Friday, January 26, 2007

Your Doctor and You -- Tired and Sick of Waiting – Times Vary in U.S., Are Longer in Canada, Can Endanger Your Health, and Require Time Management,

Waiting times for appointments to see specialists vary across the United States. Waiting times are a demand-supply problem. The greater a given specialist shortage, the greater the number of patients, the longer the wait times.

Take cardiologists. Heart disease is the most common disease in America, and by far the greatest killer.

Here are cardiologist waiting times Merritt Hawkins, a national physician recruiting firm in Irving, Texas, found in various metropolitan areas across the country in a 2004 survey. If you’re a Medicaid patient with a heart problem, it’s the most difficult to get a cardiologist appointment in Dallas, New York City, or Seattle.

City Shortest time Longest time Average time Accept Medicaid
Boston 18.7 days 120 days 37 days 11%
Philadelphia 20.1 days 136 days 27 days 80%
Portland 20.2 days 128 days 25 days 100%
Denver 20.2 days 128 days 23 days 30%
New York 20.2 days 26 days 20 days 0%
Miami 15.3 days 45 days 21 days 40%
Detroit 17.7 days 42 days 20 days 65%
San Diego 19.9 days 72 days 17 days 68%
Atlanta 20.3 days 28 days 17 days 80%
Minneapolis 20.2 days 105 days 15 days 80%
Los Angeles 18.1 days 23 days 13 days 22%
Washington, D.C. 16.0 days 23 days 12 days 100%
Houston 20.2 days 43 days 11 days 85%
Dallas 17.2 days 16 days 10 days 0%
Seattle 18.1 days 24 days 9 days 0%

Source: Merritt Hawkins Associates, 2004 Survey

Waiting Times in Canada

Waiting times for a specialty appointment are longer, on average, in Canada than in the United States.

In Canada, the median wait time between a referral by a family doctor and an appointment with a specialist increased to 58 days in 2005 from 25 days in 1993, according to a recent study by The Fraser Institute, a conservative research group.
Meanwhile the median wait between appointment with a specialist and treatment has increased to 66 days from 39 days over the same period.

Average wait times between referral by a family doctor and treatment range from 39 days for oncology to 280 days for orthopedic surgery.

Some Canadians die while waiting for an appointment, others have radiation treatments delayed, and still others cross the U.S. border for treatment.
In June, 2005, the Canadian Supreme Court struck down a provincial law banning private medical insurance and ordered the province to initiate a reform program within a year.

The decision ruled that long waits for various medical procedures in Quebec violated patients' "life and personal security, inviolability and freedom," and that prohibition of private health insurance was unconstitutional when the public health system did not deliver "reasonable services."

In February 2006, Quebec proposed to lift a ban on private health insurance for several elective surgical procedures, and announced it would pay for such surgeries at private clinics when waiting times at public facilities were unreasonable.
Nationalizing a health system may not solve the waiting problem. It often exaggerates it.

Indeed, in most nations with centralized government systems, more waiting is the rule rather than the exception. Universal government coverage prolongs waiting, for there no economic incentive to please patients.

Dying While Waiting

In the United States, patients can die while awaiting an organ transplant. The same goes for severely ill or injured patients in emergency rooms. Some doctors double-book appointments to make up for patient cancellations. And doctors say they are pulled in so many directions – phone calls, emergencies, interruptions, meetings, unexpectedly complicated patients.

Some Waits Unavoidable

In some cases, long waits may be unavoidable. Add to this that medicine is unpredictable and the fact that Medicare, Medicaid, and insurance companies are reimbursing doctors at such low rates that doctors feel compelled to see more patients. Consequently doctors may over-schedule and fall further behind as the day progresses. It may pay for you to schedule appointments early in the day.

Managing Time, The Inelastic Asset

For doctors shortening waiting times for you is all about managing time while showing you the courtesies you deserve. In the larger scheme of things, these goals require increased physician productivity (Marshall Zaslove, MD, The Successful Physician: A Productivity Handbook for Practitioners, An Aspen Publication, 1998).
For increased productivity, which translates to more time for patients, doctors can go to open access scheduling, delegate tasks to nurse practitioners and physician assistants, manage patients through email communications, conduct “virtual office visits, “encourage you to come bearing specific questions.

But in the end doctors cannot change the doctoring process – history, review of systems, physical, and treatment.

And doctors can’t create more time. Time is inelastic, irreplaceable, and unique, and they cannot make more of it. And everything a doctor does take time.

Wrapping Up

Doctors are shortening waiting times through open-access scheduling. This permits them to see patients on the day they call. Still doctors may not see you on time because of the unpredictable nature of medicine and increased demand for services in the face of a national doctor shortage.

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