Ever had a doctor/dentist actually see you at appt time scheduled?

[unclemick]

I think it may? have happened once or twice with a dentist since 1966 but not with any of the doctors that I remember.

heh heh heh -

 

[Meadbh]

It was a helpful post, thanks. As I noted at the outset, I can well understand being late on an exception basis, but not chronically late, especially for the first appt as in my case. Guess my doctors haven't heard of LEAN, interesting since we implemented ISO, Six Sigma, LEAN and 5S in manufacturing beginning in the mid 90's.



The volume of paper still in the medical profession is amusing too. Some (not all) of the old timers seem to be resisting technology with gusto. One of my friends is an accomplished 64 yo orthopedic surgeon, totally illiterate technology wise, email is a challenge to him...he just mastered texting recently, thinks it's pretty cool! But maybe he's not representative.

Thanks Midpack. To put It in perspective, I'll bet that manufacturers wouldn't necessarily know enough about healthcare to be able to diagnose and treat the illnesses of their employees. They would delegate that responsibility by providing health insurance benefits......unless they were small businesses, in which case they might not have the resources to do that. Well, most physicians in private practice are running small businesses. And they often don't know what they don't know.

 

[W2R]

My dentist not only is on time, but when I arrive a few minutes early (as is my custom), frequently he will see me early.

My doctor used to have all of his appointments at the same time. Then he would see all of us over however many hours it took. I hated that, and it was crowded and felt like border clinic I recall visiting in the past. So, he changed his policy and now we each have our own appointment. It is still crowded. Usually I get called back to the examining rooms maybe 60-90 minutes after my appointment, and then sit there maybe another 30 minutes until he can see me.

When he finally DOES see me, he spends whatever time he needs with me. He never acts rushed.

 

[Katsmeow]

I am an ex-doctor myself, although I didn't have a clinic. But I did participate in projects to improve patient flow. Here are some of the reasons that doctors are notoriously late:

That was a helpful list. My perception is that those who are always late are generally guilty of over scheduling. I always had the feeling that they wanted to schedule every minute of the day so that they wouldn't have a hole if a patient didn't show up. And, frankly, they didn't really care if you had to wait.... But I do think it is better in more recent years.

On an aside -- aren't you a retired doctor, not an ex-doctor? I mean I don't think I would ever see myself as an ex-lawyer... Even if I let my license go inactive I don't think I would see myself as an ex-lawyer.

 

[Khufu]

This discussion is typical of those concerning the deficiencies of the US medical system in that it overlooks the obvious. The medical business did not succeed in sequestering the largest share of the largest economy in the world without paying careful attention to economic incentives. In the case of doctors' scheduling of their billable time that means double-booking. My favorite case is a dermatologist I went to several years ago in NYC. I arrived on time and was kept waiting an unconscionably long period of time during which I complained to the receptionist. She matter-of-factly replied that of course the doctor double-booked; they all do. Sometime later the dermatologist appeared at last at which point I complained loudly about being kept waiting because of double-booking. The doctor looked me right in the eye and replied, "We never double-book." The punchline to the story is that the dermatologist spent about 4 minutes looking me over, decided a couple of moles could be suspicious, and told me to come back for biopsies. Why couldn't she take the samples right then? Because by making me come back for a second visit she collects another payment thereby further wasting my time while defrauding the insurance company. All routine.

So the economic incentives are the doctor can risk the occasional loss of revenue because of your no-show or routinely abuse his patients' time by double-booking for his gain and their loss. Is it any surprise that patients have to wait?

Although I have had doctors whom I respected in various ways, as a group I despise them.

 

[bUU]

I had an appointment with my PCP for 9:15 AM on Monday; arrived at 8:55 AM; and was practically done with the appointment (it was intended to be a short follow-up) at 9:20 AM. I deliberately switched doctors several years ago, intentionally choosing a more patient-focused practice over one that was clearly more doctor-focused.

