Time Magazine discovered that seeing the doctor can be a real pain in the caboose. You aren’t feeling well so you call your doctor’s office. They tell you the next available appointment slot is several weeks away. You wait three weeks and finally present at the doctors’ office, where you wait in a “waiting room” while filling out a mountain of paperwork your doctor should already have. You are led to an exam room where you wait some more. You finally see your physician, whose face is buried in a computer screen. Ten minutes later you’re summarily dismissed and told to get lab work that has been ordered for you. A month later you get the bills (plural). Your appointment lasted only 10 minutes, but your budget will feel the sting for weeks to come. If this sounds familiar, you’re not alone.
Going to the doctor may never be a fun experience, but surely it can be better than it is right now. In 2019, even before the COVID-19 pandemic rocked the foundations of health care, an Ipsos survey found that 43% of Americans were unsatisfied with their medical system, far more than the 22% of people in the U.K. and 26% of people in Canada who were unsatisfied with theirs. By 2022, three years into the pandemic, just 12% of U.S. adults said health care was handled “extremely” or “very” well in the U.S., according to a poll from the Associated Press–NORC Center for Public Affairs Research.
The United States spends more than other developed countries on health care, nearly 20% of GDP. Physicians are relatively low cost compared to other areas of the health care system, accounting for about 20% of health expenditures. But according to Time Magazine:
And the customer service sucks. U.S. patients are tired of waiting weeks or months for appointments that are over in minutes. They’re tired of high prices and surprise bills. They’re tired of providers who treat them like electronic health record entries, rather than people.
Yet about a quarter of American adults don’t have a primary-care provider, and, as of 2021, almost 20% hadn’t seen any doctor during the past year. There are many barriers: it can take weeks to get an appointment, particularly in more rural areas where fewer doctors practice, and visits can be costly even for people with insurance. Research shows that during the past year, financial strain caused about 40% of U.S. adults to delay or go without medical care.
Plus, people just don’t like going. A third of participants in one 2015 study said they had avoided going to the doctor because they found it unpleasant, citing factors like rude or inattentive providers, long wait times, and difficulty finding a convenient appointment. Many people also skipped appointments during the COVID-19 pandemic, largely because of office closures and fears of the virus—but one study found that people were more likely to forgo doctor’s visits during the pandemic if they’d had previous poor experiences with health care. People of color, women, and people who are overweight frequently report feeling mistreated by their doctors.
Doctor avoidance, as it’s called, is common according to researcher Jennifer Taber. She conducted a study in 2015 on doctor avoidance. She argues that medical schools train doctors to practice medicine but not be doctors.
“Patients won’t necessarily want to go back to doctors they don’t like,” she says. Even small gestures, like making eye contact with or leaning toward a patient as they speak, can help build a strong rapport, Taber says.
This argument sounds rediculous. Physicians’ customer service is not the root cause of doctor avoidance. Indeed, doctors themselves aren’t the cause. The system is the reason doctors behave the way they do. The system is why doctors have only about 10 minutes to spend with patients. Doctors must see a lot of patients to cover the overhead, pay the billing clerks, the office rent, heating and cooling for the waiting room, the exam rooms and the office environment, etc. Doctors didn’t demand electronic medical records with multiple pages of pull-down menus required to navigate before they can begin to chart your health concern. Physicians feel burned out too. Most don’t like the status quo any more than their patients.
Alas, Time Magazine has figured out that insurance is part of the problem. There is rigid a bureaucracy, with perverse incentives to order tests but not much incentive to innovate for better patient experiences. According to the article:
Traditional medical offices could also take cues from the services patients are increasingly gravitating toward, says Pearl McElfish, who researches health services at the University of Arkansas for Medical Sciences. Patients who can afford it are flocking to startups offering perks like same-day appointments and flat-rate monthly memberships. And one 2018 study co-authored by Mehrotra found that visits to urgent-care clinics, where patients can walk in instead of waiting for weeks, increased by more than 100% from 2008 to 2015 among privately insured U.S. adults. (During roughly the same period, primary-care visits dropped 24%.) During the pandemic, urgent-care centers only became more popular—as did telehealth.
Yes, direct primary care is popular among those who use it because it affords a better patient experience.
Traditional medical offices could make some changes right away, without waiting for big structural overhauls, he says. They could offer “walk-in only” hours to treat people without appointments, text patients when the doctor is ready to see them, and include clear explanations on bills so patients understand what they’re paying for. Even small shifts like these could make significant differences to patients.
Amazon and some drugstores are looking to get into primary care, hoping to shake up the industry. But here is the problem and it’s probably not something the folks at Time Magazine understand. When health plans process most medical bills, they can dictate how care is delivered. Health plans can dictate which physicians are in-network and what services are covered. When a reimbursement is fixed and office overhead is high, physicians don’t have the option of spending a five extra minutes with patients who need some additional time.
However, when doctors are competing for cash-paying patients, they can dispense with the bureaucracy that inconveniences both doctor and patient. Years ago, my doctor was out of town when I needed an appointment. His office referred me to a colleague who was covering for him. The doctor I was referred to did not make appointments. He did not bill insurance. He accepted cash only and his office was first come, first served. This was probably 30 years ago but I got a one-on-one discussion with the doctor, who charged me $35 for the visit. I did not feel rushed and my wait time to see him once in the office was about 10 minutes.
My wife and I know several doctors that accept cash and provide great service. One is a dermatologist whose office is 36 miles away through congested traffic. He’s so good that we endure an hour drive each way to see him once or twice a year. Another is 34 miles away while a third is 20 miles away. Dallas traffic is no picnic so if we drive that far it must be for a reason.