Dr. Andy

Reflections on medicine and biology among other things

Saturday, June 04, 2005

Waiting and scheduling

Dr. Kevin has this post on the trade-off between waiting for your doctor and brief appointments:
Are you, fellow physicians, the type who is always on time, every 15 minutes? Or do you spend as much time as it takes with each patient?

Do you, as a patient, want a physician who runs on time, every time? Or do you mind waiting 1 hour for a visit where all your problems are addressed?

Because you can't have both. It is impossible. Hence, the spectrum of waiting.
I'm not so sure I completely agree. Office schedules could be made realizstic, such that patients were generally seen on time. If several patients with particularly complex problems came in a row, the practitioner might get a bit backed up, say 1/2 hour, which I would guess is the wait at which people don't really seem to mind.

One thing I sense most physicians don't do enough is have people back for another visit. When I used to moonlight for a pediatrics practice, people would come in for "sick visits" on the weekend and then want to discuss various non-urgent issues (should they see an gastroenterologist for the constipation that had been present for the last two years, getting school physical forms filled out). If I had time I'd spend it addressing their needs as best I could (hey, I was getting paid) but if we were getting backed up I'd politely, but firmly tell them that I had to move on and they should come back and see their regular pediatrician. People seemed to accept this and patients were eternally grateful that I ran near on time (seeing 3 patients per half hour).

One thing I don't think most patients realize is how much time physicians can spend waiting when patients don't show up for their appointments and don't bother to call and cancel. This is frustrating for everyone because a physician is sitting around with no patients to see and therefore not generating any revenue. I suspect this is worse in an academic center and particularly one, like mine, that cares for a lot of disadvantaged patients. All these no-shows create the temptation to overschedule, but then if everyone shows up, we run way behind.

In Canada, there is the following solution: if you miss an appt. with a specialist without cancelling >24 hours, you are charged a fee (about $125). If you show up, the visit is free. I suspect such a system would result in a lot less no-shows and might allow more physicians to move to realistic schedules, confident everyone would actually show up.


At 5:16 PM, Anonymous ollie said...

Given today's available technology, I don't see why docs couldn't use some sort of operations research software to schedule appointments in a way that optimizes waiting time for the patients.

Any competent industrial engineer or operations research person should be able to whip such a program right out.

At 9:21 AM, Anonymous Anonymous said...

Good luck collecting the fees for the no-shows. While I agree, it would help cut down on them, I don't see it working here in the midwest, where so many people are already at the poverty level who are waiting to be seen.

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