In addition, the realities of managed care and reimbursement rates mean that--for many types of practices--doctors have to see a pretty large volume of patients

In addition, the realities of managed care and reimbursement rates mean that--for many types of practices--doctors have to see a pretty large volume of patients every day to be able to stay afloat. No doctor I've talked to likes this state of affairs, but it's a reality. This leads to dissatisfaction because patients feel that their doctor is rushing through the appointment without giving them adequate time. It doesn't necessarily mean they're getting substandard care, but it's also reasonable to feel angry or annoyed by that kind of interaction. Conversely, many practices will do everything they can to maximize physician utilization, including scheduling lots of back-to-back appointments. Inevitably, if a doctor is actually doing a good job, some visits will uncover more complex health issues than planned and require more than the 15 or 30 minute allotted to address. This means that appointments start to back up, people start having long wait times to see their doctor, and patient dissatisfaction ensues. Again, this isn't a problem with individual doctors or practices-- although it may seem that way to patients--it's systemic.