We've all been left twiddling our thumbs in the doctor's office long after appointment time has come and gone. Some wait it out to varying degrees of annoyance, while others leave in an angry huff. Often, the same docs either post a sign or require patients to initial a form stating that the appointment can be canceled, or a fee applied to the account if the patient is late. So why do doctors get a "free" pass, while patients pay a penalty? Are they implying that their time is more valuable than that of their patients?
Not really. Many doctors say the underlying cause of lateness is the patients who came before you. First, there are patients who arrive late, but still within the acceptable 15-minute grace period. The doctor's office has to be accommodating to a reasonable extent due to extenuating circumstances like traffic, especially if the patient is actively sick or exhibiting symptoms. Also, plenty of patients blow off the request to arrive 15 minutes early to update insurance and fill out paperwork. So, even if they arrive technically on time, taking care of these tedious, but necessary, steps will push the entire schedule back.
Then, there's the actual seeing of the patients. Although it varies by practice, many general practitioners schedule patients in increments of 15 or 20 minutes. For a basic and easy to diagnose complaint, that's totally doable. However, a patient presenting with a complicated history, multiple issues and new symptoms can quickly cause a backlog, particularly if they didn't disclose when scheduling the appointment that they have numerous concerns, or if an unexpected issue pops up during the visit.
"Because of the nature of health, there is no ability to say – 'come back tomorrow so that I can initiate the treatment for the heart murmur I just found,'" emails Elizabeth Woodcock, an Atlanta-based expert in medical practice operations efficiency, who regularly advises doctors on ways to improve patient flow and scheduling optimization, adding, "Delaying care is very different [from] delaying a mortgage closing, sweater purchase, meal reservation, etc., so this means that a single patient can result in a delay for everyone scheduled that day."
Most practices take steps to minimize wait times, but there's currently no magic equation. "We try to make a schedule that will accommodate complicated or demanding patients, but what if half the patients that day take more time than expected?" says Dr. Barbara Bergin, an orthopedic surgeon in Austin, Texas. "If I really want to be certain that no one waits, then maybe I only see five patients in a morning. Then I can't afford to keep the lights on."
Who Pays for Tardiness?
But is it always the patients' fault? The statistics website fivethirtyeight.com looked at a study on patient timeliness which found that just 7.7 percent of patients arrived late to appointments at one pain clinic (late was defined as being one minute past the appointment time). Almost 91 percent of patients arrived on time or early. Of course, just because the patients were on time, doesn't mean that there weren't complications during the visits which threw off the appointment schedule.
The website also reported on a separate paper looking at data from 9,945 patients at 44 outpatient clinics. It found that on average patients waited for 38 minutes: 23 in the waiting room and another 15 minutes in the exam room. The longer patients waited, the lower the satisfaction levels they reported.
Woodcock says she's never heard of a doctor reimbursing a patient for their lost time, nor would she recommend it. But on the other hand, she says, practices rarely follow through on their threat of charging fees for no-show or late arrivals, assuming they have such a policy. Typical enforcement would require invoking a collection agency, just to collect a relatively nominal fee. Most of the time, such policies, are "not even acted upon, particularly on the first offense," she says.
Another reason for delays might be something patients often want more of: evidence that their doctor cares about them. Dr. Nicole Rochester is a professional patient advocate, who used to work as a primary care pediatrician. "The thing I hated the MOST while practicing primary care medicine was regularly apologizing to my patients for being late," she says in an email interview. Although factors were often out of her control, she does acknowledge in a blog post on her site Your GPS Doc, that chatting with patients was a contributing reason.
"There is a price to pay for engaging with your patients and their families, and that price is efficiency," she writes, adding, "I'd like to think the time and attention I gave my patients made up for my being late, but I'm sure there were some who would disagree. When you add the complexities of an electronic medical record, efficiency can really suffer."
So, the next time you have an appointment, do your part to arrive early and hope everyone else does the same. And don't forget one day, it could be you who needs the extra time.
"Most patients understand that their doctor is trying their best to see them on time. They understand that circumstances are sometimes out of the doc's control," Dr. Bergin says. "And my patients also know, that when it's their turn, they will get the attention they need, even if they run over their allotted time."