Vishal Mehta, MD, thinks any attempt to reduce patients' wait times, or make practices so efficient that delays are rarely an issue, is futile.
"If I saw 30 patients a day, I would be on time," said Dr. Mehta, an orthopedic surgeon and sports medicine physician in the Chicago area. "But what happens is, throughout the day I get people calling me saying, 'Look, I hurt my knee, I hurt my ankle, I hurt this.' I get doctors calling me, 'Please get this patient in.' My option to them is to say ... 'You can come in and see me in two months,' or to say, 'OK, I am going to try to be a nice guy and try to squeeze you in here and squeeze you in there,' and before you know it, we have the wait time issues."
Experts say statements such as Dr. Mehta's are echoed by many physicians, because they find it impossible to guarantee that something unexpected won't throw off their schedules -- and those of their patients.
Instead, some experts put the emphasis on satisfying patients not by making them wait less, but by informing them why the wait is long, and how long it will be. That conflicts with other experts who push the idea of keeping on time as much as possible, not only as a way to make patients happy, but also as a way to keep a practice efficient so it might be able to fit in more patients each day.
Some studies, however, show benefits of merely telling patients you're running behind.
For example, a 2009 report by the health industry survey firm Press Ganey looked at 2008 patient satisfaction scores at hospitals and found that keeping patients well informed about delays can give scores a considerable boost. Some hospitals launched automated systems that post wait times online or on billboards to help patients decide which emergency department to visit, or to give them an idea as to how long a wait will be.
Dennis Kaldenberg, PhD, chief scientist at Press Ganey, said physician practices are in a tough spot when it comes to addressing wait times.
"They are expected to see more patients, and at the same time patients are becoming more engaged and more knowledgeable and they have more questions to ask their physicians, so they make more demands on a physician's time," he said. "Those two things make it difficult for a physician to manage time effectively."
Press Ganey's research of 2 million patients at 650 practices found that the median wait time at a physician practice is 12 minutes, ranging from seven minutes on the low end to 45 minutes on the high end.
Deciding how to deal with delays should be handled on a day-to-day basis, Kaldenberg said. Even though a practice may know its average, each day is different, and it's never predictable, he added.
Kaldenberg said Press Ganey's research has found that whether patients wait in the waiting room or the exam room, they are equally dissatisfied. However, "When the patient is satisfied about the information on the delays, they are OK about waiting longer."
A 1985 study by author David Maister looked at the psychology of waiting lines. Maister is a former professor at the Harvard Business School in Massachusetts and wrote several books on management. He has revisited his waiting line study in subsequent work and wrote in his blog that after more than 20 years, he still gets numerous calls about it.
Maister wrote in his study that, in practice, appointment systems are troublesome, because it's often hard to predict factors that could throw a schedule off.
"This is a particularly acute problem, because a customer with an appointment has been given a specific expectation about waiting times, and a failure to deliver on this premise makes the wait seem longer than if no appointment had been made," he wrote.
Dr. Mehta has decided how to handle wait times at his practice. He thinks patients will be satisfied when they know how long a wait will be. So he has created a wait-time indicator -- which he's selling to practices and hospitals -- that would let patients log on to a website to see exactly how far behind their doctor is running, and what time they really should arrive for their expected appointments.
"The reality is, I am running behind," he said. "I think people in America have come to expect that, especially in certain specialties. So I am not scared of some sort of mass exodus [of patients], because I am being honest about my wait times. I think it would be the opposite, that patients would appreciate that."