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Friday, November 06, 2009

While We're Reforming Healthcare Let's Talk About Doctors

I'm writing this over lunch having spent the better part of my morning going to and coming from an appointment at the Vanderbilt University Medical Center Hand Clinic. I never saw a doctor; I walked out after an hour and a half and I'll decide later if I go back. This morning reminds me of a study done in 2007 on the hidden cost of physician inefficiency.

This study, available on economix.com studied Americans 15 and over during 2007 to see how much time is spent in physician waiting rooms. That number...and maybe you should sit down, is 847 million hours in one year. In 2007 the average wage for American workers was $17.43/hr, so the total cost to the economy was $240 billion. The average American that year spent the equivalent of 1.1 hours per week in a doctor's waiting room. So, take your average hourly wage x 52 weeks a year x 1.1 and see what you or your employer are spending each year.

In all other commercial transactions in a capitalist system the person to whom you pay money is working for you. Medicine is an exception. Only in medicine do the people and institutions to whom we pay money (either directly, through our health insurance, or both) dictate the environment in which we'll wait, how long we'll wait, and what care we'll receive (you can assert your rights as a patient to guide or refuse the care offered which is not always appreciated by your physician). Timeliness, it is safe to say, is not a metric used to assess the performance of most physicians practices.

Let's draw a distinction for the rest of this discussion between routine care, which most of us receive, and life-threatening care such as rendered via oncology, cardiology, emergency medicine, etc... I never minded waiting in the Breast Clinic with my wife while her doctors were treating cancer. That's way different.

Now here's the big "ah ha." Practically all non-life-threatening care is routine. When was the last time you had an experimental treatment? If you're like most patients, its never. Anything that's routine can be analyzed and measured.

Whether you're treating a common cold or rebuilding someones knee, with a modicum of study you can determine how long that takes. You can then schedule your appointments around those needs. You don't have to know the diagnosis if you're an ear, nose and throat specialist; those coming to you are making appointments because they have an ENT need. Same with orthopaedists and double for primary care physicians.

In other words, there's never a good excuse for over booking your practice and making people wait unnecessarily.

This is a paradigm that we should shift while we're reforming American health care. If more patients demanded timely care, and took their business elsewhere when they didn't get it, then timely care would become a measurable performance metric in physicians and clinical practices. Those operations, for all the good they do for humanity, are also businesses and are sensitive to customer pressure. As patients we just usually don't think to exert it and we should.

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