“Wait” lifting for the busy medical practice

"There's no chance of not waiting (for the doctor) because they call it the waiting room.” Jerry Seinfeld

I have had the opportunity to visit several hundred medical practices over my 40+ year career, and I am often asked what is the “best” idea to improve and grow a practice? Finding that one best idea is like searing for the Holy Grail or the Ark of the Covenant. The truth is that there is not one, single idea that will enhance and grow a practice just like providing specimen cups would motivate ob-gyn doctors to send a urologist the spouses of the women who were trying to become pregnant.

If I had to select one idea or one suggestion that is within the doctor’s control, it is seeing patients on time. A few years ago there was an article in American Medical News about making patients wait to obtain an appointment and to be processed once they are in the office and finally become eyeball to eyeball with the doctor. The article is best summarized as “Languishing in the waiting rooms (italics is mine) causes more patient dissatisfaction than any other aspect of medical care including fees.”

Why is it of vital importance for the doctor to be on time?

I am reminded of a story of a patient who was always 30-45 minutes late for his appointment. When the receptionist asked about the chronic delays, the patient said, “When I arrive at the designated time, I always wait 30-45 minutes. So, I thought I would do my waiting at home!”

If the doctor is always late for his\her patients, he\she sends a message that the doctor’s time is more important than the patient’s time. This is hardly the message that we want to send or the impression we want to make on our patients. The patient will often compare appointments they have with their accountant, their lawyer, their dentist, or even their beautician or barber. Men and women don’t wait to see these professionals, and they don’t expect to wait to see their physician.

Let me share a scenario that is probably familiar to readers of this blog. Let’s assume that a patient has the first appointment at 9:00 A.M. The patient arrives at 8:45 and is not see by the doctor until 9:30. As a result the patient is upset; the staff is trying to calm the patient who has been waiting for thirty minutes, and the staff is also trying to mollify the patients who are now more than 45 minutes delayed in seeing the doctor. The doctor is now anxious about the delays, and the doctor and the staff have to work through their lunch hour and will essentially spend the day playing catch up.

What is the outcome of this scenario? You will have unhappy patients, and your patient satisfaction scores will plummet. Your online reputation will hover around 2-3 stars which is slightly below average. Your staff will be stressed and will ultimately result in costly staff turnover. The doctor at the end of the day is exhausted and is inviting burnout into his lifestyle which will negatively impact his\her health. In summary there will be a cloud of negativity hovering over the practice.

On the other hand, if the doctor regularly arrives ten to fifteen minutes before the first patient and sees every patient on time or within fifteen minutes of their designated appointment, patients will be delighted with their care. They will tell dozens of others about the positive experience with your practice and that you were an on-time physician. This will create positive word of mouth marketing for your practice and will generate many new patients for your practice. There will be no need for websites, social media, or creation of YouTube videos. Your staff will see their last patient on time and will not have uncompensated overtime. Consequently, there will be increased staff morale, and staff will be dedicated to enhancing the patient experience, and there will be less costly turnover. Also, it is important to understand that being on time is one aspect of your practice that you have reasonably complete control. The cost of being on time is negligible. The cost of not being on time can be catastrophic.

Let the truth be told, if we are honest, there’s less reason for doctors being late today to see patients than one or two decades ago. Why? Now most primary care doctors and internists do not admit patients to hospitals but allow hospitalists to take over the care of their patients, and do not make morning and afternoon rounds that are often accompanied by delays thus making the doctor late to start seeing patients in the office. Now there’s fewer excuses for delays since the doctor does not usually see patients in the hospital or in the emergency department.

How long are patients typically expected to wait before seeing a provider at your practice? If back-ups and extended wait times are common, consider investigating the cause. While many assume a difficult or complex patient slows the system down, it serves your practice to investigate the matter further. For example, smoothing the scheduling template and providing clinicians with appropriate blocks of time for each patient can prevent frequent delays.

