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Editor's Note
December 2015

No Time to Wait

JAMA Intern Med. 2015;175(12):1986. doi:10.1001/jamainternmed.2015.5393

When a patient is made to wait a long time to receive care from a physician or other health care professional, the implicit message is clear: the patient’s time is less important than the clinician’s. Although patients are understanding of waits due to professional emergencies (eg, when an earlier scheduled patient is very sick) or personal emergencies (eg, the physician is out ill), if a patient must wait a long time every time he or she sees the doctor, there is a problem in the system. This Research Letter by Ray et al1 captures something all physicians unfortunately and undoubtedly see in a wide variety of clinic settings: patients waiting. Still, this is an issue rarely addressed among the published studies on quality and access to care. The authors used 2 unique data sources, the American Time Use Survey and the National Ambulatory Medical Care Survey, to demonstrate that, 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

However, more worrying was their other major finding: marked disparities in the time spent to receive care. Time at the clinic was longer for racial and ethnic minorities, the unemployed, and those with less education.1 On a positive note, face-to-face time with physicians was the same (or a bit longer for those with higher education).1 While a portion of this disparity may be due to where patients are obtaining care (eg, emergency department or walk-in clinic vs a private physician’s office), it does not change the underlying implications that disparities in timeliness to obtaining care exist for more vulnerable patient populations. Because the study found that these patients also spent longer traveling to receive care, their overall burden of obtaining care is even greater. This study characterizes a problem we all know to exist. We need additional work to assure the timeliness and equitability of care through effective interventions to shorten the time spent waiting.

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Article Information

Conflict of Interest Disclosures: None reported.

Ray  KN, Chari  AV, Engberg  J, Bertolet  M, Mehrotra  A.  Disparities in time spent seeking medical care in the United States [published online October 5, 2015].  JAMA Intern Med. 2015. doi:10.1001/jamainternmed.2015.4468.Google Scholar
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    1 Comment for this article
    Time is Money - the cost of reducing outpatient waits for medical care
    David L. Keller, MD | none
    This editorial states that patients who have to wait a long time to see the doctor get the message that the patient’s time is less important than the clinician’s. However, importance is subjective. In the clinic, the doctor's time is a scarce and valuable commodity which must be allocated efficiently among many patients. A wealthy patient could eliminate waiting by hiring physicians to come to his home at convenient times to provide care, but this would be very expensive and an inefficient utilization of physician time.

    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 to treat. Overbooking reduces physician downtime due to no-shows (patients who fail to show up for scheduled appointments). Downtime is defined as times when there are no patients for an available physician to treat during office hours, when there are high fixed overhead expenses to pay. Overbooking increases the number of patients waiting to be treated, reducing physician downtime at the cost of increased patient waiting times.

    Overbooking can be reduced or eliminated in order to reduce patient waiting time, but this will also increase physician downtime, because there will be fewer patients waiting to fill in for no-shows, which can occur in clusters. On average, the longer patients wait, the less physician downtime will occur.

    Low physician compensation rates and marginally profitable practices increase the need for overbooking to ensure that patients are always waiting for the physician, and not the other way around. Just as in the case of the wealthy patient who eliminates waiting by hiring physicians to treat him at his home, less extreme measures taken to reduce patient waiting times will also increase the cost of medical care.