The New York Times had an article last week about how to deal with doctors who don’t value your time (Punishing Doctors Who Make You Wait, Jun 29). It suggests asking for a discount when a doctor has subjected you to an unreasonable wait while acknowledging “in some situations, however, you are likely to be powerless, and doctors know it.” It also highlights a firm called One Medical Group with offices in San Francisco and New York City that competes on offering fast access to physicians and longer appointments.
How does the medical group guarantee on-time appointments? The practice, which charges patients a $199 annual membership fee to join and uses information technology to help manage costs, doesn’t require that patients come in for routine ailments like urinary tract infections. Instead, the medical professionals treat them by e-mail or phone … Refills are also done online. Such policies help limit the number of patients coming into the office.
In addition, the practice has adopted certain time management policies that make starting and ending appointments on time easier, said Tom Lee, medical director of One Medical Group. Because appointment times with doctors are 20 to 30 minutes for each appointment, longer than elsewhere, they don’t tend to run over as often. This also builds in extra buffer time between One Medical appointments for physicians to deal with tasks like looking over test results or filling out forms.
The longer appointment times also create an extra buffer in case a patient shows up late (which is itself a cause of doctors running behind at many offices). Even if the patient before you shows up late, your One Medical appointment is guaranteed to start on time. Depending on when the latecomers arrive, they will either have a shorter appointment or will have to rebook for another day. “We don’t want someone else’s lateness to impact you,” Dr. Lee said. “When people show up late, they feel the penalties in the sense that time is taken out of their visit, not someone else’s.”
This all good. Of course, One Medical’s model is going to be higher cost. They are basically committing to running their resources at a lower utilization. Queuing Theory 101 says that will get you shorter waits.
It also seems incredibly bourgeois. Worrying about waits seems very second order. Manhattanites can change their doctor because they have the presumption that care is available. It is hard to imagine that patients in developing nations would view things the same way.
Well maybe that’s not the case. Check out this video about a McKinsey project in Namibia:Vodpod videos no longer available.
The accompanying article is Saving mothers’ lives in Namibia (Jun 2010, McKinsey Quarterly). As the article highlights worrying about patient waits can be as important in Africa as New York. Perhaps it is even more important. In New York, waits are a competitive issue. You can attract more patients if you can provide better service. In Namibia, waits are a symptom of a broken system. Patients are waiting because resources are not used as efficiently as possible. This is particularly problematic because resources are so scarce. Given a limited number of caregivers, it is tragic to have nurses working on tasks that are not adding value. As the discussed in the article, some small changes can free up capacity, increases access, and reduce waits.
The second point is that Namibians value convenience as well. However, their choice isn’t to switch doctors; it’s to opt out of care. If expectant mothers have to walk for hours to reach the clinic and then wait for half a day to be seen, they are not going to come that often. Reducing waits can drive demand here as well. It is not stealing from other practices; it is from reducing the cost to the patient and getting broader participation.