Anyone who has languished in a doctor’s waiting room, fuming as the minutes tick by, knows the frustration. Now, research from Harvard Medical School has calculated how many minutes patients spend seeking medical care — and the dollar value of their lost time.
The study estimates that the typical visit to a doctor consumes 121 minutes of the patient’s time — 37 minutes in travel, 64 minutes waiting for care or filling out forms, and only 20 minutes face to face with the physician.
Based on the average sum a person could earn if working during that time, the researchers figure, it costs patients $43 in lost time for each medical visit — more than the average out-of-pocket cost for the care itself, which is about $32.
“This is something we all experience,” said Dr. Ateev Mehrotra, associate professor of health care policy and medicine at Harvard Medical School and the study’s lead author. But his work, Mehrotra said, is the first to put a price on the time involved in doctor’s visits.
All told, his team estimated that Americans spent 1.1 billion hours per year obtaining such care for themselves or others — time the researchers valued at $52 billion.
Discussions of health care costs usually focus on money paid to doctors and hospitals, Mehrotra said. “Very rarely or almost never do we say, ‘Hey, how much time is this taking on [the] patient’s side?’ ”
The burden is greatest on the disadvantaged, according to a brief article published Monday in JAMA Internal Medicine. Blacks, Hispanics, and unemployed people spend 25 percent to 28 percent longer seeking health care, mostly because of longer waiting times in the clinic.
“This study is confirming what we always knew, which is that people who are marginalized in society have a harder time accessing health services,” said Dr. Ronald M. Epstein, director of the Center for Communication and Disparities Research at the University of Rochester Medical Center, who was not involved in this research. Lower-income people often have to rely on public transit, struggle to find child care, and risk losing their jobs if a doctor’s visit takes too long, he said.
Dr. Adrienne Boissy, a specialist in patients’ experiences with health care, said she was not surprised — but was still distressed — when she read Mehrotra’s findings. “It’s heartbreaking to know how much time people are spending just trying to get into our doors,” said Boissy, who is chief experience officer at the Cleveland Clinic. “Your care can be terrific. If the patient can’t access it, it doesn’t matter.”
As a working mother with two young children, Boissy said that taking her kids to the doctor can be “like a magical feat” involving shifting the schedules of multiple people. Yet physicians, she said, “don’t even talk about it. Patients show up and we see them. We could ask, ‘What went into your seeing me today?’ ”
The burdens on patients can be eased, she said, through innovations such as same-day scheduling — in which all patients can get an appointment on the day they call — and using technology to conduct “virtual visits.” The Cleveland Clinic, for example, offers instantaneous consultations with a medical professional via phone, computer, or tablet. “People should be able to access us anytime, anywhere,” Boissy said.
Dr. Dennis M. Dimitri, president of the Massachusetts Medical Society, also wasn’t surprised by Mehrotra’s work. “This is an issue that physicians are familiar with, and concerned about, and doing their darnedest to fix,” he said.
Doctors can improve their workflow, but in some regions primary-care physicians are scarce and might simply have too many patients who need them, Dimitri said.
Additionally, said Wanda D. Filer, president of the American Academy of Family Physicians, a doctor’s day is unpredictable, and the problems that come in the door can’t always be handled in the scheduled 15- to 20-minute time slot. When a patient arrives complaining of fatigue and ends up revealing suicidal thoughts, she said, “I can’t just jump up and go to the next patient.”
Mehrotra said he was inspired to do the study by an experience he had as a patient. He arrived for an appointment with an orthopedic surgeon and found that 35 people had all been scheduled to show up at 8 a.m. The doctor expected everyone to wait until he could get to them.
“It’s an extreme example,” he said. But it shows how “we often make things more suitable for us as physicians” instead of valuing the patient’s time.
The authors suggest improving office efficiency; placing clinics in schools, community centers, and workplaces; and making better use of technology such as telemedicine. Doctors should take travel time into account when asking patients to come in for a visit, Mehrotra said; sometimes a matter can be handled with a phone call or e-mail.
Mehrotra’s team drew their results from three national surveys, chiefly the 2003-2010 American Time Use Survey, administered by the Bureau of Labor Statistics. The survey asked randomly selected respondents to recall what they did from 4 a.m. on the previous day until 4 a.m. on the day of the survey. The researchers examined the experiences of the 3,927 respondents who had sought medical care during that 24-hour period. The survey did not reveal whether the visits were to specialists or primary care doctors.
The researchers published two separate articles based on this work, the first appearing in the August edition of the American Journal of Managed Care, followed by Monday’s “research letter” on disparities in JAMA Internal Medicine.
The work was funded by the California HealthCare Foundation, the US Health Resources and Services Administration, the US Agency for Healthcare Research and Quality, and the National Institutes of Health.
The Harvard medical video below illustrates the recent study: