Years ago, I had a gynecologist I really liked, but every time I visited the office I waited a minimum of 45 minutes to be seen. There was never a good explanation and it left me feeling incredibly annoyed. After two or three years, I couldn’t take it anymore and I found another doctor.
When I was a primary care pediatrician, I often ran late. Most times it was due to circumstances beyond my control, but that doesn’t make it any better for the patients and families who were waiting. My entry to each room began with an apology for being late. It was a source of significant frustration for me, and one of the reasons I left primary care to become a hospitalist.
So, why are doctors always late? Well, if you promise not to send me hate mail, I will give you some inside information to help you understand this problem a little better. There are many reasons your doctor may be behind schedule, but here are some of the common ones:
1. She accommodates late patients.
In most office settings appointments are scheduled in 15-30-minute time slots. It is not uncommon for the schedule to be completely booked, which does not allow much flexibility when patients do not arrive on time. There are legitimate reasons for being late. Stuff happens. But one late patient can disrupt the schedule for the rest of the session. Consider the scenario below:
|ARRIVAL TIME||APPOINTMENT TIME|
|PATIENT A||7:55 AM||8:00 AM|
|PATIENT B||8:13 AM||8:15 AM|
|PATIENT C||8:48 AM||8:30 AM|
|PATIENT D||8:42 AM||8:45 AM|
|PATIENT E||8:46 AM||8:50 AM|
Patients C, D, and E all arrive at approximately 8:45 AM. The patients scheduled for the remainder of the morning are not shown, but are scheduled every 15-30 minutes until noon. The doctor in this scenario has several options, each of which will leave someone unhappy. She can refuse to see Patient C who is 18 minutes late. You can imagine that won’t go over well. She can accommodate Patient C, who has a valid excuse for being late and really needs to be seen, but that will cause the remaining patients to be seen after their appointment times. In other words, the doctor is now running late. She could make patient C wait until the end of the session (over 3 hours) and continue to see the other patients who arrived on time. Patient C will not think it’s fair to wait 3 hours as a “penalty” for being 18 minutes late. Keep in mind that in a half-day session, it is very likely that other patients will arrive late, exacerbating the problem. This is a lose-lose situation unless you have a “no-show”, which may allow you to get back on track.
2. Additional patients are added to the schedule.
Most primary care doctors leave a few open slots in their schedules to accommodate same-day appointments. Illness is unpredictable. Physicians don’t want to send every sick patient who doesn’t have an appointment to the Emergency Room. However, the demand for these appointments is almost always greater than the supply. Once the open slots are taken, the scheduler must “double” or “triple” book the doctor, meaning more than one patient is scheduled for they same appointment time. The patient who calls the office complaining of a sore throat and is given an appointment two hours later is thrilled. But the patient who booked his appointment 2 months ago can’t understand why he has to wait 35 minutes to be seen. This problem has a snowball effect. One or two extra patients can completely disrupt the schedule and lead to delays.
3. A patient who is booked for a 15-minute appointment has a 60-minute problem.
There is a running joke among physicians regarding the phrase, “Oh, by the way…”. This phrase is typically exclaimed by a patient being seen for a minor problem, as the physician is preparing to exit the room, just as the doctor’s hand makes contact with the door handle. If the “oh, by the way” problem is not worrisome, the physician may ask the patient to schedule another appointment to ensure the concern is properly addressed. But if the problem is chest pain or severe headache, for example, it cannot be ignored. You get the pattern, right? The doctor is now running late.
4. There is an emergency.
Occasionally, a patient has a medical emergency in the office. When this occurs, everything stops while the doctors and nurses attend to the patient until the paramedics arrive. Even if the ambulance arrives quickly, it can take a few minutes for everyone to regroup, collect their thoughts, and resume normal activities. Due to attempts to preserve patient confidentiality and avoid chaos, patients in the waiting room may have no idea what’s going on in the back of the office until the emergency personnel arrive. Emergencies are unsettling and undoubtedly lead to significant delays. In some cases, patients may need to be rescheduled.
5. The doctor is talkative and/or inefficient.
I love talking to patients. Subsequently, patients love talking to me. Years ago, an older physician advised me to remain standing after entering the room so the visit would go faster. I promptly discarded that advice, but you’ll also recall I admitted to being habitually late when I worked in the outpatient setting. There is a price to pay for engaging with your patients and their families, and that price is efficiency. I’d like to think the time and attention I gave my patients made up for my being late, but I’m sure there were some who would disagree. When you add the complexities of an electronic medical record, efficiency can really suffer.
I know I have presented problems without offering any solutions. My goal is to facilitate mutual understanding. This article is not meant to give doctors a free pass for being late. Rather, it is an attempt to explain some of what occurs behind the scenes. Managing expectations is just one way to promote a healthy doctor-patient relationship.
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But this happens ALL the time. I cannot ever remember being seen on time. Even if I have an early appointment.
Why don’t doctors leave more open space for these issues?
Steve, I know it can be very frustrating. Some offices are better than others. Appointment scheduling is not done by the doctor and if your doctors work for a health system as opposed to an independently owned private practice, they likely have very little input or influence regarding the schedule. Often doctors are double or triple booked, which is a recipe for disaster in terms of time management, but it also allows them to see the patients that need to be seen in a given day. That being said, my former PCP always saw me on time. I have no idea how he did it.
