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I also find doctors to be late in perpetuity, ive never in my life waited less than 10 minutes PAST the actual appointment time. This is both an easily identifi

I also find doctors to be late in perpetuity, ive never in my life waited less than 10 minutes PAST the actual appointment time. This is both an easily identifiable problem and easy to fix, the receptionists could easily structure appointments more appropriately.

schn 16y ago
This is a byproduct of their time generally being worth so much more than yours. You would not complain if you had to visibly pay for any time a doctor is waiting with no patients. As for structuring appointments more appropriately, it's quite easy to think of reasons an appointment could take more time than anticipated, and if you had to buffer for that time, you would have to pay for the buffer.
- demallien 16y ago
  No, you don't have to pay for the buffer time, or at least, yes, ok, you do have to pay for the buffer time, but the hourly rate of 'buffer time' will only be a percentage of what you pay for actual 'visit time'. The percentage that you pay for buffer time should be a reflection of the probability that the doctor will be busy for that buffer time. I would expect that buffer time would be billable at about 30% of visit time, because on avergae a doctor will be busy for the buffer time about two thirds of the time. Obviously that number is just a guess, but it should certainly be under 50%, if I believe my experiences in doctors' waiting rooms..
papa 16y ago
Well the problem may vary from provider to provider (and country to country), but after observing my wife's situation as a physician in the U.S., I can tell you that many doctors aren't late volitionally. First, the problem isn't easily fixed. Here's the deal: At her HMO each doctor has a panel of several thousand patients. Each patient visit during a normal clinical day gets a 15 minute allocation with the MD. It used to be 20 minutes at her HMO but was recently reduced in order to increase the patient volume. Typically my wife's schedule is stacked appointment to appointment from 8-Noon and then again from 1-5pm. A couple of time slots are left unscheduled for high priority, emergent visits (if you've got a routine visit, forget it, you'll get something a month or two out into the future). No as you can imagine, 15 minutes per patient isn't much time. Some patients require more time. With each successive visit, the wait will get longer and longer. This isn't because the doctor (at least some of them) is being a jerk or dismissive, it's because they're trying to do a thorough job with the time allocated. If they can't finish what they need to in 15 minutes, well, she goes over that time. It isn't too hard to realize how screwed up the schedule can get after a couple of tough back-to-back cases. My wife then tries to catch up during lunch hour because she doesn't take lunch. After working through lunch, she kicks into the afternoon half of clinic hopefully caught up, but sometimes not. And the cycle repeats itself. The receptionists can't "easily structure" the appointments more appropriately -- at least at the large providers -- b/c they're not the ones running the game. I'm not going to defend the overall system. That's a much bigger problem and mess that a lot of smart people have looked at and have yet to solve. But I do think it's worth realizing that, yes, many doctors do think your time is valuable and don't purposefully try to waste your time. Many doctors are overworked and are doing the best they can within the parameters of what they've been given to practice medicine and that at some point you might be that person that has an appointment that goes over the time allocated (and when you do, hopefully you'll be happy the doctor ended up being attentive to those needs). Just hoping to lend some extra perspective (especially as someone who used to feel the same way you do).
- billswift 16y ago
  It was her choice to work in that situation, so I have very limited sympathy.
Someone 16y ago
It is only easy to fix at the expense of decreasing productivity of the doctor. Because of that, most doctors do not really see this as a problem, let alone one that needs fixing. The problem is that meeting a doctor cannot be planned perfectly. A meeting might take 5 minutes, or it might take 20. If, on average, a doctor can serve 4 patients an hour, and she wants to reach that on a 9-5 working day, she must schedule her first patient at 08:45 or thereabouts. Reason: the first patient might be late. That would give her idle minutes that she would need to serve later patients, some of which might take 20 minutes. Similarly, she must schedule her second patient at 09:00-ish, to have a patient waiting in case the first one happens to take only 5 minutes to serve. And yes, that appears rude, but mostly, it is the economical thing to do. You can only get better service by paying your doctor more. You will notice that many people who can afford that are willing to do so. As an extreme example, I doubt that the president of the USA has spent much time waiting for his doctor. For the maths behind this, google queueing theory.
SoftwareMaven 16y ago
The real problem is that the customer is not the person getting the care, it is the person paying the bill, so that is what gets optimized for. The healthcare world is directly analogous to the auto repair world, we just don't fit in the same place: You, car, mechanic :: Insurance co, you, doctor.