 

[Midpack]

Thanks Midpack. To put It in perspective, I'll bet that manufacturers wouldn't necessarily know enough about healthcare to be able to diagnose and treat the illnesses of their employees. They would delegate that responsibility by providing health insurance benefits......unless they were small businesses, in which case they might not have the resources to do that. Well, most physicians in private practice are running small businesses. And they often don't know what they don't know.

Somewhat tongue in cheek? At least where I am, many doctors seem to have consolidated practices and joined much larger health networks. And I thought that was happening nationwide. I would think these large/huge organizations would "know" what they don't know - and I know some have indeed implemented LEAN and other productivity tools. I thought the independent, small business practices were rapidly disappearing?

I don't know for sure, I am asking...

The high cost of healthcare in the US is a compounding issue for me. And our local hospital was just torn down after a new one was built. The new one is like a high tech 5-star resort. And I just had a prescription filled that retailed for $670, and cost us $50 - that's nonsense IMO. So my objectivity may be in question...

 

[Gatordoc50]

I think most doctors/dentists want to be accommodating to their patients health concerns as well as time constraints. Scheduling is definitely an art. Three days of the typical doctors or dentists schedule and most of you engineers would kill yourselves. Try putting together a spreadsheet in the dark, looking backwards in a mirror with a massive tongue randomly swiping across the keyboard, all in a mist of blood borne pathogens. And complete it in 30 minutes, not 32.

 

[frayne]

Being a morning person, I like to make appointments first thing in the AM and very seldom if ever have to wait. On appointments made during the day, very seldom do you get your appointment on time. If you ever worked in a profession where you saw people based on appointment time(s) you understand how easy it can be to get backed up. Patience is a virtue I lack according to DW but it is something I work on. I think it comes from standing in line while in the service, hurry up and wait was the cliché if memory serves me correctly.

 

[Bestwifeever]

I wait maybe 10 minutes from checking in to seeing my doctor, but I don't mind waiting longer for her. Sometimes there is some triage going on that is not obvious. I never wait more than 5 minutes for specialists or tests like mris, colonoscopies, mammograms. My dentist is almost always waiting for me even if I get there early.

I would change doctors if something annoyed me--serenity now--because that is all you can do about it.

The cool young dental implant guy our dentist sent me to was horrible--always 30 minutes late for my three or four appointments, while he met with salesmen, talked on the phone, joked around with his staff, schmoozed a plastic surgeon about doing a cosmetic procedure package with him (hello I can hear you, buddy). When DH needed an implant later, he told our dentist I did not want DH go there and why, and was sent to an amazing caring practice instead.

 

[MRG]

The Dr. and denist I go to now are prompt and on schedule, that's one litmus 'test' I use. If they can't schedule their time, why would I trust them with my health?

I would understand a specialist or a Dr. that took emergency calls being unable to predict unpredictable events being late.

I left my last dentist, he and his wife/office manager were having marital issues. They couldn't manage to keep it out of the office. I deceided I could stay out of their office. Very happy I did.
MRG

 

[rodi]

Midpack - your comment about larger organizations learning efficiency might have some merit. I've been a client of Kaiser Permanente for most of my life - and rarely have to wait for an appointment. The walk in nurses clinic is a whole different story - I had to wait 3 hours to get my tb test read earlier this year.

KP seems to have put in scheduling processes that result in mostly on time (within 15 minutes) appointments.

My dentist is a sole proprietor office - but he and his staff seem to have things down pretty well... the dentist moves between rooms, while the staff does all of the prep/cleanup/cleanings...

 

[M Paquette]

Midpack - your comment about larger organizations learning efficiency might have some merit. I've been a client of Kaiser Permanente for most of my life - and rarely have to wait for an appointment. The walk in nurses clinic is a whole different story - I had to wait 3 hours to get my tb test read earlier this year. KP seems to have put in scheduling processes that result in mostly on time (within 15 minutes) appointments. My dentist is a sole proprietor office - but he and his staff seem to have things down pretty well... the dentist moves between rooms, while the staff does all of the prep/cleanup/cleanings...