Keeping patients abreast of increased wait times is crucial. When they are given updates, they are more likely to feel in control and able to make necessary changes to their schedule for the day ahead. While you may be stuck at the office all day, your patient should not have to be. Consider how your wait times affect the remainder of their day, including potential issues with transportation, childcare, medication/eating schedules, caregiver availability, etc. Many practices are looking into secure video visits to offer patients the convenience of seeing their provider from wherever they are.

Time is not your friend when it involves patients waiting to see you. You can lose patients by not valuing their time. However, by developing the reputation of being an on-time doctor is one of the best ways to establish a positive image for your practice, to improve your patient satisfaction scores and to enhance your online reputation. This article will discuss a few suggestions to become more sensitive to a patient’s time and become known as an on-time physician.

Numerous surveys show that a patient can only tolerate a delay of less than 20 minutes without becoming anxious or developing hostility toward the doctor and toward the staff. A survey of over 300 patients and 1,000 physicians discovered the impact patient wait times have on small practices. The results showed:

• 53% of physicians say patients often experience wait times longer than 20 minutes.
• 63% of physicians believe wait times have no, or minimal impact on their ability to retain patients.
• 26% of patients say they’ve changed doctors because of long wait times.

Begin by declaring to your staff that being on time is important and set being on-time as a goal for the practice.

Begin by surveying your existing patients about their perception of time with you and your office. I can assure you that what patients tolerated several years ago is longer acceptable to most patients today. If you keep them waiting, they will be asking for their records and going to a doctor that respects their time.

I did this survey with my patients using a “time and motion” study. This study will give you objective data about the time component of your practice. You can easily accomplish this by attaching a sheet as shown in Figure 1 placed on the door which records the time the patient arrives, time of the scheduled appointment, the time the patient was seen, and the time the patient left the office. You can see after surveying just a few patients where the problem lies. If you discover patients are spending ninety to one-hundred and twenty minutes in the office and only five minutes with the doctor, you can be sure that patient will not feel that they had a positive experience with the practice. If you identify the problem occurring at certain times or on certain days, this will help identify the problem and offer solutions for the time delay.

Next look at your office scheduling procedures:

Are you double booking to finish the clinic early?

Does the staff fail to triage the patients properly and allow non-emergencies to be seen thus negatively impacting the schedule?

These and other questions should be reviewed at staff meetings. For example, if you identify that most days have two to three urgencies and emergencies each day that throw off the schedule, then allow open slots for these emergencies which you can anticipate will be filled.

Managing delays

If you learn that you will be late for the office, notify your staff as soon as possible so that the patients are told about the delay giving them an opportunity to wait, to leave and return, or to reschedule for another day. I suggest that someone from your office walk into the reception area and explain the delay and give an estimate of how long they can expect to wait. You can take patient’s cell phone numbers and allow them to leave and contact them when the doctor returns to the office.

Offer pleasant distractions such as decaffeinated coffee or bottled water. This shows concern for their health and makes the wait appear shorter.

Finally, if you are significantly late, perhaps more than sixty minutes, and you can visibly see that the patient is very upset and angry about the delay, you might consider not charging the patient for their office visit. It is far better not to charge a patient and have them leaving with the attitude that you are sensitive about their delay. I have been in social settings and when I was introduced, the person said, “Are you Doctor Baum? I heard about you and that you didn’t charge a patient that was made to wait!” What great public relations and what an inexpensive method of managing the angry, upset patient who was made to wait.

Bottom Line: Today being on time is vital to maintaining patients in your practice. Patients expect the same sensitivity to time as they receive from other services such as airlines, dentists, hotels, and appointments with financial planners, stockbrokers, or CPAs. Finally, you can encourage and attract new patients if you develop a reputation in the community as being an “on time” doctor and lift the excessive waits that your patients are experiencing. If I had to select just one idea to enhance or improve your practice it would be to develop a commitment and a philosophy to being an on-time physician.

Neil Baum, M.D., is a professor of clinical urology at Tulane University in New Orleans, Louisiana. Dr. Baum is the author of several books, including the best-selling book Marketing Your Medical Practice: Ethically, Effectively, Economically, which has sold over 225,000 copies and has been translated into Spanish.