Even if you are fortunate enough to have health insurance, it is growing increasingly difficult to get an appointment with your doctor. Managed care and cost containment have put the squeeze on doctors and their patients.
“There is only so much time in the day to see patients,” said Dr. Audrey Kunin, 41, a board-certified dermatologist who gave up her private practice in Kansas City, Mo., three years ago to start a Web-based dermatology business.
“Changes in insurance reimbursements practically mandate that a doctor see way too many patients a day in the first place in order to make overhead payments, not to mention a paycheck. So getting an office visit in a timely manner can be challenging, if not impossible,” Kunin said.
“When asked the reasons for delaying or not obtaining care, respondents are increasingly reporting problems obtaining appointments,” said economist Paul B. Ginsburg, president of the Center for Studying Health System Change in recent testimony before the Subcommittee on Health of the House Ways and Means Committee.
Ginsburg’s research shows that though physicians are devoting more time to patient care, the waiting times for appointments, for both Medicare and private patients, are growing longer. “The increase in hours spent in patient care is consistent with anecdotal reports that physicians are working harder to make up for lower fees,” Ginsburg said.
Making the call
Most patients pause and take a deep breath before calling their physician for an appointment.
Should I call? Am I really sick? Can it wait? Will it go away?
By the time they call, they want an appointment right away–to get immediate relief from unpleasant physical symptoms, such as aches, pains or itches or to allay the anxiety often associated with even minor health problems.
Dr. Paul Crawford, a nephrologist, is a member of a large Chicago-area, single-specialty group practice. “Some patients don’t understand the gravity of their illness,” Crawford said. “They are in denial and wait until the last minute to call for an appointment. Other patients procrastinate because they fear that they will have to go on dialysis.”
When a patient finally calls an internist or specialist, they are likely to face off with a multitasking receptionist, nurse, medical assistant or other gatekeeper who is juggling a tight schedule that is booked weeks, if not months, in advance.
Emergencies come first
Kim Dodd of Mt. Kisco, N.Y., is an office manager and receptionist to a busy internist who is vice president of the local community hospital. Though her boss sets the general rules for how the office is run, Dodd holds a position of great authority and power herself. She handles the doctor’s busy phone lines and decides who gets seen and when.
How does Dodd decide who gets on the schedule?
“It depends on the symptoms,” Dodd said. “Fever, shortness of breath, pain that’s radiating and severe headaches are all red flags.” Whenever possible, someone who has more acute needs will be seen right away. If, in some rare instance, the doctor or his associate isn’t available that day, she will make plans for the patient to be met by a doctor in the emergency room.
Crawford is unequivocal about front-desk protocol involving emergency visits. “If a patient needs to be seen urgently, we will make the arrangements.”
Make it personal
“True emergencies always go to the top of the list,” Kunin said. “But let’s face it; the person with the itchy rash doesn’t want to wait 20 weeks to get in for the ‘routine’ appointment the receptionist has offered.”
Kunin offers some straightforward advice to patients to shorten the waiting time for non-urgent care. Above all, she stresses the importance of developing a good relationship and establishing rapport not only with the doctor but with everyone else in the front office. To get an appointment, it helps to have them know and recognize your name.
According to Dodd, knowing the patient helps the person at the front desk set priorities.
“The patient who never calls but then calls with a problem raises a loud alarm for me,” Dodd said. “When they call and sound concerned, you do everything you can to get them seen the same day. When people wait a long time because of fear and finally call, you don’t want to lose that opportunity to get them in.”
Kunin admitted that it doesn’t hurt when patients are “thoughtful” to gatekeepers. “Nothing says thank you like some cookies at the holidays or a really cute card,” Kunin said.
Communicate clearly
Kunin urges patients to be candid with the doctor’s staff. Patients need to communicate clearly and succinctly the reasons they want an appointment. Is it a routine checkup? If not, what symptoms are they experiencing, over what length of time?
“If you have a bad disease, share the story,” Kunin said. “When I was pregnant, I had an extremely high-risk situation and most people in the obstetrician’s office knew. If I had any problem I made sure everyone knew my story because they were far more likely to run things past the schedulers or doctor himself.”
Dodd explained that she tries to run the office the way she would like to be treated as a patient. She believes that if a patient isn’t comfortable waiting for an appointment, he should raise those concerns directly with the doctor.
No patient should have the feeling that a doctor’s “handlers” are “running interference.”
“Remember you always have a right, as a patient, to demand to speak to the doctor. If you are given an appointment that is not appropriate or if you can’t get your doctor to call you back when you really need to come in, it may be time to switch doctors,” Dodd said.
Referrals to specialists
Appointments with specialists are among the most difficult ones to make.
“Go through your primary-care physician,” Kunin said. “Nothing works like a friendly call from the internist.”
Some innovative offices are using “open-access” scheduling, which allows patients to be seen the same day they call for an appointment.
To make this work, 30 percent to 50 percent of appointment slots are set aside for same-day or follow-up visits. Results from 42 medical practices across the country (reported in Family Practice Management, the journal of the American Academy of Family Physicians, October 2001) suggest that the new approach not only increases consumer satisfaction but also results in greater efficiency and productivity.
As consumers play a more active role in their own health care, they are increasingly intolerant of long waits to see a doctor.
Sheri Ziemann of Lake Forest is a former nurse who now works as a public relations executive for a large medical center outside Chicago. Ziemann was frustrated each time she called her doctor.
“She was very sweet and friendly when I saw her,” Ziemann said. “But she only worked part time on certain days. I eventually had to change doctors because it was too hard to get an appointment.
“In my mind, my doctor is a highly trained consultant, but he works for me. If he doesn’t, he’s fired.”
