Total Access Medical - Direct Primary Care Blog

Why Is It Difficult to Schedule Same Day Doctor Appointments?

Posted by William Kirkpatrick on Oct 17, 2016

Medical-Records-Management.jpgCholene Rajauski didn't carry a stopwatch when she went to see her primary care physician for a sore throat, but she is certain the physician was not in the exam room with her for more than four minutes.

"He looked inside my mouth to the back of my throat, told me that it was inflamed, then told me to go see the nurse for a prescription and that was it. He was gone. I've never been in and out from a visit faster," said Cholene. It's apparent that doctors have one eye on the patient, and one eye on the clock. 

With modern healthcare the way it currently is, stories like Cholene's are increasingly common. Patients and physicians say they feel hurried as never before as doctors rush through appointments to see more patients and perform more procedures to make up for flat or declining reimbursements.

It's not unusual for primary care doctors' appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they've been asked to see patients every 11 minutes. And the problem is exacerbated by the millions of consumers who gained health coverage through the Affordable Care Act. Some of these people may only see doctors rarely and may have a slew of untreated problems.


Related Article: Why Do I Have To Wait To See My Doctor

Related Article: Direct Primary Care Eliminates Patient Wait Time 


Short visits take a toll on the doctor-patient relationship, which is a key ingredient for good health care, and may represent a missed opportunity for getting patients more actively involved in their own health. When there is less a dialogue between patient and doctor, there are increased odds that patients will leave the office frustrated and unsatisfied.

Shorter visits also increase the likelihood that the patient will leave with a prescription for medication, rather than for behavioral change — like trying to lose a few pounds, or going to the gym.

Primary care physicians don't like where primary care is heading, either. They do not want to be rushed when meeting with a patient, but for them, time is money. Most primary care physicians are still paid per visit, with only minor adjustments for those that go longer.

And many doctors may face greater financial pressure as many insurers offering new plans through the health law's exchanges pay them even less, offering instead to send them large numbers of patients.

Doctors are thinking, "I have to meet my bottom line, pay my overhead, pay my staff and keep my doors open." So, it's a hamster wheel, and they're seeing more and more patients. And the result is a 10 - 12 minute visit.

How did visits get so truncated? No one knows exactly why 10 - 12 minutes became the norm, but many experts trace it back to Medicare's adoption of "relative value units," or RVUs, to calculate doctors' fees. RVUs were supposed to take into account the physician's effort and cost of running a practice, not necessarily how much time he or she spent with patients. The typical office visit for a primary care patient was pegged at 1.3 RVUs, and the American Medical Association coding guidelines for that type of visit suggested a 15-minute consult.

Rushed Doctors Listen Less

Generally, doctors start by asking a patient how they are and why they came in, trying to zero in on the "chief complaint" or the patient's primary reason for the visit. But most patients have more than one issue to discuss. Here's the thought process from both the patient perspective and the doctor perspective: 

The patient thinks, "I'm taking the afternoon off work for this appointment and I've waited three months for it. It's finally time to ask my doctor the questions I've compiled for the past three months." Meanwhile, the doctor thinks, "I've got 15 minutes." 

To make things worse, studies have found doctors often fall short in the listening department. It turns out they have a bad habit of interrupting. A University of South Carolina study in 2001 found primary care patients were interrupted after 12 seconds by either the health care provider, a beeper or a knock on the door.

People feel dissatisfied when they don't get a chance to say what they have to say. 

Why You Have Difficulty Scheduling Appointments

In an article posted by The Washington Post, we learn that residents of some of the country’s most prominent cities are experiencing prolonged wait times when they try to schedule an appointment with their physician. The study found that out of the 15 cities researched, 12 of them had patient wait times of 14 days or longer. The article's primary point is that "the average wait time for a new patient to see a physician in five medical specialties is 18.5 days." This means that someone identified a concern they have about their health and then had to wait more than two weeks to get answers.

The obvious problem here is that people are waiting a long time to receive medical care, and not all patients have time to wait. Most of these people will hear how long they have to wait for their doctor and they’ll go straight to the emergency room or urgent care so that they can find an immediate solution to their problem. This causes expensive and unnecessary bills for the patient and often their employer.

The successful practices will figure out new ways and approaches to shortening wait times because in the long run, this is not going to be acceptable. The solution exists within one of America's newest and fastest growing form of primary care: direct primary care. If you sign up with a direct primary care practice than your wait time won’t be much longer than a couple of hours. With 24/7 access to your doctor, you may even be able to avoid a costly ER visit by getting medical care over the phone or with the convenience of same-day or next-day appointment scheduling. Direct primary care practices don't make you wait. Rather, you chose the time that's most convenient for YOU to see your doctor.

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Topics: Healthcare, Direct Primary Care, Physician Shortage, Primary Care Today, Healthcare Today

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