Sounds familiar. I'm another Kaiser customer. I don't think I've ever had to wait over 15 minutes on a scheduled appointment.

The dentist I see now has three dentists in the office, and the usual supply of assistants and techs. Again, no waiting there.

 

[Meadbh]

For profit organizations have a powerful incentive to be efficient.

 

[Meadbh]

On an aside -- aren't you a retired doctor, not an ex-doctor? I mean I don't think I would ever see myself as an ex-lawyer... Even if I let my license go inactive I don't think I would see myself as an ex-lawyer.

Point taken, pardon my imprecision. I am debating whether to cut the cord and let my license go.

 

[MichaelB]

For profit organizations have a powerful incentive to be efficient.

Yes, and especially so when the providers are the primary partners. That does not mean they need to overbook or make people wait. I recall a weekly column by a physician in the WSJ, he discussed this topic a couple of times and shared his own experience. When his office reduced the number of scheduled appointments and programmed "open slots", wait times fell dramatically, satisfaction immediately improved, and the number of patients seen per day increased slightly.

Contrast that to my mother's ophthalmologist. It is a family owned business, perhaps 40 physicians operating in 4 or 5 locations. The typical wait in the front waiting area is close to an hour, another 30 minutes in the back. Average total appointment time can easily hit 2 hours. My father used to call it "the factory". The last couple of times I went with her I sat back and studied the flow of patients and it occurred to me that they don't book individual appointment slots. Instead, they book groups of patients all for the same time, say 25 people at 1:00, another 25 at 2:00, etc, all for 4 or 5 physicians, and then just see them in the order they arrive. They are totally unconcerned with patient wait time. And the waiting room is always crowded.

 

[jon-nyc]

What I don't understand is why people put up with that. I had one appointment with a rheumatologist once and waited 30m in the waiting room, no call no apology, nothing. I walked out.

Although (thinking out loud) maybe in the US its related to reimbursement rates. Perhaps those who serve a large medicare population (or certainly medicaid) do this type of thing more often. That could explain why I only saw it once in my decades in NYC, and that at the office of a rheumatologist, where most patients were probably on medicare.

 

[Gatordoc50]

Yes, and especially so when the providers are the primary partners. That does not mean they need to overbook or make people wait. I recall a weekly column by a physician in the WSJ, he discussed this topic a couple of times and shared his own experience. When his office reduced the number of scheduled appointments and programmed "open slots", wait times fell dramatically, satisfaction immediately improved, and the number of patients seen per day increased slightly. Contrast that to my mother's ophthalmologist. It is a family owned business, perhaps 40 physicians operating in 4 or 5 locations. The typical wait in the front waiting area is close to an hour, another 30 minutes in the back. Average total appointment time can easily hit 2 hours. My father used to call it "the factory". The last couple of times I went with her I sat back and studied the flow of patients and it occurred to me that they don't book individual appointment slots. Instead, they book groups of patients all for the same time, say 25 people at 1:00, another 25 at 2:00, etc, all for 4 or 5 physicians, and then just see them in the order they arrive. They are totally unconcerned with patient wait time. And the waiting room is always crowded.

The average ophthalmologist sees 3.2 patients per hour or about 1 every 18 minutes according to the data. They are a high volume specialty. It's easy for me to see how they could fall a few hours behind seeing that many patients per day, especially if there are 5 doctors. The good news is that the per visit cost, by average, is only 118 dollars with insurance picking up most of the bill. Of course, many will pay a lot more per visit to cover those that pay little or none in order to get to the average of 118.

 

[Donzo]

I went to the dentist last week. Got there 15 minutes early. They brought me in 5 minutes early to do all the X rays - put me in a room in a dentist chair....for 45 minutes! I tried to take a nap, but was perturbed ....the Dentist finally came in and apologized. He spent 45 minutes on me (check up and smoothing a chipped crown). I got to the front desk and he had waived my co-pay for waiting so patiently. I guess I hid how I was feeling!

