Alan B. Krueger is a professor of Economics at Princeton University and writes a blog for The New York Times on the cost of life - how what we do (or don't) and how we live (or don't) affects our bottom line.
I really liked his recent blog about the long waits at doctor's offices. I'm lucky, my wait time is less than a few minutes to be seen by a medical assistant and then about 10-15 minutes in the waiting room for the actual doctor. But when I lived in a different city, the wait time at my doctor's office was over an hour, and that was out in the general waiting area. I (and a few others I knew) ultimately fired the doctor.
My children's doctor is becoming a different story. It used to be a 10 minute wait. Now it's 25 minutes before our names are called, and my kids are weighed and have their vitals taken. Then it's up to a half an hour before we see the pediatrician. I think our pedi is wonderful and I'd hate to have to 'fire' her too, but sitting around a doctor's office with 3 small children (and at least one of them sick) for an hour is unacceptable. Or it should be.
Back when I had one child and cared much more about what others thought of my mothering skills, I'd hush my child and cradle him and mentally beg him to try to be quiet while we waited. Now I'm pretty happy to wait 20 minutes with all the usual rules in place. After that, I let them make some noise in the tiny patient waiting room. Once we get to the 45 minute mark I let them roam the halls. Not just because it's stifling to have four people in a tiny room with an even tinier basket of kid books to amuse us. But because I want the staff to know that we're getting frisky, and impatient, and that it's not ok to let us marinate for an hour, with sick kids, in a tiny room with blinding fluorescent lights.
So when my kids start to run amok, I look at the staff with that kind of "what can ya do?" shrug and I lie in secret wait for them to say something of a "can you keep it down?" nature. I'm ready to pounce with my arguments stated above.
And the truth is my kids don't scream or yell or upset everyone. I wouldn't let them. But surely a doctor's office that specializes in children would not overbook or run behind so often - and on a daily basis. I understand the business of health care and those pesky HMO's ; I worked in the business of health care. I understand that patient emergencies happen. And, like airlines, I comprehend the need to overbook. What I don't comprehend is the length and regularity of these waiting times. When something 'bad' happens every day, it's time to modify the something.
Professor Kreuger used the tool known as the American Time Used Survey and calculated that Americans aged 15 and up spend 850 million hours every year in waiting rooms.
And according to these numbers, "if we value all people’s time at the average hourly wage of production and nonsupervisory workers ($17.43 in 2007), Americans spent the equivalent of $240 billion on health care in 2007.
Put another way, omitting patients’ time caused national health care expenditures to be undercounted by 11 percent in 2007. "
http://economix.blogs.nytimes.com/2009/02/09/a-hidden-cost-of-health-care-patient-time/#more-889
Reading some of the comments below the Professor's blog, it's clear to see the frustrations patients have with the endless hours spent waiting to see a healthcare professional and the subsequent 4-5 minutes one actually spends with the doctor after all that waiting. Some have even walked out and billed the doctor for THEIR time in the waiting rooms. Many patients have to take unpaid time off to see their doctors.We simply can't afford to sit and wait. Our time - and money - is valuable too.
By the way, I did tell the pediatrician that the wait times had gone from understandable to excessive and she agreed. Now all she has to do is actually do something about it...
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Add a Comment9 Comments
I read everyone's comments and agree to many valid points. Nevertheless, I believe that punctuality is not a one way street. If the doctor's office can charge late fees for being 10 or 15 min late, then the patient should be able to charge the office the same. After all, the appointment WAS at 1:30pm, not 2:30pm, correct?
As noted above, many times you will see a doctor in less time than you would wait for a table at your favorite restaurant.. but the main difference between these activities is that going out for dinner is voluntary, whereas going to the doctor is many times involuntary. I can choose to go out or not for dinner, but I cannot choose to keep a sick child at home. No good parent would.
With this in mind, parents and patients many times have to accommodate their busy schedules to make the "unforseen" appointment with the doctor. It is a mutual agreement between both parties and should be honored by both. If the doctor's office is to be a business, then it too should abide by normal consumer regulations. Offering compensation for "unsatisfactory" service.
When has anybody turned around and said, "I'm not satisfied with your service and I would like a refund" ????
I have been in school for 10 years now, like most doctors, but I would find it unethical to charge my clients late fees and not be willing to give them a refund or compensation if they found my services unsatisfactory on good grounds.
October 15, 2010 - 11:07amThis Comment
I don't have a lot of patience with posts complaining about wait times in doctor's offices. When I've really needed my doctor's time - such as the day he had to tell me that I have leukemia - I've gotten his time and full attention. I'm sure that other patients had to wait that day as we had to deal with the illness and the immediate need for hospitalization. On other days when I've had to wait I realize there may be others who have a serious medical problem and are getting his time and full attention that day. And, some days, the practice has been held up by the insurance company's restrictions on what my doctor can and can't do. All of this is a balancing act for everyone, and if people would try to work together to find the right balance things would go a lot more smoothly.