Not until I worked a nurse in a surgical practice did I fully understand how quickly the day’s scheduling can run off the rails. We had three surgeons. One of them would see any of his patients no matter how late they were. Another (with a military background) would see his patients only in the order that they were scheduled, no matter what order they arrived in. And the third would see whoever was present and ready to be seen. All it took was a couple of late patients and the day went to hell in a handbasket.
Ever since that stint, I show up at least 20 minutes early for my appts. More often than not, I’m brought back early.
I’m very sympathetic, but it is tough sometimes as the patient. My OBGYN is ALWAYS behind and my quick prenatal check where I see the doctor for less than 10 minutes always results in me having to call out of work for at least 2 hours. I’m trying to save my PTO for maternity leave so this is definitely problematic for me. I’m lucky that I do have one weekday off that I can schedule my appointments for but then that means I have to bring my son who is barely even 2 years old and make him sit in the office with me for 2 hours while he runs around, gets into things, and whines because he is bored and restless. Having an engaged doctor does make up for it a bit but when you’re being followed for something like pregnancy where you are coming in frequently it gets old real quick.
Sandra, I completely understand and I’m very sorry. I wish appointments were booked in a manner that was more patient-centered. Best of luck with your pregnancy!
I see my doctor four times a year. I have never arrived at my doctor’s office later than ten minutes before my appointment. Every time I go, I book the next visit. I have a 50% policy. If I’m seen within 30 minutes of my appointment time, I consider that “on time.” If the on time percentage for any one-year period drops below 50%, I’m finding another doctor for my next visit.
Yes, 31 minutes is late. You have to draw the line somewhere. I’m aware that some may think it unfair. Life is unfair. If I am 30 minutes late, I’m a no-show at most clinics and will get billed. I hold the pedigreed professional to the same standard to which he holds me.
Jeff, I think this is a very reasonable approach. Thanks for sharing!
I have a new doctor
Already and hour behind and still waiting
Certainly someone has done some serious consideration to this problem. There has to be an answer. Would it be fair to say that doctors are sometimes overbooking.?
This is especially hard on people who already are feeling badly.
If I were in the medical Profession I would not be able to make people wait so long without it bothering my conscience
Jane, most doctors have little control over their daily schedule. I remember being consistently overbooked when I worked for a large HMO at the beginning of my career. There are algorithms used by most doctor’s offices that take into account no-show rates, etc. Of course, the primary goal of these algorithms is to maximize revenue, which is not patient-centered at all. I agree with you that it’s a hard pill to swallow (pun intended) when you are already feeling badly. This is yet another example of our broken healthcare system.
I had a doctor who had a “if you are more than 20 minutes late you must reschedule” sign in the waiting room. This helped, but didn’t solve the problem. So I adopted the same policy. If the doctor is more than 20 minutes late I leave. It’s unfair to post a policy you yourself don’t adhere to
I worked in a doctor’s office. There are only so many hours in a day and more patients need appointments than there are slots. People don’t want to wait to get an appointment so you end up trying to squeeze people in. 9 out of 10 times the doctor is late helping someone else. Be grateful you aren’t the person who needs the help. It’s not as though the docs are sitting around eating Bon bons. This is so frustrating for both sides. If you run late you get a bad review. If patients think you didn’t spend enough time with them you get a bad review. If they can’t get a timely appointment you get a bad review. It is frustrating on the office end where we really just want to help people. If everyone came on time and no one needed to be squeezed in because they were really sick and everyone was fine with waiting month for an appointment then sure there would be no reason for any doc to be late.
After managing medical practices for 26 years the schedules are dictated by the doctor. He/She will set how many patients a day they want to see, and the time for each patient. My staff and I would often tell our doctors you cannot see a new patient in 20 minutes and follow-up in 10min and god forbid if the schedule wasn’t completely booked…. our doctors would go off if they didn’t have a full schedule. Even though most times the doctor wouldn’t show up on time in the morning for whatever reasons (personal or providing medical care elsewhere) this is why most doctors schedules don’t work and patients have to wait. Not to mention the grief your team takes apologizing to their patients for running late, and of course it’s always the staff fault….”they didn’t schedule correctly” BS!
Furthermore, when you schedule per your doctors directive and you have to work in an emergency patient, and your doctor is running late; your day is now out of control!
All around it’s just an evil circumstance for patients, staff, and doctors.
This was not my experience while working in primary care (large practice owned by a health plan) but I appreciate your perspective. It’s a catch 22 because, in order for a medical practice to be profitable (given the insurance reimbursement), doctors often have to see 25-30+ patients/day, especially in primary care. This is untenable and, as you stated, does not allow for emergencies, late patients, etc.
I went for a follow up visit this morning and I arrived 10 min early and went into the exam room 5 min after I got there. assistant said the Dr. will be right in, well, after waiting over 30 mins, I opened the door and headed out. As I passed the assistant, I said, I’m done, and went home, another 30 min drive for me. About an hour and a half later, the receptionist called and left a voicemail and said the Dr. wants to refund your co-pay. Not a word about why I left or was something else wrong or asking if I needed to come back.
I do PFT’s in a doctors office. Appointments are every half hour. One patient showing up even 5 minutes late messes up the whole day. When I run behind, it causes the doctor to run behind. Patients need to make sure they arrive with plenty of time to check in, validate insurance and pay any co-pay. If your doctors office is running behind, 99% of the time it’s because a patient was late!
If a patient is late then they should be told they have missed their appointment and need to rebook. Simple.
It’s just not fair to the patients who are always on time.