Why do doctors overbook?

I swear, every time I go a doctor or specialist there's a huge line of people waiting. Now that's perfectly understandable, but I thought the whole use of an appointment system was to prevent that?

Sometimes you want to make an appointment and have to wait up to 3 months to get a spot, only to finally arrive and see 10 people seated ahead of the time slot which was supposed to be reserved for you.

I just don't get it. If it takes 20 minutes on average for the doc to see a patient, then the first appointment should be at 9am, second one at 9.20, then at 9.40, 10am, 10.20 and so on. But if I arrive at a designated appointment and there are crowds of people ahead of me, they've obviously been careless in their bookings management by accepting multiple people at overlapping time slots.

I don't meant to rant but come on. In 2019 this is just rude and unprofessional. I respect doctors and know plenty who take their reputation and patient care beyond what's required of the law, I just wish they were committed to being that professional with their time management.

Comments

  • +13

    It's because some people take 2mins appointments, and then you have the person that takes 45mins. It's a snowball effect

    • +2

      Yea I get that, but that's the point of average appointment times isn't it? 20 minutes per appointment on average seems pretty reasonable. Definitely enough to make up for the time wasted in long appointments. If its not, doctors should realize over time that they need to increase the average appointment time buffer to 30 or even 40 mins. That means if a patient is booked at 9am, there should be no appointments accepted before 9.40am.

      • I work in this industry. That's how it's supposed to work but it doesn't. Some doctors are notoriously slow, arrive late, appointments go over time or even the practice itself is poorly managed. Happens nearly everywhere unfortunately. Doctors generally won't kick someone out after the 10 minute appointment time has expired.

        • Sounds like my local medical centre. If I book the first appointment of the day then I have to wait for 3 people in front of me, after of course the doctor arriving late, doing his morning dump and finishing his cup of tea.

      • How would they make any money? Medicare pays them like $37 per appointment, if you're booking 30 min appointments that's $75 an hour. Most appointments shouldn't take more than 10 minutes

        • +1

          $37 Is for a 10 minute appointment. Specialist appointments are longer but they are not $37 either.

      • Any good business should have this data already with adjustments for day of the week/months/seasons etc, however doctors have enough demand and low supply that they aren't forced to do anything on the customer service side to improve customer retention.

  • +3

    Imagine if the person booked before you had a major issue that takes >20 mins, like a mental health crisis with high risk of suicide.
    Would the doctor cut their appointment before fully dealing with this just to make sure they are running on time?

    • +3

      Not sure if my Podiatrist would know how to deal with that….

      • +2

        You may be surprised, as your podiatrist is a professional and deals with a variety of people every day.
        What would you do if someone approached you asking for help as they were in crisis?

        We should all be trained in mental illness first aid, along with physical injury first aid.

      • Have friends who're doctors. You'd be surprised. People tend to open up to doctors, and especially for embarrassing stuff, they might let slip in casual conversation with a Dr, any Dr, instead of actually making an appt specifically for that issue.

  • +2

    $_$

    • +1

      This is my reasoning too. More appointments per day = more money per day.

      I don't have an issue with people maximising their profits, especially doctors, but when it comes at the cost of disregarding other people it's an issue that needs to be addressed. There should be tighter regulations around this. I can't imagine packing crowds of sick people into a small office is in line with safety or health regulations surely?

      • Because sometimes it's not about the money

        You start off the day fully booked
        then 5 patients ring in and say they're really sick and need to see a doctor
        What do you do? Ignore someone sick and tell them to go somewhere else?

        The reason some doctors see more patients is because they have to.

        It's called Responsibility mate

        Do you think a doctor really wants to work on Saturdays and Sundays and not see their family?

      • You realise that Dr's taking LESS appointments would mean that LESS people are seen per day right? The people who want to make appts don't suddenly have their issues disappear because they couldn't get an appt.

  • +1

    Imagine if the person in the waiting room was sick from work that day and required prescription medicine and/or medical certificates. Do you expect them to wait up to 3 months too?

  • +1

    Because they can. Their time is worth more than most.

    I don't like it either BTW

    FYI I find usually if you take the first appointment in the morning, they see you on time or closer to it…

  • +6

    also because people book appts and then don't show up.

  • +3

    Isn't this quite normal for countries that bulk-bill. I see it everywhere. You either pay and get the time you deserve or you get a tax payer funded service. On one end of the spectrum you will have private companies pushing the limits of BB ie. bulk volume. on the other hand you niche services which provide a better and adequate service for a fee ie. GAP-payment.

    When the government runs out of money Hospitals fill up and people are more willing to pay for Private health, when the government coffers are busting , everyone doesn't want to pay? Bit of a see-saw action happening.

