Why is scheduling doctor appointments so hard?
Waiting is dreadful, but why. According to a survey from Merritt Hawkins, patients waited up to 24 days on average to see a doctor in 2017, and it’s getting worse. Yet, the average fill rate for primary care doctors remained at 78 percent with a 10 to 20 precent of no shows and cancellations.
Do we need more doctors? With a 9.5M workforce in patient care, why do people still find it so hard to see a doctor when we need them the most?
While a plethora of platforms makes online booking and searching available to today’s consumers like ZocDoc, SolvHealth, Google, Yelp, and the many doctor directories managed by large health plans, the problem with patient access is yet to be solved.
If there are is a high demand for primary care coupled with a physician shortage, shouldn’t there be no gap in doctor schedules?
Let’s do a simple calculation. There are roughly 500M annual office visits a year distributed over a workforce of 180,000 licensed primary care physicians*. Assuming only 70% of these physicians work full time and the rest is either part-time or inactive, that’s 3500 visits per annum per physician or 13–14 visits a day for a 5-day work week. Considering a 20-visit day being the ideal productivity benchmark, there is a 30% of room for improvement in term of filling in the productivity gap.
Booking doctor appointments = jumping through hoops
In a recent comprehensive report on healthcare productivity, McKinsey found there are four areas that contributed to doctor scheduling gaps: physician preferences, patient preferences, informational gaps, and practices’ ownership structure. Thinking of these four challenges as the “hoops” patients have to jump through in order to see a doctor, the probability becomes slimer and slimer for a patient to find the right doctor at the right price and the right time.
The trade-offs between quality, cost, and wait time
A study by Bankrate shows that one out of four American skipped medical attention in 2017 because of the cost. A similar study by McKinsey and my own interview of 120 patients found that quality and cost are the top two most important factors for patients while choosing primary care doctors. Adding the matrix of convoluted access to doctors, we now have a health system that only works for the very few informed consumers who can wait.
What happens to those who can't? Empowered by the new age of consumerism, Millennials and Gen Xers are making trade-offs and find alternatives that work for them. Many of which are leaving the traditional health systems — an alarming trend for incumbents. Google searches for the word “urgent care” increased by four folds in the last ten years and CVS Minute Clinics went from 0 to 40 million total visits in the same time period — now commanding half of the retail healthcare market share.
Rethinking scheduling: Should we even schedule at all?
What’s the difference between airline ticketing and doctor scheduling? Only less than 10% of all healthcare appointments are booked online and more than half of which are for the same or next day — 80% of flight tickets are booked online in advance. So why are we still trying so hard in healthcare to mimic other industries when it comes to scheduling?
As industry experts are coming up with ways to optimize the doctor calendar, I ought to ask one question: If we can’t seem to schedule our sickness, why should we at all try to schedule medical appointments?
Can changing how we think about scheduling improve productivity? If patients are making trade-offs between quality, cost, and access to get their health issues resolved quickly, can we back-fill the productivity gap with health needs that can’t wait?
Not only this is viable, but the financial rewards for physicians are very real. For an average of $125 per visit, the average primary care physician generates anywhere from $400,000 to $450,000 in annual revenue at a 70 to 80 percent productivity. By participating in such network and opening up an hour a day for two walk-in visits, every primary care doctor is looking a $65,000 gain in revenue or a 10-15% upside in take-home income.
Conclusion
Productivity as an imperative for primary care in the next decade should make healthcare executives stay up at night. However, optimizing scheduling alone may not the best bet.
Consumer behaviors are changing rapidly, the majority of people with health issues also procrastinate. They demand not next day, not same-day, but same-hour medical attention. This “I-need-it-now” demand has been the force behind why many patients resort to the ER even though they know it is not the best venue for experience and cost.
If primary care physicians are our first responders and same-hour medical attention is on top of the need hierarchy, how do we connect the two?
This article is part of a series, I will discuss how to build a viable network to facilitate away the productivity gaps in physician schedule in the next piece.
*Number of primary care office visits from CDC. Number of primary care physicians according to CMS NPI data including General Practice, Family Physician, and Internist excluding advance practice providers.
