Doctors That Overbook
 

What is so freaking special about doctors that they are allowed to get away with overbooking and making us wait an hour or longer. Then they hustle you into another room to wait even longer. I challenged the receptionist, then the nurse then the doctor after waiting 45 minutes yesterday. The receptionist said my chart was mixed up and she was sorry. This was after I heard her tell someone on the phone that the doctor was not in the office yet. The nurse said they were running slow (I had a 9:15 appointment and they open at 9. The doctor said he was sorry and that his staff double booked. I guess we have to live with it.

I just take a book or save the newspaper. I try not to **** off people who write my prescriptions. I have one doctor that is always an hour late and another doctor who is on time and I was five minutes late and got a lecture. Doctors were almost always close to the appointment time back in good ole Cincinnati. sigh.

Perhaps they were double booked because a patient had an emergency....being late to work? Well I guess that's his bad.

I have had 2 appointments with Dr. Ballingit and have walked out on both times because I was kept waiting for 1/2 hour, now I have to find a new doctor.
It wouldn't be quite so annoying if the staff kept the patients informed as to what was going on, a simple "Doctor is running about an hour late" would solve a lot of problems, one could leave an them come back rather than be left uninformed in a consulting room.

In a medical office the scarce resource that has to be managed is physician's time. If it comes down to the physician or the patient waiting; well, the patient loses. Given the shortage of physicians, this is just an issue of supply and demand. Airlines and hotels overbook all of the time. Same reasoning.

You might be willing to justify and accept bad behavior by medical offices but I am not. It is rude and unprofessional and the only reason an office gets away with it is because patients roll over and let them. I will allow that emergencies happen but that is not what we are talking about. Class operations, such as the Mayo Clinic (where I have been more than once), do not keep patients waiting because they do not overbook. My limit is 20 mins and then I will leave. My last Dr. didn't keep me waiting, ever. We will see how it plays out here in The Villages but my one visit so far (to meet the Dr.) was on time. My two dental visits so far have been on time. If you want to put medical offices up on a pedestal and let them waste your time that is your business but please don't suggest that it is normal or acceptable behavior for the rest of us because it isn't. By the way, airlines and hotels do not overbook "all the time". In fact, overbooking by airlines is now a relatively rare event, which is actually too bad as I enjoyed volunteering in the past for a free ticket. Regarding hotels, I have only seen it once in the 20 years when I traveled frequently for business.

I have mostly accepted the fact that I will have to wait in a doctor's office.The reason or reasons for the wait is beyond my control. I too bring a good book and 'go with the flow' as much as I can. I try to never schedule two medical appointments for the same day lest I get crazy with time elements.

I do get antsy when I cannot read due to inane and annoying day time television shows blaring away in the doctor's office with hair trigger and senseless prolonged clapping and standing ovations at the drop of a hat. That's when long waiting becomes torturous.

My thoughts exactly. An occasional wait is tolerable, but if I knew I had to take a book and read for an hour, I would find another doctor. My current doctor and dentist do not overbook. My dentist, Dr. Novak at Bushnell Family Dentistry, is extremely punctual, as are the hygienists there. Add a very nice staff into that mix, and it's a model office that doesn't treat its customers like cattle.

I have only once waited longer than 20 minutes for my family doctor, who then apologized profusely.

We also go to Bushnell Dentistry and I could not agree with you more - very nice practice and it gets my wife's stamp of approval - she is a retired dental hygienist.

This is not to condone doctors who make wait more than 15-20 minutes. I don't like it either. Our time has value, too.

But if you want the current shortage of primary care, private-practice, self-employed doctors to get a whole lot worse, just keep insulting their efforts and sacrifice of personal/family life by comparing their practice to research hospitals like Mayo, which has over 2,000 residents in training to take care of the emergencies of your doctor's patients there.

I do NOT think a 3-12 hour drive to research-teaching hospitals like Mayo--for primary care or even common specialist visits--is the answer to saving patients time in getting routine medical care.

