On 2015 Oct 19, David Keller commented:

Actual patient wait times were not measured directly, and the estimation method was flawed

In their editorial comments about a study on patient waiting times in medical clinics, Ross and Katz state "on average, Americans spend 80 minutes at a clinic to receive care, during which approximately only 20 minutes are spent face-to-face with the physician" [1]. They implicitly attribute the remaining 60 minutes of clinic time to excessive waiting and call for "effective interventions to shorten the time patients spend waiting."

However, the "other activities" patients engaged in during their 60 minutes in the clinic when they were not face-to-face with the physician included "completing paperwork, paying bills, interacting with non-physician staff and/or waiting", as noted in the study's Discussion section [2]. One important way in which patients interact with non-physician staff is having their blood drawn for tests ordered by the physician. An electrocardiogram, if indicated, would be obtained during this time, usually without the doctor's face anywhere in sight. Other tests, such as spirometry, audiometry, visual testing, even the measurement of height, weight and vital signs are performed by non-physician staff, while the ordering physician might be examining another patient altogether.

The bottom line is that the data sources used in this study only ascertained 2 time intervals in the doctor's office: the total time patients spent in the doctor's office, from arrival to departure, and the duration of facetime with the doctor. Subtracting the facetime from the total time spent in the office does not provide accurate information about the amount of time the patients spent waiting. They may have been undergoing diagnostic or therapeutic interventions during this interval rather than just waiting.

References:

1: Ross JS, Katz MH. No Time to Wait. JAMA Intern Med. 2015 Oct 5:1. doi: 10.1001/jamainternmed.2015.5393. [Epub ahead of print] PubMed PMID: 26437319.

2: Ray KN, Chari AV, Engberg J, Bertolet M, Mehrotra A. Disparities in Time Spent Seeking Medical Care in the United States.JAMA Intern Med. Published online October 05, 2015. doi:10.1001/jamainternmed.2015.4468.

On 2015 Oct 11, David Keller commented:

Time is Money - the cost of reducing outpatient waits for medical care

The editorial "No Time to Wait" argues that when a patient is made to wait a long time to receive care from a physician "the implicit message is clear: the patient’s time is less important than the clinician’s", adding that "if a patient must wait a long time every time he or she sees the doctor, there is a problem in the system" and concludes that doctors "need additional work" to "shorten the time spent waiting." I reply below:

First, physicians who intentionally keep patients waiting to send a message about the importance of their time should have their licenses revoked before they can do any real harm. All zero of them.

However, in the clinic, the doctor's time is clearly a scarce and valuable commodity which must be allocated efficiently among many patients. This task is complicated by the fact that each patient requires an unpredictable amount of physician time to diagnose and treat. In addition, it is common for a doctor to allow a number of patients with urgent problems to be added onto an already full schedule, and for patients who do have appointments to simply not show up, without notice. It is rare for these no-shows and added-on appointments to occur with the timing required to cancel out each other's effects.

The underlying reason doctors run late is overbooking, which is the practice of scheduling more patients to be treated than there is time on the schedule for their treatment. The opposite of overbooked time is downtime, when there are no patients for an available physician to treat during office hours, when there are high fixed overhead expenses. Overbooking reduces physician downtime caused by no-shows, but it increases the number of patients waiting to be treated, reducing physician downtime at the cost of increased patient waiting times.

In order to heed the call to reduce patient waiting times, overbooking could be reduced or eliminated. However, less overbooking would also increase physician downtime, because fewer patients would be waiting and ready to fill in for no-shows, which often occur in clusters. Overbooking increases waiting times for patients, but it reduces costly physician downtime. Are patients willing to pay extra for the convenience of reduced wait times?

Low physician payments and marginally profitable practices increase the need for overbooking to ensure that patients are waiting for the physician, and not the other way around. Actions taken to reduce patient waiting times may have the unintended effect of increasing physician downtime, and thereby jacking up the cost of medical care. Lastly, requiring "additional work" of already overworked physicians to reduce patient waiting time could cause unintended side-effects far more deleterious than spending an hour or twelve in a waitinig room.

