Saying a doctor is busy is like calling the sky blue. You still might be asking though, why are clinic schedules so damn packed? After we take a trip behind the scenes for why the doctor’s waiting room earns its title, you’ll be prepared to handle any reasonable wait time.
There are really two boxes to unpack for talking about how doctors get heavily booked: 1) the day-to-day operations (when the doctor is quick or slow to get you at any given time) and 2) the big picture trends and seasons explaining the congestion in the first place. This is why I’m going to split this episode into sections for those areas. We’ll start with a situation that hits very close to home: you’re in the waiting room, and you seem to be waiting much longer than you should. It doesn’t matter whether you’re going to a private clinic or the largest health system in your state. In either place, you’re probably going to hunker down and scroll through your phone, twiddle your thumbs, or both while the doctor gets ready to pick you up.
There could be many reasons why your provider runs behind or has a long wait-list, but one major factor that always stays the same is that doctors’ earnings rely on volume and procedures—not by time spent per patient. Procedures involve both materials and motor skills as well as time it should be no surprise for that being expensive. But a doctor generally can’t bill a consult to patients or insurance plans by the minute like a lawyer can, at least not without serious proof of medical necessity. This reality of the medical profession is a major part of why clinic schedules get overbooked and things run slow. Not to mention that demand for medical care runs high to begin with. A doctor’s lateness on any given day usually varies by specialty. A mostly consultative practice like internal medicine or family medicine may not keep you waiting more than 20 minutes, but it could be normal for a popular surgeon to have an hour-long wait.
Regardless of specialty, the fact of the matter is that day-to-day responsibilities unrelated to actual patient care pile up fast. Let’s step in the primary doctor’s shoes for a moment. You see your first patient at 8:00am for a 30-minute visit. You go through the usual routine of getting medical history, doing the physical exam, and hopefully putting together a treatment plan if needed. It feels like it’s been five minutes but the clock has already moved 20 minutes. Then your patient has a last-minute concern or question right at the 29th minute. You’re obligated to address those issues. You and a scribe are frantically trying to enter all this info on a chart note. Suddenly it’s been 35 or 40 minutes and you realize there are 20 to 30 patients to go. Oh, and you also need to deal with any prescriptions, lab orders, follow-up plans and whatnot. In a nutshell, that is how a doctor’s calendar snowballs. I’m not trying to put blame on either the doctor or the patient—that scenario I mentioned is just reality. Besides administrative needs there also could, of course, be an emergency, or there may be a doctor-to-doctor phone call that needs to be answered. Everything I mentioned tends to be the main obstacles to keeping an efficient schedule which these days seems impossible. This is why, even if you as a patient have an appointment that’s supposed to start at 10AM, you should ask the front desk staff at the clinic what the current wait time is and if the doctor is running behind. A couple years ago when I saw my primary doctor, I needed to wait an hour in the exam room. When my doc finally got to me, he looked so rushed and harried that I didn’t even bother to ask about the delay. This is why you shouldn’t have any major plans booked right after a medical appointment.
There’s no doubt that medicine is a complicated profession and the issues we talked about throw the schedule out of whack. However, you need to have clear standards for what acceptable timing should be. My rule is that if a primary doctor or specialist makes me wait over half an hour for at least three appointments in a row, I’m getting my medical care elsewhere. You might be okay for waiting longer or less than I do, so consider what you can tolerate. I’ll link some more background info for what slows down a doctor’s schedule on my Substack page, which you can find at rushinagalla.substack.com. Sometimes though, you might be lucky enough to be part of a clinic that runs on time and keeps you waiting 10 minutes at the most. But the doctor’s waitlist could be four months to book a visit. This is more of a big-picture, macro issue compared to the day-to-day factors we just went over.
Of course, if a given doctor is skilled and popular, it would make sense for that person to have many eager patients lined up. That being said, medical offices do have a little seasonality. The clinic directory and promotion company ZocDoc crunched some of their visit data back in 2016 and put out some helpful insights with a graphic showing the busiest months of the year for each medical specialty. I’ll link the data at rushinagalla.substack.com but generally speaking, the findings suggest that March, January, and August (in that order) tend to be the crowded months with November and December being less busy. This would vary by specialty. The main bias of this study is that most of the clients ZocDoc tracks are private or semi-corporate clinics that aren’t necessarily part of a greater hospital system. Regardless of that issue, the general take-home point is that you should aim to book your visit in a calmer month and either early in the morning or right after a clinic’s lunch hour. Another helpful recurring survey done by the healthcare staffing company AMN found that even back in 2017, the average wait for a new patient appointment booking was about 24 days! This is before the COVID-19 pandemic made schedules crazier. That number grew about 30% from 2014. The stats were drawn through five major specialties the study reviewed: cardiology, dermatology, orthopedic surgery, gynecology, and family medicine. That AMN study argues that increased health coverage, more chronic issues (e.g. diabetes, hypertension), and a continued under-supply of doctors are the main drivers for raising wait times. If you’re having an emergency, you need to just roll with the given time that a facility offers, but the data imply that you should book medical visits more than a month ahead of time when possible. A simple calendar or app reminder goes a long way.
With a little patience and the background info you know now, there are a couple takeaways from this topic. Getting medical care in a timely manner gets easier when you have 1) defined standards for delays you’re willing to tolerate and 2) that you book your standard visits months ahead of time, especially when you can work to see your doctor for preventative rather than reactive care. One awesome tool that can also help you with navigating our medical system is actually telemedicine. Telehealth and telemedicine were growing before the pandemic but they’re popular services now. We’ll spend time in the next post on when it makes sense to use those virtual health tools. Stay tuned and subscribe to Friendly Neighborhood Patient for more healthcare guidance. I’ll catch you at the next episode.