Mayo Clinic - MN Campus
2012 Statistics

Staff physicians and scientists: 2,158

Residents, fellows and students: 2,899

Allied health staff (clinic and hospital): 29,166

Total: 34,223


Facts about Mayo Clinic in Minnesota - About Us - Mayo Clinic

I agree, if everyone cancelled their appointment after waiting 15 or 20 minutes, the doctors would soon realise this is not acceptable behaviour, it would also result in less revenue for the practice that should make them sit up and take notice. My family doctor explained to me that if you have an appointment at 2 o'clock she would not be considered late until after 2.15, the first 15 minutes is for the nurse to do weight, blood pressure etc.

I've had really good luck with short or no waits at tThe Villages Care Center-Colony.

I think the doctor wants to keep us all together in a small room so we can all get each other illness and he makes more money.

On another note, I heard a good idea to control Ebola. Send all the affected people to Vegas because what happens in Vegas stays in Vegas.

I have great respect for the doctors that care for me. I can be impatient but when it comes to issues such as this I remember that my docs give will give me the required time I need just as they had the previous patient. Those that want fast forget that thee are many competing vices for a doctor's attention. I would not want my doc tor rush me and miss something

I am not insulting anybody - not sure where you got that from - reread my post. I am objecting to any office that books appointments under the assumption that patients have nothing better to do then wait. As I indicated, I understand that emergencies can happen. My point is there are practices that don't routinely waste patient's time. If people stopped accepting bad behavior perhaps it would become less common. My visits to Mayo (in Jacksonville, not Minnesota, which is about 2+ hours away) were for an orthopedic problem and there were two issues that drove me there: waiting beyond my scheduled appointment time at two sports medicine practices and their inability to diagnose and repair the problem. Neither of these issues existed at Mayo. This was when I lived closer to Mayo. I also know people who go there for what many might consider routine stuff because of the way the place is run (i.e. patient scheduling) and that really has nothing to do with how many people work there. The orthopedic guy saw me on time (for multiple consult, and pre- and post-op visits) because they schedule enough time for each appointment. The nature of the operation at the Mayo is such that they need to do this because often a patient will have multiple appointments in a single day and chaos would break out if each appointment was not taken on time.

That is fine and they should schedule appointments to reflect the amount of time they need with patients. Some offices do this and others don't care about your time. While I understand that it won't be precise, if you find that you are consistently having to wait a "long" period of time after your scheduled appointment time then you are being told that your time is worthless.

I was dealing with a doctor with whom appts were impossible. He was a specialist, good ones are extremely hard to find here, and the average wait time was 3 hours. I do not wait 3 hours for ANY doctor....if he doesn't respect his patients, I have no respect for him. When the one hour mark arrives I get up and leave.I also do not accept a PA in place of a doctor because THEY ARE NOT doctors and when that is all being offered I will not pay for a doctor visit. Then you have our wonderful hometown hospital where anything more complicated then a bloody nose and they send you off to Shands hospital...it happened to me and my neighbor as well, forcing my wife to drive 1.5 hours each way. With very few exceptions, the medical experience that the villages health system tries to say is available is total BS! It's your health!

Again, Mayo having 29,000 hospital and clinic employees, 2000+ attending doctors, and 2000+ resident doctors certainly helps to make patient scheduling run like a well-oiled machine….

..with doctors also having the benefit of "enough time for each appointment" to observe, think and analyze properly the patient's condition.

Developer Gary Morse (R.I.P.) explained that dilemma best when introducing the TV Healthcare concept:

"Medicare is a lifesaving program but it has been set up in such a way that doctors are no longer able to care for us senior citizens in the same manner that we grew up with,” said Villages developer Gary Morse.

“Medicare pays a doctor for every patient he sees, not how much time he spends with that patient. If the doctor sees 100 patients a day, he or she makes twice as much as seeing 50 patients.”

