Shallow NYT coverage of waiting time to see a doctor

Thanks to SimulConsult CEO Michael Segal for sending me his analysis of a recent New York Times article on waiting times in physician offices (Sick and Scared, and Waiting, Waiting, Waiting).

From the article:

Change cannot come too soon for irate patients like Howard Levine of Boca Raton, Fla., who endured a two-hour wait before storming out of a vascular surgeon’s office.

“I was in the restaurant business for 20 years, and if I made you wait in a restaurant for two hours, you would be pretty upset,” Mr. Levine said. “We’re not coming there for social visits. We’re coming because something is wrong.”

From Michael:

There is lots of room for improvement on waiting times for doctors, but silly analogies like this are as self-deceiving and distracting as comparing electronic health records to cash machines. People care whether they see a particular doctor. If they didn’t it would make perfect sense to run a medical practice like a restaurant.

One way to improve the situation is to make it easier to charge patients for missed appointments. A major reason for overbooking is holes in the schedule from no-shows. One could pair this with offering free visits to patients who would agree to be bumped, but if something goes wrong in the meantime the doctor bears a huge malpractice risk that airlines don’t have to figure in.

The article does not mention another problem that doctors wrestle with: how to reduce delays in getting an outpatient visit appointment.

Overall it is a shallow article that overlooks the complexities of an issue where progress can be made, but not by shallow thinkers.

August 22, 2005

9 thoughts on “Shallow NYT coverage of waiting time to see a doctor”

  1. Quoting Michael:

    “Silly analogies like this are as self-deceiving and distracting…People care whether they see a particular doctor…If they didn’t it would make perfect sense to run a medical practice like a restaurant.”

    Do people not care where they eat? I think they do. I think they care more about where they eat than what doctor they see. Other market-driven industries (like the restaurant industry) compete on quality and price, often through marketing campaigns that forge discinct identities from otherwise homogenous products (McDonald’s vs. Burger King).

    Medical providers, however, operate in almost total obscurity, immune from having to compete to the same degree. That’s the problem. Let doctors compete. Let consumers care about who they see, what procedures they recieve, and what both cost, and waiting times will disappear.

    Trapier

    http://www.isemmelweis.com

  2. .
    I agree with Trapier that people generally care about where they eat.

    Unfortunately, that’s irrelevant.

    A large part of the problem is that a given physician has a finite number of working hours in a day (as do we all), and each hour (really, each part of each hour) is scheduled.

    Sometimes (often?) the doc will encounter a patient who needs more time and work than anticipated, and things back up. That’s life, deal with it.

    The restaurant analogy fails in another respect: if they’re out of your favorite dish, you can substitute another, or find another establishment. If the doctor finds that the patient ahead of you has a more serious condition than anticipated, he can’t just walk away because he has another patient scheduled.

    And no, I’m not a physician (don’t even play one on the teevee), but my family is lousy with them (hmmm, that doesn’t sound quite right, does it), and I’ve heard them express their frustrations, too.

  3. At a restaurant you are not in queue for one particular table. If one table remains occupied because the people stayed an unexpectedly long time you are given a different table. This dynamic allocation makes it easy to balance load in the restaurant business. Seeing a doctor is analogous to being in queue for one particular table, with unpredictable delays unless you didn’t mind being shunted to a different doctor.

  4. How many resteraunts have you returned to, or referred friends to, which tell you “That’s life, deal with it,” after you’ve been waiting 2 hrs to eat. Probably few. That’s because the resteraunt industry is dymanic in more than one sense and cannot survive with such poor customer service. It’s dynamic at the time of the meal, meaning that inputs can easily flow. But it’s also dynamic in that a consumer has a lot of choice and can easily shop elsewhere next time. The market for physicians is very non-dynamic, so, in effect, it is “life” and so far sick people have had to deal “with it.”

    Trapier
    http://www.isemmelweis.com

  5. How many resteraunts have you returned to, or referred friends to, which tell you “That’s life, deal with it,” after you’ve been waiting 2 hrs to eat. Probably few. That’s because the resteraunt industry is dymanic in more than one sense and cannot survive with such poor customer service. It’s dynamic at the time of the meal, meaning that inputs can easily flow. But it’s also dynamic in that a consumer has a lot of choice and can easily shop elsewhere next time. The market for physicians is very non-dynamic, so, in effect, it is “life” and so far sick people have had to deal “with it.”

    Trapier
    http://www.isemmelweis.com

  6. How many resteraunts have you returned to, or referred friends to, which tell you “That’s life, deal with it,” after you’ve been waiting 2 hrs to eat. Probably few. That’s because the resteraunt industry is dymanic in more than one sense and cannot survive with such poor customer service. It’s dynamic at the time of the meal, meaning that inputs can easily flow. But it’s also dynamic in that a consumer has a lot of choice and can easily shop elsewhere next time. The market for physicians is very non-dynamic, so, in effect, it is “life” and so far sick people have had to deal “with it.”

    Trapier
    http://www.isemmelweis.com

  7. Did I read the comments too quickly, or did no one fail to mention that a major part of the problem with waiting times is the contents of the waiting room! At least this is my experience in pediatrics.

    Waiting rooms (and emergency rooms, but that is a subject for another thread) are full of patients who don’t need to be there. An important reason for this is because there are no financial disincentives to patients to visit the doctor.

    In the restaurant at least, the customer sees the price of his meal and actually pays it!

  8. >>Waiting rooms (and emergency rooms, but that is a subject for another thread) are full of patients who don’t need to be there. An important reason for this is because there are no financial disincentives to patients to visit the doctor.
    >Seeing a doctor is analogous to being in queue for one particular table, with unpredictable delays unless you didn’t mind being shunted to a different doctor.
    >A large part of the problem is that a given physician has a finite number of working hours in a day (as do we all), and each hour (really, each part of each hour) is scheduled.

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