Friday, May 08, 2009

Waiting for the Doctor

Via Medinnovationblog I recommend two posts regarding time. In this blog Dr. Richard L. Reece takes a cold, hard look at the overall state of medical care and keeps readeers up to speed with the wrinkles and pitfalls in the reform debate.

Time is Important for Patients, Too concentrates on ways that physicians can save time for their patients. How many time have we altered other important matters in order to accommodate a doctor's crowded schedule for an appointment? And how many times have we moved heaven and earth to insure that we were there ON TIME, just to spend the next half hour or more doing nothing but sitting in the waiting room? Then, more often than not, we are ushered into yet another waiting room, for what? More waiting. And before we actually have a moment's face time with the doctor we will already have learned the names and childrens names of one or more PA's, nurses or techs. I could go on, but it's already turning into a cheap shot. Forgive me.

The supply of time is totally inelastic. No matter how the demand, the supply will not go up. Moreover, time is totally perishable and cannot be stored. Yesterday’s time is gone forever and will never come back. Time is, therefore, always in exceedingly short supply.

Time is totally irreplaceable…Everything requires time. It is the only truly universal condition. All work takes time and uses up time. Yet most people take for granted this unique, irreplaceable, and necessary resource.

A more revealing and pertinent post about wait times is Doctor Wait Times, Costs, ER Visits in Massachuset...
That other post is about wasted time as a nuisance. This one is about what happens with wasted time becomes (if I may apply a term now in fashion) a pandemic. Citing an article in the Boston Globe

Long wait times in Boston may be driven in part by the health care reform initiative that was put in place in Massachusetts in 2006. The initiative succeeded in covering many of the state’s uninsured patients. However, it has been reported that many patients in Massachusetts are encountering difficulty in accessing physicians. Long appointment times in Boston may signal what could happen nationally in the event that access to health care is expanded through healthcare reform. Increased demand resulting from improved access to care for 47 million uninsured people can be expected to extend doctor appointment wait times in many markets.
[I corrected a couple of typos in this quote and didn't furnish a link, but neither did Dr. Reece. I guess it's okay since the Globe, last I heard, is on the verge of going out of business. A couple of typos is the last thing they have to worry about.]

More revealing to me is the wait times -- in DAYS -- to get an appointment with a specialist.

The average wait times for appointments in Boston for cardiology are 21 days, dermatology 54 days, obstetrics-gynecology 70 days, orthopedic surgery 40 days, and family practice 63 days.

The average cumulative wait times for the 5 specialties just mentioned are,

Boston, 50 days

Philadelphia, 27 days

Los Angeles, 24 days

Houston, 23 days

Washington, D.C., 23 days

San Diego, 20 days

Minneapolis, 20 days

Dallas, 19 days

New York, 19 days

Denver, 15 days

Miami, 15 days

Portland, 14 days

Seattle, 14 days

Detroit, 12 days

Atlanta, 11 days

Next time someone argues against the Canadian or British systems because they have to wait such a long time for elective surgeries and the like, mention how long it might take in America to discover if a procedure is, in fact, elective or not.

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