What is not mentioned in that is that the reason the primary care doctors have to see more patients is to bring in enough revenue to pay the fixed overhead costs of a practice, while Medicare pays less than cost, and private insurers pay accordingly.

http://www.thevillageshealth.com/art...20Hometown.pdf

a different view of things.
 

I am a nurse or was a nurse up north. My doctor was always late. He never rested or loaf.
The reason he was late is that he cared for his patients. I don't know how many times he would be done with an exam only to have a patient start in on many many issues. This of course would make him late for the next patient. It would be one thing if he was in and out of the room but all too often he would find or discover a problem that would need more time and follow up or the patient would be scheduled for a yearly and then start asking him to remove moles etc etc and all of that took extra time.https://www.talkofthevillages.com/fo...milies/bow.gif

The patient that was waiting would get his full attention when he was in the room with them.

BTW I tried to always let my patients know what was going on and bring them magazines to read.

I am not saying this is the case down here but it is my experience.

Also if the doctor is not in the office yet....he may be at the hospital taking care of someone.

I had 9:30 appointment for a test I got in at 10:30 and asked how it took so long.

The answer from the nurse and assistant was they overbook when it comes to testing it was doctors day off and they try to cram as many appointments as they ca, naturally more test more money even the aide and nurse were upset because they get stuck with pushing the testt as fast as possible.

ssmith i said the same thing. In addition docs are now required to develop emr as they visit with you. This creates additional office visit time. Add to that other government regulations paperwork etc and its a wonder waits aren't longer.

We always try to get an early appointment. That way we are first and do not end up waiting because of any backlog/overbooking.

I can take a 10-20 minute wait if the receptionist tells me he is running 15-20 minutes behind schedule. I do not and will not sit there for an hour when I have a scheduled appointment.

My EX-dermatoligist was the worst for booking several appointments for the same time and making you wait. First in the waiting room and then in the examination room.

Z

We now know why they call it a "waiting room":1rotfl:

And they'd be even more upset if the dr. cannot bring in enough revenue to pay them. The employees have to be paid regardless of even zero patients come in that day.

This is best explained by a family physician explaining why direct care on a small monthly subscriber fee works far better and lowers costs of providing care:

"The clinics frequented by most people bill insurance for the great majority of the clinic’s income. Once
 a decision is made to bill insurance for health care services it starts a chain reaction that ends in having to hire a large number of people and/or invest in a lot of technology.

Employees and software are needed to make sure that the patient’s insurance is active before the visit starts, employees have to be hired to call the insurance company to obtain prior authorization for suggested procedures, software is needed to prepare the bill that has to be in a certain format, and more people are needed to call the insurance company after the bill is returned unpaid with a note saying that an “i” wasn’t dotted or a “t” wasn’t crossed. Patients have to wait 15 to 30 minutes and listen to hold music to speak to an actual human being when you call your insurance company, health care professionals have to wait just as long.

Before doctors even open the doors of a new clinic that accepts insurance, they’ve had to hire a number of people just to manage the clinic’s relationship with insurance companies. Part of the clinic’s overhead expenses are these employees that must be paid even when no patients come in. And these paid positions have nothing to do with the quality of medical care that the patients receive.

Now let’s talk about what your insurance company will pay for your visit. For 
a typical follow-up visit for low to moderate severity issues, your insurance company pays anywhere from $45 to $75 to the doctor’s office. You can also add your $20 copay to this amount. The American Medical Association suggests that these visits are supposed to take 15 minutes face-to-face with the patient. That doesn’t happen very often.

If your doctor has 4 of these visits per hour, she is paid anywhere from $260 to $380 per hour when you include the payment from the insurance company and the collected co-pay. The last primary care doctor I spoke with told me that his hourly overhead is $700. When your expenses are greater than your revenue the math doesn’t work, but those are the numbers……"

How direct primary care reduces the costs of care

I appreciate it when a nurse or office staff lets the patients know what is going on. The GI I had an appointment with last summer was an hour late getting to the office, and it was not because of any emergency. I know this because his procedure scheduler told me that the doctor had changed the time he normally arrives after lunch, and yet the person who schedules the appointments just kept right on putting patients in for that hour that he was never going to be there.

