Patients often wait weeks or months for medical appointments. The Fraser Institute of Canada recently reported that Canadians typically wait 10 weeks to see specialists. Long wait times are one of the reasons why Canada ranks behind other developed countries in the quality of health care.
In the United States, wait times are shorter but also increasing. Merritt Hawkins reported an average wait of 24 days in his 2017 sample, up 30% from 2014.
When they finally arrive at the doctor’s office, patients from both countries often face further delays. They may spend long periods in the waiting room, despite specific appointment times. It’s something we love to complain about.
This wait in the office occurs for many reasons. Maybe these patients arrived early. Maybe past patients have made doctors late, or urgent calls have cut them off.
But sometimes clinics voluntarily schedule appointments before doctors expect to be ready. They do this to make sure the doctors don’t run out of work.
So, the time of your appointment could be when your doctor really expects to start seeing you. Or maybe it’s just when they want you to start standing in the waiting room.
Appointment schedules aim to maximize physician productivity to avoid wasting valuable healthcare resources. But they should also try to minimize the wait for patients in the office.
Real and simulated wait
Our university’s research aims to improve appointment scheduling by better balancing these competing goals under various conditions. One study looked at the impact of emergencies interrupting doctors. Another involved patients arriving earlier or later than expected.
Each study began by recording the arrival of patients, wait times and treatment times in several clinics. Together, the two studies collected this data for 664 patients. In addition, clinic staff completed surveys about their experiences.
In these samples, about half of the dates started later than expected. A third started early and the rest were on time.
Most of the late departures occurred because doctors were not yet available. Few were due to the late arrival of patients.
The next step was to load the data into computer software that simulates the flow of patients through a clinic. The simulation estimates the expectation of patients and doctors. He can compare different times to see what works best.
Of course, planning would be easy if no one was ever late: just spread appointments evenly throughout the day. If treatments still take 10 minutes, schedule a patient every 10 minutes. Patients would show up on time and come in directly.
The delay is bad, the unpredictable is worse
Alas, reality is rarely so fluid. Some patients or doctors are late and the wait is happening. But the simulation confirmed that the type of delay matters.
It is easy to compensate for a constant delay. If patients usually arrive late, the clinic should schedule appointments a little earlier in the day. If doctors always start late, schedule appointments a little later.
But the schedules of patients and doctors often vary randomly.
If half of the patients arrive early and the other half late, it is more difficult to compensate. (“Absent patients” who do not arrive at all have had relatively little effect on the schedule at these particular clinics.) In these less predictable situations, regularly spaced appointments do not work well. Doctors periodically run out of patients.
Instead, doctors do better by scheduling appointments earlier and closer. Ideally, all patients would arrive as soon as the clinic opens, to make sure they always have them on hand.
But this “ideal” would mean very long wait times for patients. They would arrive at 8 am and maybe wait for hours.
Instead of these simplistic extremes, research has tested more creative planning approaches. He found two that handled the variation well.
The first method reconciles appointments near the start and end of the work session. This helps keep doctors busy. But he rules out appointments further between the two. This reduces the waiting time for patients.
Suppose a doctor works from 8 a.m. until the lunch break at noon. Their early morning and just before noon appointments can be eight or nine minutes apart. Rather, mid-morning appointments could be every 11 or 12 minutes. The average would remain 10.
The second approach brings the rendezvous together in clusters of two or three, while spreading the clusters apart. The proximity within clusters and the distances between clusters increase as the day progresses. Clusters keep doctors busy. The spaces between the clusters reduce patient waiting times.
With this method, early morning dates can alternate at five and 15 minute intervals. Subsequent reservations could alternate between zero and 20 minute intervals. (Zero means two patients are programmed simultaneously.)
The simulation indicated that the clustering method best balances physician productivity and patient wait times. But the other approach works almost as well. Some clinics might prefer its simpler model.
Small details help to have a big picture
Patients often wait weeks for their appointment. They may find it frustrating to wait a few more minutes in a doctor’s office.
But ironically, the latter expectation can help reduce the former. By keeping doctors busy, effective appointment scheduling helps them see more patients per day. This increased capacity reduces the number of days patients have to wait for their appointment.
Improving scheduling systems is therefore a small way to increase the efficiency of the health care system as the population ages and physicians face a greater demand for their time.
It’s better for us than reducing the time doctors spend with each patient. And cheaper than paying to add more doctors or more hospital beds.
So, for the foreseeable future, we patients need patience.