On 2015 Oct 11, David Keller commented:

Time is Money - the cost of reducing outpatient waits for medical care

The editorial "No Time to Wait" argues that when a patient is made to wait a long time to receive care from a physician "the implicit message is clear: the patient’s time is less important than the clinician’s", adding that "if a patient must wait a long time every time he or she sees the doctor, there is a problem in the system" and concludes that doctors "need additional work" to "shorten the time spent waiting." I reply below:

First, physicians who intentionally keep patients waiting to send a message about the importance of their time should have their licenses revoked before they can do any real harm. All zero of them.

However, in the clinic, the doctor's time is clearly a scarce and valuable commodity which must be allocated efficiently among many patients. This task is complicated by the fact that each patient requires an unpredictable amount of physician time to diagnose and treat. In addition, it is common for a doctor to allow a number of patients with urgent problems to be added onto an already full schedule, and for patients who do have appointments to simply not show up, without notice. It is rare for these no-shows and added-on appointments to occur with the timing required to cancel out each other's effects.

The underlying reason doctors run late is overbooking, which is the practice of scheduling more patients to be treated than there is time on the schedule for their treatment. The opposite of overbooked time is downtime, when there are no patients for an available physician to treat during office hours, when there are high fixed overhead expenses. Overbooking reduces physician downtime caused by no-shows, but it increases the number of patients waiting to be treated, reducing physician downtime at the cost of increased patient waiting times.

In order to heed the call to reduce patient waiting times, overbooking could be reduced or eliminated. However, less overbooking would also increase physician downtime, because fewer patients would be waiting and ready to fill in for no-shows, which often occur in clusters. Overbooking increases waiting times for patients, but it reduces costly physician downtime. Are patients willing to pay extra for the convenience of reduced wait times?

Low physician payments and marginally profitable practices increase the need for overbooking to ensure that patients are waiting for the physician, and not the other way around. Actions taken to reduce patient waiting times may have the unintended effect of increasing physician downtime, and thereby jacking up the cost of medical care. Lastly, requiring "additional work" of already overworked physicians to reduce patient waiting time could cause unintended side-effects far more deleterious than spending an hour or twelve in a waitinig room.

On 2015 Oct 19, David Keller commented:

Actual patient wait times were not measured directly, and the estimation method was flawed

In their editorial comments about a study on patient waiting times in medical clinics, Ross and Katz state "on average, Americans spend 80 minutes at a clinic to receive care, during which approximately only 20 minutes are spent face-to-face with the physician" [1]. They implicitly attribute the remaining 60 minutes of clinic time to excessive waiting and call for "effective interventions to shorten the time patients spend waiting."

However, the "other activities" patients engaged in during their 60 minutes in the clinic when they were not face-to-face with the physician included "completing paperwork, paying bills, interacting with non-physician staff and/or waiting", as noted in the study's Discussion section [2]. One important way in which patients interact with non-physician staff is having their blood drawn for tests ordered by the physician. An electrocardiogram, if indicated, would be obtained during this time, usually without the doctor's face anywhere in sight. Other tests, such as spirometry, audiometry, visual testing, even the measurement of height, weight and vital signs are performed by non-physician staff, while the ordering physician might be examining another patient altogether.

The bottom line is that the data sources used in this study only ascertained 2 time intervals in the doctor's office: the total time patients spent in the doctor's office, from arrival to departure, and the duration of facetime with the doctor. Subtracting the facetime from the total time spent in the office does not provide accurate information about the amount of time the patients spent waiting. They may have been undergoing diagnostic or therapeutic interventions during this interval rather than just waiting.

References:

1: Ross JS, Katz MH. No Time to Wait. JAMA Intern Med. 2015 Oct 5:1. doi: 10.1001/jamainternmed.2015.5393. [Epub ahead of print] PubMed PMID: 26437319.

2: Ray KN, Chari AV, Engberg J, Bertolet M, Mehrotra A. Disparities in Time Spent Seeking Medical Care in the United States.JAMA Intern Med. Published online October 05, 2015. doi:10.1001/jamainternmed.2015.4468.