In this case, the staff made an announcement to the room that the GI would be over an hour late, and we would have the choice to reschedule or see the PA. I chose the PA as I had already cleared the decks for this appointment and needed to get the procedure scheduled in a timely fashion due to upcoming travel.

And that brings up another problem... sure, you can get up and leave, but you've gone out of your way to make room in your schedule for this particular appointment, and the doctor should do the same. Now you have to start back at square one.

There are good doctors here that don't overbook. If you go to a doctor more than twice and have to wait too long, you can search for another doctor.

Please don't use the Mayo Clinic as an example of how your local physician office should operate. Do you want your local MD to "squeeze" you in if you are ill? Try to walk in at Mayo... Here is what their website says about walk ins

Can I get into Mayo Clinic without an appointment?
Mayo Clinic in Rochester accepts "walk-in" patients. This method, however, is not encouraged, and you should be prepared to wait several days to a week or longer, depending on appointment cancellations and others waiting for an appointment. Waiting times tend to be shorter in winter.

So walk in is only ok in Rochester MN, and be prepared to wait several days to be seen. If you'd like Rochester MN in the winter the wait is shorter.

However, if the office is open at 9 AM the doctor should be there before 9 AM. Here is where it gets difficult. If your appointment is 9 AM does that mean you should arrive at 9 AM? If so then there is time checking in, getting your vitals done, nurse doing a brief history, updating your chart. You are not going to be ready until 9:15 or later. If as the 9 AM patient you show up at 9:10 figuring the doctor is always a bit delayed, now you have messed up everything. So should the office tell you 8:45 when they really don't expect you to be ready for the doctor until 9:15 just to be sure you are on time? Should they turn you away if you are 15 minutes late so as not to allow you to inconvenience all the later patients? Some practices wave schedule. Tell 4 patients to come at 9 AM and don't schedule the next one until 10 AM, 4 more. That way you even out the early and the late people but likely see your 4 patients in that hour. Now if all 4 are there at 9 AM and it is the "first" appointment of the day, somebody is going to be the last of those 4 to be seen, and be upset.

I know this may sound silly but when I call for an appointment, especially with a new doctor, I inform the nurse that I will NOT wait more than 15-20 minutes to see the doctor. I inform the person that after that time I will leave.

They will usually inform you that either the doctor is usually on or close to schedule or is running late.

Too late - bye bye!

My Doctor has never kept me waiting. I get there maybe 10 minutes early, the nurse does my vitals, asks if there are any changes, asks if I need meds etc., enters everything into the computer in the room, the doctor comes in, checks the computer and then talks to me.

I asked him about it and his reply was he has told his people not to overbook him and they don't.

I had an appointment with my Gyno and the nurse came out and said she had been called to the hospital for an emergency (surgery the day before) and she would be an hour late. Reschedule if you wish, or sit and wait. They then cancelled all the other appointments for the morning hours.

My husband sees other doctors and he just will not wait, gets up and leaves if they are not on time. They know him by now and he is NEVER kept waiting.

Me too..... but many times the very first appointment is 9:00am and the doctor walks in from the parking lot at 9:20. I can wait 20 mins, but once waited 1 1/2 hours and told the doctor I was just getting ready to have a pizza delivered there. I think it sunk in how I felt.

no reflection on your husband whatsoever but that only means they make someone else wait...
more disturbing is the trend to have you accept a PA visit in place of a doctor, no offense to most, but some PAs are too obtuse to diagnose their own headaches, yet people are supposed to accept their word on things like cancers, etc.

If my appointment is at 9:00, I expect to be taken in by the nurse at 9:00 and seen by the doctor shortly after she's done with me--like within 5 or 10 minutes.