April 22, 2010 - 6:57pmThis Comment
I totally understand everyone's point, how ever. My wife is a family practice doctor and I run her office in a small town in Oklahoma. There are allot of factors that go into play on how long a patient waits in the waiting room or exam room. For instance, if a doctor is having to train a new nurse or nurses, if a new receptionist is having to be trained the upfront time could take longer than usual. The doctor has to spend time with drug reps to get samples for his or her patients and to do that, they have to spend sometime with them. Trust me, I would rather my wife be in with patients then spending time with drug reps, because you don't get paid for time with them. One of the biggest issues is when patients are late for their appointment, it through everyone else's time off. Then lets not forget all the paper work that the doctor has to fill out for patients, insurance companies, DME companies and by the way, none of that time spent in her office will she get paid for. The insurance companies expect doctors to jump though hopes just to get reimbursed a couple of bucks. It is getting to the point now that insurance companies wont pay for the medicine that works the best, so now my wife has to spend even more time trying to find a drug that her patients can afford. There are allot of other things that goes along with this but, I don't have all day long to explain. So when you are in the waiting room or exam room think about what I wrote and try to be a little bit more understanding, after all the doctor wouldn't be doing this as a profession if they didn't care about you.
March 27, 2009 - 11:57amThis Comment
If your wife has a new nurse or receptionist?....schedule accordingly. If your wife has to see drug reps?....schedule accordingly.
Sorry, but your post did nothing to help me be more understanding for a doctor's plight. Quit trying to jam so many patients into a work day and the wait times will decrease. IMO, training nurses, dealing with drug reps, tardy patients, heavy paperwork loads, and insurance regulations are all things that a doctor should know and come to expect. It comes with the territory. I'm not saying every doctor is the same but many with their own practices work very limited schedules. I've known some who work 1 day a week. Others I've know may work 4 days a week. How about a 6 day work week like so many people do when they need to get caught up on their work load? How about playing that round of golf some other day Doc?
From the sound of your post, it would seem she (but maybe more likely you) is not happy with her career choice. Maybe a change is in order. English teacher perhaps?
I think it's ridiculous that a doctor can charge you a fee if you cancel within 24 hours but when they cancel with the same short notice it's OK. Be late for an appointment and they charge you a fee but god forbid they see you in a timely manner. How is that "caring about you"???
I think I will start sending a bill to my doctor for my time. I'll charge a fee if they cancel within 24 hours and I'll charge them an hourly rate for every minute PAST my appointment time that they make me wait. Of course, on every invoice I'll have to add a processing fee, fuel surcharge, mileage fee, misc supplies fee, postage fee, etc, etc, etc....
June 11, 2009 - 9:25amThis Comment
Patients coming in with kids climing the walls, unfortunate elderly people that can't hear or are so lonely they take longer just so they can talk to another human being during the day, people who can't speak English, patients with a laundry list of complaints who don't believe any of your recommendations, patients showing up late, difficult medical cases that require an unusual amount of time to diagnose and require extra procedures to do so, angry patients on the phone who don't think twice about dropping $100.00 for dinner but will complain for 20 minutes about paying a $10.00 copay that their insurance mandates, the patient asking for a copy of their medical records because they didn't get better even though they didn't follow any of your directions and want to find another Doctor, 18 minutes of paperwork mandated by the government for coding (to avoid a $150,000.00 fine and being accused of fraud) for a 3 minute diagnosis, meeting the demands and threats of employees that they'll leave without notice ( after a year of training them) if you don't increase their salaries while insurance companies are paying less and less, all this while your rent, supplies and malpractice companies are charging more and more. That's why your doctor runs late and keeps you waiting in the waiting room. That's why they feel they can charge you a$50.00 no show fee when you didn't care enough to cancel your appointment after your 3rd no show, even when they make you wait sometimes in their waiting room ( waiting less time than you would for a table in your favorite restaurant on a Saturday night). It's not because Doctors
April 21, 2010 - 4:46pmdisrespect patients' time. No Doctor loves entering a room with an angry patient. No its not because your Doctor dislikes his or her profession. It's because your Doctor's office is unfortunately also a business. As in every business we have to pay our expenses and bills to keep our doors open so that patients have a place to go when they're uncomfortable and in pain and need someone to help them feel better. Think about that next time you complain about the wait in your Doctor's office. Ask your insurance company thinks its fair to reduce reimbursements when the cost of living continues to rise. Ask the government why
Doctor's can be sued for ridiculous claims and still have to pay thousands of dollars in defense, why they have to be penalized for human unintentional errors or things that they have no control over. Ask the government why we have 3 times the amount of paperwork as Doctor's did 15 years ago, ask the government. Ask your friend or neighbor why they treat Doctors with less respect than ever even though we gave up our youth to study, most of the time with little or no pay until we're 30 years old? You think we're making you wait because we're playing golf or too busy picnicking in the back with our employees?
