Visiting the doctor is often an exercise in inconvenience. I once read that when you include travel time, waiting time, filling out paperwork, waiting in the exam room and talking with office nurse, that 15 minutes of face time with your doctor takes up about three hours out of your day. That sounds a little high, but the average time varies by physician specialty and whether the clinic is urban, suburban or rural. Then there is the lead time required to schedule a visit. The average time to see a family physician is three weeks (20.6 days) according to a recent survey. That is actually an improvement from 2017 when the waiting time was 29.3 days. A cardiology appointment is the opposite. It was three weeks in 2017 and 26.6 in 2022.
The New York Times wrote about the time taken up by physician visits. A senior who the Times interviewed explained every body part has its own doctor:
Ms. Hendrickson reeled off a long list of her health care providers: a primary care doctor; a cardiologist, because she has mild heart disease and a concerning family history; a lung surgeon and a pulmonologist who oversee an annual scan because of her family history of lung cancer.Plus an ophthalmologist, a gynecologist, a urologist, a podiatrist, a gastroenterologist — “and I just came back from the dentist.”
Hendrickson estimates she sees a doctor or gets medical services about 24 times a year. She is not alone. Medicare data shows that people 65 and older average about 17 contacts with the health care system annually (excluding the dentist). For seniors with a myriad of chronic conditions (14% of seniors), contact days with the health care system rise to 30. And 11% of seniors see the doctor or some other ambulatory medical service 50 times a year. Seniors can even experience treatment cascades, where the more they go, they more that is found wrong – leading to more treatments that often cause more harm than good.
One strategy: reducing what experts call “low-value care.” Her research has confirmed what critics have pointed out for years: Older people receive too many services of dubious worth, including prostate cancer screening in men over 70 and unneeded tests before surgery.Health care systems themselves have a major role to play in reducing treatment burdens. They could put specialists in the same building, for example, and adopt payment models that reduce incentives to schedule additional visits and tests.
The previous two paragraphs sound like happy talk by public health advocates but make little sense to an economist. Our health care system is not competing on price, quality or other amenities. Doctors’ schedules are typically fully booked. The only incentive they have to reduce low value care is if they can instead fill their time with more lucrative patient treatments. Considering some of the care they provide is performed by others (blood tests, CT scans, physical therapy, etc.) turning away a low value care patient is unlikely to boost their income but would reduce their hospital employer’s income.
There may be another more sinister mechanism at work. Many seniors like going to the doctor. A while back I read an article about seniors in Florida, a state with a large senior population. The article claimed that visits to the doctor also function as social occasions for many seniors. Seniors go to the doctor and talk to other seniors in the waiting room, compare notes and recommend new doctors to each other. Strangers they did not know prior to their visit now want to see the doctor another senior raved about. Indeed, it is well known that seniors living in retirement destinations see their doctors more than seniors living in places with a lower concentration of seniors. I have even talked to some pharmacists and policy analysts, who said seniors often refuse to switch to mail order prescriptions because their trek to the pharmacy is part of a monthly ritual that gives their life purpose.
If seniors want a heath care village (you know, it takes a village) with interaction with other seniors, tons of care at low cost, my idea of social media-based interactive group therapy would work well. That’s another discussion for another day. Apart from that, it may not be easy to make physician visits less of a pain, or to discourage unnecessary physician visits.
See New York Times: So Many Days Lost at the Doctor’s Office
Could it be that general practitioners receive too little reimbursement from Medicare for office visits to be worthwhile, and so they refer all of their patients to specialists for ongoing monitoring?
My old neighbor said his wife’s Medicare GP never treated anything. She only referred his wife to specialists. It could also be that seniors perceive being referred to more doctors as better care.