I consider it my responsibility to arrive in the waiting room and be ready to be taken in by the nurse by the time 9:00 rolls around. I am always ten minutes early and do not count those ten minutes against the doctor.

I wouldn't try to walk into Mayo unless my family doctor was at Mayo.

To provide a view from the other side.

The last 28 years of my professional life were spent in a medical group where everyone was salaried, so our income was not affected by how many patients we could cram into the day. My day was fully booked in advance, all day. We also had a policy that if someone presented to the clinic with a problem, they would be seen. If a patient was very late for their appointment, they would be seen. If a patient showed up on the wrong day, they would be seen. Added to those were patients sent to us by other departments. And, of course, we added our own patients who required follow-up even though there were no available appointments.

My early patients were generally seen on time. But, as the morning progressed, patients who required more time than was booked plus those other add-on patients caused me to be farther behind time. Most of the time I would finish my AM patients a bit after my PM patients were already checking in. A lunch break was a dream. Grab a bite of sandwich and a sip of a drink and get back to work. I would finish my PM patients well after the clinic closing time. Then I could embark on finishing my charting, preparing for the next day's patient load, read my messages, return phone calls from patients or colleagues, or go over lab or technician results.

Fortunately, my front office staff kept our patients informed of the wait.

Just to say that overbooking occurs for other reasons than revenue. Sometimes it's medically necessary.

It seems to me that if your day is fully booked from the get-go, it's guaranteed that there will be no time to fit this in without causing patients to wait... "if someone presented to the clinic with a problem, they would be seen. If a patient was very late for their appointment, they would be seen. If a patient showed up on the wrong day, they would be seen. Added to those were patients sent to us by other departments. And, of course, we added our own patients who required follow-up even though there were no available appointments."

That's the same thing as overbooking, in my opinion. They shouldn't have booked your day so fully that you couldn't accommodate these other issues that pop up. Or else establish some rules that latecomers would not be seen, wrong-day patients would not be seen, patients sent by other departments scheduled in at another time. And limit the number of patients or appointments to accommodate these things.

There were many good doctors in my former state who simply got to the point where they would not accept new patients because they couldn't be accommodated.

Booking fewer patients in advance per day results in extending the wait time for a routine appt to an unsatisfactory level. While this thread is about the wait once you get to an appt, there are other threads/posts that have concerns regarding the wait to get that appt. For example, at one point, the wait for a routine appt with me was approaching three months. Completely unacceptable. The best solution would be to add staff to better handle the patient volume. But that means additional space for them to work and additional support staff and room for them. Then there needs to be more OR time for the additional staff, and more beds for patients that require admission. And on and on. So, let's build another facility. But the response of insurance companies and government to increasing health care costs is to cut reimbursement to health care providers, so where does the money come from to make these changes.

Another's solution is to add extenders such as PAs or NPs. But we've seen how some patients object to not seeing the doctor.

Do I have an answer? Nope. I guess I just am troubled by the inference that because a patient is kept waiting that the doctor doesn't care. My personal experience is that most of the time a patient may be kept waiting because the doctor really does care, for the patient right there in front of them, which is their primary concern at the moment.

I don't think the doctors don't care, Mikeod. I think the accountants don't care, and push the doctors into an unacceptable position. Then the patients/customers suffer.

Maybe the answer is to enter a teaching hospital's medical system. Our experience with the University of Michigan health care system, for example, was so far superior to our experience with local medical groups in our location outside of Grand Rapids, MI. We encountered so much overbooking and poor service and attitude in our local community that we switched our total health care over to U of M even though it was almost three hours away. The difference was amazing. No overbooking, acceptable waits, better treatment of us "customers," (none of the "doctor-is-God and you're lucky he's seeing you" attitude from the staff) and excellent care. We asked two of the doctors at U of M what they perceived the difference to be, and their answer was that they had no idea what the billing and profit-making practices were, did not have to be involved with that in any way, and could simply concentrate on their patients.

