Among my first concerns when scheduling a visit to a doctor — whether for me or one of my children — is the length of the visit, including travel and waiting time. How much of my day will it take? In my experience, end-to-end, most doctor visits take at least two hours. To me, that time away from work or other more enjoyable activities is a massive cost, and one we rarely discuss.
But two papers, published last year by Kristin Ray and colleagues do discuss it. The findings of both papers are entertainingly summarized in this video:
The first paper, published in the American Journal of Managed Care quantifies patients' burden of doctor visits in time and opportunity cost (time monetized by wage rate). Using data from the 2003-2010 American Time Use Survey (ATUS) and the 2003-2010 National Ambulatory Medical Care Survey (NAMCS), the authors found that the average physician visit takes just over two hours.
Of those two hours or so, just 20 minutes (or 17% of the time) is spent with the doctor. The rest is travel time (37 minutes, on average) and time in the clinic not seeing the doctor (64 minutes, on average). That non-doctor clinic time is a combination of all other activities at the clinic, which includes waiting, consulting with nurses, paying one's bill, or making the next appointment. I suspect that most of this time is spent waiting, though.
According to the study, people accompanying others — whether children or other adults — spent even more time on a typical doctor visit. Average time with the doctor was about the same as above (approximately 20 minutes), but those accompanying a child spent 110 minutes beyond that traveling and waiting. Those accompanying another adult spent 118 minutes on those activities. This makes sense. When I take my kid to the pediatrician, in addition to the time it'd take me to get there and wait, I also have to get my kid out of and back to school (if it's a school day). That takes time.
Monetized by wages (as had been done in prior work), the opportunity cost of a physician visit is about $43, according to the study. That's the monetary value of time lost to see a doctor, only a small fraction of which is, well, actually seeing the doctor. This figure is higher than typical out-of-pocket costs for physician visits, $32, though it is well below the $279 total, average cost, most of which is paid by insurers.
Put anther way, to see a doctor, we spend more with our time than with our out-of-pocket dollars. Across the entire US population, we spend 2.4 billion hours annually seeing doctors — most of is spent not seeing them — at an opportunity cots of over $52 billion. These figures are equivalent to the total, annual working time and income of 1.2 million people. The time cost of physician visits adds about 15 cents to every dollar spent on them (including insurance payments).
A second paper, by the same authors and published in JAMA Internal Medicine, characterizes disparities in the time cost of care. According to the study, time spent in the clinic during a physician visit and travel time is longer for racial/ethnic minorities and unemployed individuals.
For example, clinic time [which includes time spent in the clinic, including with the doctor, with nurses, completing paperwork, and waiting] for non-Hispanic whites was 80 minutes vs 105 minutes for Hispanic individuals (P < .001). [...] [T]ravel time for non-Hispanic whites was 36 minutes vs 45 minutes for non-Hispanic blacks (P < .001).
But, these groups spent no more time face-to-face with a physician. All told, total time for visits is about 25% longer for racial/ethnic minorities and unemployed individuals. The authors emphasized that the difference was driven by clinic time — more waiting, time with nurses, or doing paperwork for minorities and the unemployed.
It's possible that, in some cases, we could cut down the time required for office visits. Options include improvements in scheduling to reduce waiting time, placing clinics in schools, at workplaces and in or adjacent to stores people visit anyway (retail clinics) to reduce travel time, and greater use of telemedicine, when appropriate. I will return to the last of these (telemedicine) in a subsequent post.
Austin B. Frakt, PhD, is a health economist with the Department of Veterans Affairs, an Associate Professor at Boston University’s School of Medicine and School of Public Health, and a Visiting Associate Professor with the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health. He blogs about health economics and policy at The Incidental Economist and tweets at @afrakt. The views expressed in this post are that of the author and do not necessarily reflect the position of the Department of Veterans Affairs, Boston University, or Harvard University.