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Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA |
Waiting…And Waiting…
And Waiting
My wife is currently six months pregnant with our second child. Of course, we’re very excited and looking forward to a new member of the family. Unfortunately, along with the excitement of the pregnancy come many visits to the OBGYN’s office. My wife’s doctor is very nice, appears knowledgeable, and has a strong reputation. So, why do I say “unfortunately?” Two words: long wait.
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Every time my wife visits this doctor’s office, she has to endure long wait times, usually on the order of 1 ½ hours on average. This doctor is in a semi-solo practice (he has a nurse midwife who covers a different hospital call), so he has a full load of patients needing care. As such, he’s stretched thin and constantly runs late. You might ask why we haven’t found another doctor. My wife is too far along to change and is also comfortable with him from a social standpoint. Usually she goes to these appointments without me, but a few weeks ago I was unlucky enough to accompany her to an appointment that had us waiting in the exam room for an extra hour. We were about to leave (after I’d pulled most of my hair out) when the doctor hurried in saying his apologies.
Waiting is a significant contributor to patient dissatisfaction. Unfortunately, this is an all too common occurrence for many of our patients; I just happened to be on the receiving end of the waiting game this time. Excessive waiting is an unusual event for most of us personally (unless you do night surgery at a hospital), and it’s easy to lose track of this part of our practice flow, especially considering our patients are physically separated from us in the waiting room.
How long do your patients wait?
I would cite three primary reasons patients may have prolonged wait times:
Randomness – Everyone has that patient that takes longer than expected: the urgent diabetic infection that pushes the schedule back, the unanticipated postoperative complication. It’s not possible to predict every moment of one’s day, and there’s no controlling this (although it can be minimized).
Nature of physician reimbursement – This one’s not controllable either. We in the healthcare industry get paid by the procedure, rather than how much time we spend with patients. The more procedures we do (with decreasing reimbursements per procedure) – and the more patients we see – the more money we make. As a result, we’re forced to see increasing numbers of patients, with less time for each patient. Until the way in which we’re paid changes – unlikely- we’re going to have to keep squeezing in more patients, and they’re going to have to wait a little longer for us.
Disorganization – This is the most controllable of the three. A majority of our clinic time can be planned and streamlined to keep our patients from waiting overly long time periods. It’s often lack of planning that leads to long patient waits.
Managing organization to shorten wait times
Here are a few examples of methods to decrease patient wait times and mitigate the damage whenever they occur.
- Scheduling all of your patients for standard intervals will lead to problems. A simple fix that would maximize physician time would be to vary the allowed time for schedules based on patient characteristics. A new patient with a diabetic ulcer will take more time than a follow-up plantar fasciitis patient, and they should be scheduled as such.
- Certain procedures can be “automated” by staff, allowing the physician more time for the complicated issues. Below knee casting in select patients would be one of those automated tasks.
- Intake paperwork including historical information allows the physician to quickly review and flesh out this data and move on to the physical examination, thereby saving time.
- Creating algorithms for common conditions further saves time. The list of these fixes goes on.
- Train staff to communicate effectively with patients. Most patients will appreciate when a staffer informs them the doctor is running X minutes late, and they’re not being ignored.
- For the less experienced practitioner, schedule in a couple of “catch-up” breaks (perhaps 10 minutes or so) during your day.
- Take a step back and analyze your office flow and your own movement patterns. How many times do you have to leave the exam room when seeing a patient? Take, for example, a new plantar fasciitis patient. After walking in the room and gathering history, you order radiographs, and see another patient. You then come back in the room and plan to give him a heel injection, but first you draw up your cocktail, but the meds are in another room. After the injection, you apply a low dye taping, but have to leave the room again to grab your materials. You’ve been in and out of the room 3 times. Next time, follow a protocol in which plantar fasciitis patients receive a radiograph before you see them and your staff is trained to draw up your injectibles and prepare your strapping. With these adjustments, you’d enter and leave the exam room one time.
Most patients complement their doctors who spend extra time with them. No one’s satisfied with a doctor that runs late, appears rushed, and doesn’t take enough time with them. This often comes across as disinterest (clearly not intended by most of us) and leads to decreased patient satisfaction. Although not possible to eliminate all of the factors that make us run late, a little preplanning and preparation will make a world of difference. I’m definitely not looking forward to my wife’s next appointment!
Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum.
Best wishes.
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
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