Wednesday, 15 February 2012


The opportunity costs of doctors' time is higher than that of most of their patients, so it makes sense that there's typically a small backlog of patients in the waiting room. If somebody finishes early, the next in line jumps in and the doctor isn't left waiting around. Because of our willingness to wait around a bit, we all wind up paying a bit less for the doctoring services.

That's enough to explain short queues in the waiting room. But it isn't enough to explain half-hour waits. I'd wondered why the appointment scheduling software doctors use doesn't automatically send out update notifications to patients via SMS or email when backlogs hit the 20-minute mark; @GraemeEdgeler figured the cost of the system could never be recouped by most doctors.

That might be true in New Zealand, and especially for services provided under contract to the public health system. But the system is up and running in the States: MedWaitTime charges doctors $50/month, or $300/month for a full medical facility, for patient updating services. There's an iPhone app for patients. The doctor's secretary spends 30 seconds updating the doctor's status from Green to Yellow (moderate wait) or Red (long wait). Patients check the iPhone app before heading in. It's apparently not yet integrated directly into the doctors' appointment scheduling software, but I really can't see how that's all that hard; it's surprising that the folks who make the appointment and patient management software haven't already integrated in this kind of feature. The gains to patients avoiding long queues has to exceed $300/month for even a single doctor, never mind a practice.

It'll likely come to New Zealand. Eventually. After it's pervasive in the American system and enough ex-pats complain about not having it here.


  1. The flip side of the coin is that a queue also has an aggregate salary/wage cost that may exceed that of the doctor, and every patient is likely to have some sort of timetable.

    I well remember a session on this sort of thing at a course back in the 80s. The facilitator asked how many people in the room considered the doctor to be a friend.. virtually every hand went up. The next question was how many present had had a meal at the doctor's house.. no hands went up.

    The point was this is purely a business relationship and the doctor had as much responsibility to organise his time properly so that every client was seen at close to the appointed time.

    The next time I had to wait 10 minutes I went up to the counter, explained my time was valuable to and walked out.. a couple of minutes later I had the satisfaction of seeing the doc rush into the car park looking for me. It doesn't hurt to occasionally remind the docs of the flip side.


    1. There are reports of US folk who have billed their doctors for bad waiting room delays, and who have been paid.

      The nonsense is more understandable with slack incentives in the NZ public system; that's why I expect the US to bear the fixed costs of sorting out the scheduling software.

  2. What I don't get is even if you have a morning appointment, say 9:30, they still are behind.

    NZ GPS aren't really operating privately, they receive a subsidy per patient from the government and supply of doctors is constrained.

    There are probably many ailments that you don't really need to visit a doctor for, but you do anyway for peace of mind.
    The market doesn't provide really allow for provision of these solutions, overall there is little incentive for innovation, at least on the level of the individual clinic.
    That isn't to say there is no innovation occuring.


    1. Looks cool, but while it talks about text reminders of upcoming appointments, can't easily tell if it warns patients of delays...