm lawyers billing by the hour are getting by, not getting rich.

None of which is intended to in any way take physicians to task for any thing at all. I represent some docs, and much of the same stuff I describe applies equally to docs in office practice; they ain't printin' money, either.

Doctors and lawyers both get to endure endless "free advice" opportunities at all social events, too.

 

[mikea]

I took Mom to the surgeon office for a 10:30AM appointment. Even though I was early enough to town to take her to breakfast we walked in the door at 10:30. Got seen at 11:30. The doctor got called to a real emergency. No complaint.

To "save us time" she orders a test to be done at the nearby hospital. As I led Mom in her walker to the "adjacent" building in the 20 degrees with a 5 below wind chill....It took us 20 minutes to get to the entrance. I cursed the nimrods who made the hospital entrance face the lake rather the population. We had to walk around the perimeter of three city blocks across ramps that were placed at the furthest possible place for a pedestrian.

Down hospital halls, desks, forms, (She has been here each of the last 3 weeks. They know every datum on her possible.) elevators 2 waiting rooms. At 1:30PM we left the "convenient" nearby hospital and we hadn't had the test.