    I have a feeling we are going down the UK route of providing fully BB services for health for the foreseeable future at the expense of quality of care. (disclaimer i work in healthcare)

    • +1

      Hi, most of my experiences like described have been with specialists where I have actually paid for an allocated time slot to be reserved for me weeks or months ahead of time.

      • While many variables are at play. For specialists running behind. Its usually because they can.
        It's a lack of competition due to a few things. But mostly protectionists policies.

        • +1

          I see two specialists, neurologist & epileptologist, regularly as a private patient and I always try and make the appointment for their first of the day. For the neuro I'm always the first in the waiting room, only to see him rock up 20 minutes after my appointment time and for him to call me in 10 minutes later. I think he banks on people being late. Irritates me to no end. The other specialist is normally on time.

          For GP's it's people that take a lot longer than the appointment time. My GP you can book a regular or long appointment but he's almost always running late when I can only get an appointment in the afternoon. First thing in the morning and he's normally on time. My wife asked him about how sometimes the wait time is so long and his response was people not showing up or being very late to appointment and still expecting to be seen or people having really long appointments with multiple concerns that go far over the allotted time. His staff get to know these people who always take a long time so they can adjust the schedule but it's not exact.

          The neurosurgeon specialist I see at the public hospital I've had to wait over two hours past my appointment time at the neuro clinic but he can be called away for an emergency consult or surgery taking longer than expected etc.

          • @Rockets84: Specialists are busy because it takes a lot of money, training, and just innate ability to become one. So there are never enough. And the proof is in the pudding - if you could find a better one, you would have. But you can't - because there aren't enough.

  • +2

    Old people

  • +4

    I don't meant to rant but come on. In 2019 this is just rude and unprofessional.

    I agree wholeheartedly. Just this week I had an appointment time, turned up and was told it was running about 45 minutes late. I said I'll go for a coffee. Came back about 35 minutes later and asked how it was going. Got told the doctor was in with one patient and there were still 2 ahead of me.

    I appreciate "sh!t happens", but I've got commitments I've made that can't just be put on hold indefinitely. If I ran my business in this way, I'd be out of business.

  • +6

    Because some patients run late, holding the rest of the line. Some come in because "I think I've got the cough" and we're confronted with late stage lung cancer.

    We simply don't know what the hell we're gonna see.

    I had two patients with late stage SCC who came in for unrelated complaints, back to back. It very obviously put them in the 6 months to live category. I ran 3 hours late.

    (I did do the whole, "Stacey, clear my afternoon" thing.)

    • +3

      I went to my GP thinking I had an ear infection. Turns out I had a brain tumour the size of an orange. Needless to say my poor GP ran well over that day because I actually saw him twice. First time when he really thought I needed an urgent CT scan which he booked himself and after the CT scan with the results back at his office where I was put to the head of the queue.

      • Make sure you buy the GP a basket of oranges.

        Sorry to hear about your condition but there's always opportunity for humour.

        • Non malignant meningioma. Successfully removed removed a week later, a little damage to the language centre and I'm now a epileptic. Not too bad all things considered. That was 5 years ago. My wife sent him a very nice present.

          I love a good tumour joke, especially Kindergarten Cop "It's not a tumour" memes.

          • @Rockets84: Glad to hear it all worked out. Orange sized anything is bad and considering this one was the squishy part of the head, I think they did well.

  • It comes down to good policies, discipline and management of the practice.

    1) Short vs long appointments - the receptionist should screen patients when they call to book, and book appointment lengths that suit the nature of their needs. i.e. just need a script = 5 mins, brain surgery = 45 mins :)

    2) Walk ins can often screw the system - i.e. they think oooo 7 mins till my next appointment, let's fit in a walk in… and the walk in takes 30 mins and now everyone has been pushed back.

    3) Allowing buffer time - in between each appointment, which the doctor can take time to update patient records, follow up on stuff, get ready for the next patient, and also help alleviate appointments that run over.

    4) Set times for walk-ins/appointments - e.g Doctor A takes appointments in the morning and walk-ins in the afternoon, and Doctor B handles walk-ins in the morning and appointments in the afternoon. That way both appointments and walk-ins can be accommodated for.

    Of course in the real world practice managers want to maximise their revenue so a lot of these go by the wayside.

    • 1) Short vs long appointments

      This! My doctor allows online bookings but then lists a bunch of things that may go over the allocated time and says “if it’s for this just call and ask for an extended booking”

      Also for me I just book the earliest appointment in the day. Though this didn’t work well recently when I had an appt somewhere at 9am and they didn’t rock up to work until 9:05 then had to spend 10 mins getting ready 🤦🏼‍♀️

  • +4

    I agree that it is frustrating, but know people who are GPs who get frustrated by the other side of the equation. If the appointments are more spaced out it has 2 impacts:

    • less ability for the doctor to make money (which I consider them to be entitled to, given the effort and duration they have had to put into their education and training to get the job
    • less appointments available, which would be a disaster - it is hard enough as it is to get a same day appointment when you need one

    There are lots of articles on how this happens and I consider it to generally not be driven by greed, but by the variability in cases and the care typically required. For example, read this as just a basic example of what a GP's day can look like: https://www.kevinmd.com/blog/2015/02/know-doctor-late-read.h...