 

[Midpack]

What I've learned is we're bad at picking doctors (and dentists to a lesser extent). Some overbook/plan-manage time poorly (deliberately or not) while others are much better at it (being seen early, unheard of for us even though we show up early). There have been times that I came within an inch of leaving, but I thought if I reschedule odds are I will have to wait all over again. Again, I understand waiting sometimes, just not every time - especially on first appt of the day!

 

[Bestwifeever]

What I've learned is we're bad at picking doctors (and dentists to a lesser extent). Some overbook/plan-manage time poorly (deliberately or not) while others are much better at it (being seen early, unheard of for us even though we show up early). There have been times that I came within an inch of leaving, but I thought if I reschedule odds are I will have to wait all over again. Again, I understand waiting sometimes, just not every time - especially on first appt of the day!

Is this the same doctor who dropped you for not seeing him/her for six years (when you were getting company physicals) http://www.early-retirement.org/forums/f38/doctor-gp-dropped-me-without-warning-63938.html ?

 

[youbet]

As a test of everyone's sincerity regarding docs keeping to schedule.........

If you're with doc, in an appointment booked for the normally scheduled amount of time, and he/she finds an "issue," are you OK with the appointment cutting off promptly on schedule with instructions to book a follow-up to see what's going on? Or do you feel doc should blow off his/her schedule, spend an additional 15 mins with you?

If your doc could pretty much eliminate schedule slippage by seeing 10% fewer patients and allowing some "padding," would you be OK with your personal cost for the visit going up to compensate?

 

[MichaelB]

The average ophthalmologist sees 3.2 patients per hour or about 1 every 18 minutes according to the data. They are a high volume specialty. It's easy for me to see how they could fall a few hours behind seeing that many patients per day, especially if there are 5 doctors. The good news is that the per visit cost, by average, is only 118 dollars with insurance picking up most of the bill. Of course, many will pay a lot more per visit to cover those that pay little or none in order to get to the average of 118.

As a test of everyone's sincerity regarding docs
keeping to schedule.........

If you're with doc, in an appointment booked for the normally scheduled amount of time, and he/she finds an "issue," are you OK with the appointment cutting off promptly on schedule with instructions to book a follow-up to see what's going on? Or do you feel doc should blow off his/her schedule, spend an additional 15 mins with you?

If your doc could pretty much eliminate schedule slippage by seeing 10% fewer patients and allowing some "padding," would you be OK with your personal cost for the visit going up to compensate?

There are physicians that fall off schedule because their patients need more time, and there are practices that deliberately over-schedule in an attempt to maximize billing. As we all here know, one instance does not indicate a trend, when it happens most of this time, it is probably deliberate.

 

[MRG]

youbet,
Great points, yesterday I was at my always on time Dr. It was a routine follow up after a recent hospital visit. He spent 30 minutes with me, not the normal 15, I hadn't asked for a double appointment. So I'm sure someone waited.

I was very appreciative of his extra time, given that they have no idea what is wrong with me. If there was an extra charge I would have happily paid it.
I did have to wait for labs(30 minutes) as the tech had to look up what what he wanted.

He saw me last week, I had taken wife her Dr., his nurse saw me and pulled me, him in, to review the CT of my head, that was chalked up to a nurse visit, no charge.

Now the neurologist appointment, scheduled today, first available is 3 1/2 weeks. I'll be in 20 minutes early with paperwork in hand. I won't be surprised or upset if she's an hour late.

MRG

 

[Midpack]

Is this the same doctor who dropped you for not seeing him/her for six years (when you were getting company physicals) http://www.early-retirement.org/forums/f38/doctor-gp-dropped-me-without-warning-63938.html ?

He's one of several, it's not just one. It's been pretty universal for DW and I...