This Comment
Patients coming in with kids climing the walls, unfortunate elderly people that can't hear or are so lonely they take longer just so they can talk to another human being during the day, people who can't speak English, patients with a laudry list of complaints who don't believe any of your recommendations, difficult medical cases that require an unusual amount of time to diagnose and require extra procedures to do so, angry patients on the phone who don't think twice about dropping $100.00 for dinner but will complain for 20 minutes about paying a $10.00 copay that their insurance mandates, the patient asking for a copy of their medical records because they didn't get better even though they didn't follow any of your directions, 18 minutes of paperwork mandated by the government for coding (to avoid a $150,000.00 fine and being accused of fraud) for a 3 minute diagnosis, meeting the demands and threats of employees that they'll leave without notice ( after a year of training them) if you don't increase there salaries while insurance companies are paying less and less, all this while your rent, supplies and malpractice companies are charging more and more. That's why your doctor runs late and keeps you waiting in the waiting room. That's why they feel they can charge you a$50.00 no show fee, when they make you wait sometimes in their waiting room ( waiting less time than you would for a table in your favorite restaurant on a Saturday night). It's not because Doctors
April 21, 2010 - 4:38pmdisrespect patients' time. No Doctor loves entering a room with an angry patient. No its not because your Doctor dislikes his or her profession. It's because your Doctor's office is unfortunately also a business. As in every business we have to pay our expenses and bills to keep our doors open so that patients have a place to go when they're uncomfortable and in pain and need someone to help them feel better. Think about that next time you complain about the wait in your Doctor's office. Ask your insurance company thinks its fair to reduce reimbursements when the cost of living continues to rise. Ask the government why
Doctor's can be sued for ridiculous claim, why they have to be penalized for human unintentional errors or things that they have no control over. Ask the government why we have 3 times the amount of paperwork as Doctor's did 15 years ago. Ask your friend or neighbor why they treat Doctors with less respect than ever even though we gave up our youth to study, most of the time with little or no pay until we're 30 years old?
This Comment
Susan, your post reminded me of a similar thing in this weekend's New York Times magazine. In the Ethicist column, written by Randy Cohen, a woman asks this question:
"A few hours before a dentist appointment, I had to cancel because the baby sitter was ill. The dentist charged me $25 for canceling within 24 hours. Days later, just two hours before my rescheduled appointment, the dentist's office called: because of an emergency, my appointment had to be rescheduled. This is hypocrisy on their part, but should I accept that "policy is policy" or demand "an eye for an eye?" "
Mr. Cohen writes that "For a precept to be fair, it must apply no matter who transgresses. Here this means that whether dentist or patient cancels at the last moment, the same penalty should apply."
He goes on to write that either party suffers if the other cancels at the last minute -- the dentist misses the opportunity to make income during that time, or the patient loses her baby sitting fee or the ability to make other plans. And that the $25 fee is compensation for the harmed party, and therefore should go both ways. And that either party should have the ability to cancel in case of emergency; in other words, the dentist's emergency is not more important than that of the patient.
I had two thoughts while reading it:
1. He's exactly right, and
2. It'll never happen.
But wouldn't it be nice?
February 11, 2009 - 9:32amThis Comment
I think it also depends upon the practice or facility how well they can handle their patient load. Good for you for being straightforward with your pediatrician about the excessive wait time.
About excessive wait times in emergency rooms, there was an article posted a few years ago on this subject, citing cases of people who had died waiting to be seen or admitted.
We're fortunate to be surrounded by enough hospitals/ER's within a five-mile radius to count on one hand. One in particular has the best reputation for getting ER patients attended to in short order, and without making the paperwork more urgent than the care.
My daughter's ENT tends to have a bit of an office wait. But, when he does get to her, he takes his time in his consultation. This I appreciate, as he doesn't make you feel like just a number on a file folder.
I love the idea of billing the doctor for your excessive wait time, although I doubt your invoice would be paid. I also like the new generation of first care clinics popping up where people can go for vaccinations and non-emergency care instead of making an appointment with their primary care physicians. These clinics are lower cost and staffed by Nurse Practitioners, nurses with advanced credentials. Such clinics help ameliorate patient load and can probably take care of sore throats and sniffles more expeditiously than your pediatrician.
February 9, 2009 - 5:59pmThis Comment
Susan, Thanks for such a great share. I think waiting times and health insurance issues are the biggest non-condition related headaches facing many of us. To your point, a relative of mine recently spent almost eight hours in a hospital emergency room less than a few weeks ago. While she had her blood pressure checked, blood drawn and a few tests completed in that time, it took her the entire eight hours before a doctor could see her to let her know what was going on on. And she really did receive superior care once she had the opportunity to visit with a doctor. And I know ERs are busy during this time of year -- but given that she was ill and worried, the waiting time seems a little cruel.
On the flip side, I have actually waited longer for a hair cut than in my doctor's office. The waiting time is usually around 15 or 20 minutes to see an assistant and the doctor is usually in within 10 minutes of that time. He is very good about asking questions and going through the standard checks. I've recommended him to both my husband and my sister-in-law. He seems to have a genuine respect for other people's time and has a few things in his office to keep the little ones occupied should the wait ever get to be too much.
February 9, 2009 - 2:03pmThis Comment