schn 16y ago

This is a byproduct of their time generally being worth so much more than yours. You would not complain if you had to visibly pay for any time a doctor is waiting with no patients. As for structuring appointments more appropriately, it's quite easy to think of reasons an appointment could take more time than anticipated, and if you had to buffer for that time, you would have to pay for the buffer.

demallien 16y ago
No, you don't have to pay for the buffer time, or at least, yes, ok, you do have to pay for the buffer time, but the hourly rate of 'buffer time' will only be a percentage of what you pay for actual 'visit time'. The percentage that you pay for buffer time should be a reflection of the probability that the doctor will be busy for that buffer time. I would expect that buffer time would be billable at about 30% of visit time, because on avergae a doctor will be busy for the buffer time about two thirds of the time. Obviously that number is just a guess, but it should certainly be under 50%, if I believe my experiences in doctors' waiting rooms..

papa 16y ago

Well the problem may vary from provider to provider (and country to country), but after observing my wife's situation as a physician in the U.S., I can tell you that many doctors aren't late volitionally. First, the problem isn't easily fixed. Here's the deal: At her HMO each doctor has a panel of several thousand patients. Each patient visit during a normal clinical day gets a 15 minute allocation with the MD. It used to be 20 minutes at her HMO but was recently reduced in order to increase the patient volume. Typically my wife's schedule is stacked appointment to appointment from 8-Noon and then again from 1-5pm. A couple of time slots are left unscheduled for high priority, emergent visits (if you've got a routine visit, forget it, you'll get something a month or two out into the future). No as you can imagine, 15 minutes per patient isn't much time. Some patients require more time. With each successive visit, the wait will get longer and longer. This isn't because the doctor (at least some of them) is being a jerk or dismissive, it's because they're trying to do a thorough job with the time allocated. If they can't finish what they need to in 15 minutes, well, she goes over that time. It isn't too hard to realize how screwed up the schedule can get after a couple of tough back-to-back cases. My wife then tries to catch up during lunch hour because she doesn't take lunch. After working through lunch, she kicks into the afternoon half of clinic hopefully caught up, but sometimes not. And the cycle repeats itself. The receptionists can't "easily structure" the appointments more appropriately -- at least at the large providers -- b/c they're not the ones running the game. I'm not going to defend the overall system. That's a much bigger problem and mess that a lot of smart people have looked at and have yet to solve. But I do think it's worth realizing that, yes, many doctors do think your time is valuable and don't purposefully try to waste your time. Many doctors are overworked and are doing the best they can within the parameters of what they've been given to practice medicine and that at some point you might be that person that has an appointment that goes over the time allocated (and when you do, hopefully you'll be happy the doctor ended up being attentive to those needs). Just hoping to lend some extra perspective (especially as someone who used to feel the same way you do).

billswift 16y ago
It was her choice to work in that situation, so I have very limited sympathy.

Someone 16y ago

It is only easy to fix at the expense of decreasing productivity of the doctor. Because of that, most doctors do not really see this as a problem, let alone one that needs fixing. The problem is that meeting a doctor cannot be planned perfectly. A meeting might take 5 minutes, or it might take 20. If, on average, a doctor can serve 4 patients an hour, and she wants to reach that on a 9-5 working day, she must schedule her first patient at 08:45 or thereabouts. Reason: the first patient might be late. That would give her idle minutes that she would need to serve later patients, some of which might take 20 minutes. Similarly, she must schedule her second patient at 09:00-ish, to have a patient waiting in case the first one happens to take only 5 minutes to serve. And yes, that appears rude, but mostly, it is the economical thing to do. You can only get better service by paying your doctor more. You will notice that many people who can afford that are willing to do so. As an extreme example, I doubt that the president of the USA has spent much time waiting for his doctor. For the maths behind this, google queueing theory.

SoftwareMaven 16y ago

The real problem is that the customer is not the person getting the care, it is the person paying the bill, so that is what gets optimized for. The healthcare world is directly analogous to the auto repair world, we just don't fit in the same place: You, car, mechanic :: Insurance co, you, doctor.