I don't know what the answer is, and I certainly don't think that doctors don't care. But I do know that we have been able to find some good doctors down here who don't overbook.

It's interesting that you bring up university hospital systems which are buying up physician practices. Patients not on Medicare, who have to pay for their new higher deductibles of $3,000 to $8,000 per year now, are painfully aware of the facilities fees being added onto doctors' office visits/procedures simply because they are part of a "hospital" system. What were "physician office visits and procedures" are now "Hospital visits and procedures", at a much higher price.

These out-of-pocket costs are forcing many people to NOT go to the dr. when they need to, because they do not have the cash and still have the ethics to not run up bills they cannot pay:

"Facility fees’ add billions to medical bills" (Kansas City Star)

"ST. LOUIS
It was a minor skin infection. The visit to the dermatologist’s office at SSM Cardinal Glennon Children’s Medical Center took just a few minutes.

Before she left, Allison Zaromb paid $40 for her 4-year-old son’s care, the amount listed on her insurance card for an office visit to a physician specialist.

Zaromb assumed she had settled the bill, until a shocker arrived in the mail: After paying for the doctor, she still owed about $200 for a “facility fee” charged by Cardinal Glennon.

“I had no idea you would have to pay another fee because the doctor’s office was on a hospital campus,” Zaromb said.

“It’s just not fair. It’s like paying the barber for a haircut and then being charged extra for sitting in the barber chair.”

Fair or not, facility fees are built into the way Medicare and commercial insurance plans pay for health care. Hospitals have charged them routinely for years for services at their outpatient clinics.

But the fees are getting new scrutiny now that hospitals nationwide are buying up physician practices and putting thousands of physicians on their payrolls.

Sometimes by making few visible changes beyond putting their logos on the door and issuing new ID badges, hospitals can declare newly acquired practices part of their outpatient department and start billing patients more.

The doctor’s office doesn’t have to be in the hospital or even on the hospital campus to charge facility fees. It can qualify if it’s as far as 35 miles away.

Facility fees can more than double the cost of a visit to the doctor, a major hardship now that many people have high-deductible insurance plans with substantial out-of-pocket expenses…...

Read more here: Day 2:

Never had any facility fees added, before or after being on medicare. Besides, the issue here is wait times at doctors' offices.

I give them 20 min. maximum unless there is a good excuse,and then I'm outta there.......There is no shortage of lawyers or physicians here and I'm living a tight schedule myself........:icon_wink:

fumar

And yet many of them will charge us if we're late or miss an appointment! So galling.

I had the first 8 am appointment with Dr. Chin recently and when I arrived and signed in, saw that there were two other patients with 8 am appointments for Chin. If she wonders why I was crabby and ill-tempered when I finally got to see her at 8:50, she should look examine her own conscience.

I had an appointment yesterday where I was getting ready to walk out after 69 minutes sitting in the exam room, but the stupid guy is only here once a week and I'd already waited 5 weeks for that appointment. During which he didn't listen and scolded me for taking a certain medication. Hey! I DIDN'T WRITE THE PRESCRIPTION MYSELF, you know. Thank the bozo before you.

And get this -- is it a thing now for a dr. to ask a question, then while I'm answering, take out his cell phone and start texting with someone? WHILE I'M TALKING. No apology, no explanation, just ignoring me. It's bad enough that half of them sit with their backs to you while they enter info into the computer. The last guy who did that (eye dr), I turned my back to him when I answered.

Patients unite! If enough people complain about these things, something will change. If the doctor was texting something that had nothing to do with me, I would be mad enough to walk out. I would certainly ask him what and to whom he's texting, and why.

So good for the posters who have said they will not wait past a certain amount of time, and for the ones who tell that to the office when they make the appointment. We have to look at ourselves as consumers and demand fair treatment, or we'll take our business elsewhere.