    The alternative is instead of a doctor seeing 30-32 patients a day (assuming 15 minute appointments, existence of not of a scheduled a lunch break). If it was changed to 20 minute appointments, that drops to 24 a day and 8 people missed out. The inconvenience of waiting is reduced, but the convenience of getting an appointment drops as well.

    It's a tough situation all round - you're scheduling based on averages against a highly time variable activity. No one has yet come up with a simple solution for this - you need to know the problem to know how long it will take to treat, which you probably won't know until the patient is in the appointment.

    • I have been reading some of the stuff on that website - even if half of it is true who would ever want to be a doctor?

  • +1

    My GP clinic send a test the day ahead to remind me of my appointment.
    So hard could it be to send a text shortly before your appointment to let you know to expect a delay.

    • +1

      There are softwares that do that but it is heavily reliant on the receptionist actually checking in patient status, ie. Present, in surgery, check out.

      If even the slightest bit is not done properly, patients can receive all sorts of text like "2 hour delay" when there's no delay. Of course, now the patient rocks up 2 hours late and we do have a mess for a schedule.

      There's no ideal solution I'm afraid. I've tried the whole automated status text thing and it didn't do much most of the time. When it didn't work properly, it is catastrophic. Poor trade off.

    • +1

      My GP clinic send a test the day ahead to remind me of my appointment.

      That's because it's automated and in my experience also prone to issues, like the software running out of SMS credits ;)

  • +1

    Damn it Jim, I'm a doctor not a booking agency.

  • +3

    don't forget the doc is probably as thrilled as you are that he or she is running late - skip lunch or finish late or sacrifice something else.

    I don't like it, but I understand it. A GP can't get half way through a serious consult and just say 'sorry, time is up, make another appointment' - I have been to a GP that did that to me and I will NEVER go back to that doctor.
    One other reason is that sometimes emergencies happen. I know I caused one or two in my time when I've stumbled into a random GP surgery experiencing an asthma attack. The GP essentially stops everything to deal with the emergency.

    We have to stop thinking of the health system as something that can be regulated and managed right down to the minute, the fact that is is all based around dealing with the chaos that is humanity means it will never be perfect.

    • +1

      Honestly, GP consults shouldn't be covered by Medicare. Subsidised sure, but not fully covered. I'd be more than happy to pay the $38 per appointment out of my pocket. It's a small price for your health and would weed out the people who just rock up for useless reasons. Heck some people are so tight they would probably avoid taking days off work because they don't want to waste the money paying for a GP and getting a sick leave note. Everyone wins.

      Hospitals could probably be the same. Don't charge for something that ends up being an actual emergency or excruciatingly unbearable pain (ie someone breaks an arm and needs painkillers), while this walking in at 2am because their baby coughed or bumped their head should pay for the luxury of having a wasted everyone's time. Medicare is unsustainable in it's current state anyway.

      • +2

        Some people don't have 38 bucks for a gp appointment. You do. I do. Some don't.

        If you didn't, you'd have very different feelings about doctors being bulk billed.

        • Well duh. If I was poor, of course I'd want food to be free. That's not the point. Capitalism requires people to be at the bottom and those who are can and should receive a helping hand on a case by case basis, but the system should not be designed around them. It should be designed around the majority who actually fund it.

          If you can't afford $38 for a doctor's appointment, a medical condition is the least of your worries.

          • +1

            @SlavOz: Sounding more ignorant rather than less.

            Yeah if you don't have 38 bucks you're poor, but your medical condition could indeed be the most of your worries.

            Case in point, old people living on the pension. They don't have 38 bucks to get a prescription for a long standing condition.

            Capitalism requiring a base of hard working poor people to generate profit for business owners doesn't preclude government funded healthcare. Unless you're so hardline against socialist policies that you'd complain about the lack of free market forces in funding the defence force.

            Lol at "everybody wins" - yeah I definitely want sick people rocking up to work because they can't afford a doctor. Please make my food while sick with the flu. Everybody wins.

            • @ozbjunkie: So someone can't afford $38 for an appointment, yet they probably have a job? Not making much sense here mate. If you have a job in Australia, you can afford the odd $38 fee to save your life. Simple as that. The only people who can't are those at the bottom of the bottom who can't even qualify for Centrelink, in which case I can't imagine they'd be able to see a doctor anyway without a phone number, address, Medicare number etc.

              I have no problem with government assistance footing the bill for the odd person who can't pay, but to imply the system would fall apart because millions of hard-working Aussies wouldn't have $38 to spare is insulting.

