Once upon arriving tardy when in high school, the assistant principal once told me it was “better never than late.” I found out what he really meant when serving in the military; being late might really mean nevermore when the real deal comes. So, being punctual, even to a fault, has been burned into my character.
When I make an appointment to meet a client, or prospective client, in my office. I try my very best to not keep them waiting past the appointed time. Sometimes an urgent phone call comes that delays my attendance a few minutes. When that happens, I usually apologize to the client by (partially) jokingly saying that “I don’t want you to think you have come to a doctor’s office.” (Disclaimer: I never have to wait more than a few minutes past an appointment time in my regular doc’s office and I don’t think I get special treatment. I seem to be in a minority, however.) It’s bound to get worse — for everybody. Read on.
Why the Doctor Can’t See You
August 16, 2012
Here is the problem: The health care system can’t possibly deliver on the huge increase in demand for primary care services — there aren’t enough doctors.
When demand exceeds supply in a normal market, the price rises until it reaches a market-clearing level. But in this country, as in other developed nations, Americans do not primarily pay for care with their own money. They pay with time. As a result, the time it takes to get a doctor’s appointment will rise.
- For example, the average wait to see a new family doctor in this country is just under three weeks, according to a 2009 survey by medical consultancy Merritt Hawkins.
- But in Boston, Mass. — which enacted a law under Gov. Mitt Romney that established near-universal coverage — the wait is about two months.
When demand exceeds supply, doctors have a great deal of flexibility about who they see and when they see them. Not surprisingly, they tend to see those patients first who pay the highest fees, such as those paying out-of-pocket for services like Botox.
Patients in plans that pay below-market prices (such as Medicare, Medicaid and likely those acquired in the ACA’s health insurance exchanges) will likely wait longest, as a result. Their wait will only become longer as more and more Americans turn to concierge medicine for care. Concierge medicine basically means that patients pay doctors to be their agents, rather than the agents of third-party-payers such as insurance companies or government bureaucracies.
Here is the problem.
- A typical primary care physician has about 2,500 patients, but when he opens a concierge practice, he’ll typically take only about 500 patients with him.
- The 2,000 patients left behind now must find another physician.
- So in general, as concierge care grows, the strain on the rest of the system will become greater.
Goodman predicts that in the next several years concierge medicine will grow rapidly, and every senior who can afford one will have a concierge doctor. A lot of non-seniors will as well. We will quickly evolve into a two-tiered health care system, with those who can afford it getting more care and better care.