Open Scheduling at Doctors' Offices Could Make Waiting for Appointments Obsolete

I hate waiting. I hate waiting in traffic jams, I hate waiting for airplanes, and I hate waiting in line for coffee. Most of all, I hate waiting at the doctor's office.

Because I hate waiting so much, I always ask for the first appointment of the day. I am always very clear when I make a doctor's appointment that I want the first appointment so that I can get my children or myself in and out without having to wait. Usually the appointment coordinator is cooperative when I make the appointment and will look for a day that has the first slot of the day available.

Yesterday, I had to take my daughter to her ENT for an appointment. My husband and I made the appointment six months ago, and when we made the appointment we specifically requested that we get the first appointment of the day. My daughter is just a year old, and for her waiting in a confined space is like trying to corral a wild pony. We also knew when we made the appointment that we would have to coordinate our schedules. My husband planned to take our two-month old to daycare at the same time that I took my daughter to the appointment. If everything worked out as planned, I would be able to go to my daughter's appointment, drop her off with my husband, and get to work on time.

Unfortunately, things did not go as planned. As usual, my daughter and I arrived at the 7:45 a.m. appointment on time and got checked in at the front desk. Then we waited for 20 minutes in the waiting room before a nurse called us back, and we waited another 40 minutes in the exam room for the doctor. While we waited, I spoke to two nurses and the appointment clerk, all of whom told me that they could not help the wait and that I should speak to the doctor if was a problem. In fact, one nurse told me point blank that "it was not her job" to answer my questions about scheduling.

When the doctor finally arrived an hour after our scheduled appointment, we spent about three minutes with him. He looked in each of my daughter's ears and in her throat and pronounced her in fine health. As he was walking out the door, I asked him if he could give me any advice on limiting our wait time, since we had done everything in our power to be there on time and get the first appointment of the day.

The doctor immediately became defensive, claiming that he arrived on time and it was not his fault. He said I should talk to his staff if I had a problem with the wait. He then proceeded to inform me that if I did not like waiting to see him, I was free to see another doctor. I requested my daughter's file on the way out.

According to a recent study by Anderson, Camacho, and Balkrishnan entitled, "Willing to wait?: The Influence of Patient Wait Time on Satisfaction with Primary Care," patients are often willing to wait in return for spending more time with their physician. However, if patients had a long wait time in combination with a short visit, overall patient satisfaction declined. The authors hypothesized that "the patient's resource investment (time) is higher and is likely appraised as a poor trade for the obtained outcome."

Practice management expert Judy Capko is aware of this trade off, and in her article "Stay in Tune with Your Patients," she has broken the total office visit into five components: the patient's arrival in the office, the time it takes for the patient to be roomed, finalizing rooming tasks, the time the physician arrives in the exam room, and the time the physician departs from the exam room. The total wait time is calculated by considering the time between the patient's arrival in the office and the time the physician enters the exam room, less the time it takes to complete the initial rooming tasks like history taking.

According to Capko, "If the average [wait time] is more than 15 minutes you can bet your patients are frustrated and may be downright unhappy." Says Capko, "When patients experience wait times of more than 15 minutes it is generally an indication of a poorly managed schedule and/or a lack of discipline. It's time to recognize that you can do something about it."

Some physicians are taking steps to minimize wait times for patients. For example, the Baylor Family Medicine practice has utilized what is called "open access scheduling." The concept emphasizing scheduling appointments within 24 hours of the initial patient call rather than waiting weeks or months for an appointment. Only about half of a doctor's patient slots are filled for each day ahead of time, leaving the remainder of appointments free to be scheduled that day.

According to Baylor Family Medicine, open scheduling allows doctors to see 50 percent of patients on the same day they call to make an appointment. The remainder are seen within 15 business days, usually by their own choice to accommodate their schedules.

Imagine calling in the morning and scheduling a follow up appointment with your doctor on the same day, without having to wait. The concept of open scheduling may make waiting for an appointment obsolete. Until then, my husband and I will continue our search for a doctor who respects our time and values us as patients.

Sources:

Baylor College of Medicine, "Open Access Scheduling," Baylor Family Medicine.

BMC Health Services Research, "Willing to Wait?: The Influence of Patient Wait Time on Satisfaction with Primary Care," Roger T. Anderson, Fabian T. Camacho, and Rajesh Balkrishnan.

Practice Management, "Stay in Tune with Your Patients," Judy Capko.