              • +1

                @SlavOz: Insulting, yeah that's a weird way to appraise claims and arguments. Valid, invalid, sound, unsound, factually correct or incorrect, any of those would be fine. Insulting is a bit weird though.

                When's the last time you made minimum wage and lived independently in a major city, perhaps while studying full time? Nah, I don't want a society where people can't see a gp for free. You're allowed to have a different opinion, but please don't be insulted.

                • @ozbjunkie: It's insulting because you're misrepresenting the Aussie population and suggesting we pour resources into something which is pretty much unsustainable. If you can't stand the thought of a society without free doctors, you don't want to know what it's like when shit really hits the fan.

                  To answer your question, I've never lived independently in a major city on minimum wage while also studying. And I'm extremely proud of that. The people that do are the world's most financially irresponsible person. Living in a major city is not a human right and if you choose to do so without the financial capacity you're setting yourself up to fail and have nobody else to blame but yourself.

                  Like I said, we can't build the system around silly people.

                  • +1

                    @SlavOz: If you've never lived independently in a major city, while also studying, I guess I can forgive your hyperbolic claim that such people are the world's most financially irresponsible people. You just don't seem to know that others have very different lives from you, and there are certain examples of people who have little choice but to live independently while studying and of course those people need a job, and they don't have many skills, so it often ends up a minimum wage job.

                    But let's not get bogged down in minutiae, there are many people that can't afford 38 bucks for a gp. How about single mothers of multiple children, living on Centrelink. (Oh and please, before you say these people are now the worst in the world, please consider that some people in this position are not there by their own fault).

                    Basically, I think it's great for you that you wouldn't have to worry if you had to pay for a gp. But you could one day be in a position where it was a worry, and while I hope that never happens, it is possible, and I think you'd change your tune if your life circumstances were different.

                    • @ozbjunkie: Studying and living in a major city aren't human rights dude. They're luxuries. If one chooses to do them without the financial capacity to afford it, it's their fault if they end up broke.

                      Like I said, I'd be happy to have special allowances for people under a certain threshold who don't have to pay the $38. We already have this for a lot of other things. But the majority of people in Australia can reasonably afford $38 every 2 or 3 months to see a doctor. The ones who can't would be a tiny minority. We shouldn't design the system around them though. Giving everyone a free pass just because an tiny part of the population needs it is just financially irresponsible.

      • Medicare keeps the cost of seeing a GP low
        Without medicare the cost of a GP will like be at least $60 per 15mins

        Medicare bulk billing has artificially kept the cost of GP visits low for the benefit of the people

  • +1

    Some schedule to account for a percentage of DNAs

  • Ask Doctor who 😀

    • *Whom

  • +2

    My wife has taken to calling the practice about 10 mins + travel time before the appointment to see if the GP is running on time (or more accurately, how late they are running that day).

  • Doctors must work with appointments, walk-ins, urgent cases and longer appointments than scheduled.
    So they dont over-book at all.
    They are just trying to provide the best service possible to everyone

  • If doctors are to be hauled over the coals for inefficient management of their appointments, then let's be fair and also point at all the tradies and servicepeople (eg Telstra/Optus) who want you to be at home during a 6-hour window of time and then turn up late or not at all, and then ask to reschedule AFTER you've already taken a day off work to be there waiting for them to turn up.

  • If it takes 20 minutes on average for the doc to see a patient

    Law of averages mean that even if this bears out, the last patient will get out on time, but it'll still be a crapshoot any time during the day.

    It's medicine. Tends to lend itself to unexpected situations, emergencies, things that can't be put off, etc.

  • I find that some Bulk billing GP are very unprofessional and and only treat you like a dollar sign that they can get paid from Medicare.

    They need to be reported if you come across one that doesn't listen to you describing your health concerns and prescribing correct treatment.

    • I find that some Bulk billing GP are very unprofessional and and only treat you like a dollar sign that they can get paid from Medicare.

      They need to be reported if you come across one that doesn't listen to you describing your health concerns and prescribing correct treatment.

      Yes, a great idea. The solution to not having enough GPs and GPs overbooking patients is to reduce the number of GPs and the appointments they take.

    • Why not. Under the law, robbing a person of their time should be equal to robbing them of their money. It would be illegal for a corporation to tell you something will cost $20 and it ends up costing $50 instead. It should be illegal to tell them it will take 20 minutes if it takes an hour and a half.

  • Medicine is unpredictable, emergencies happen and sometimes complications occur (beyond anyone’s control) mid procedure that require more time.

    On the flip side, some patients will arrive late to their appointment and ask to still be seen because of the urgency of their medical problem.

  • Specialists are doctors too! I think you're referring to GPs.
    The ones who double book are usually bulk billing. Be glad you don't have to pay a cent from your own pocket to see them.

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