By Marisha Burden
We’ve all been there: You wait 45 minutes in the exam room when the doctor finally walks in.
They seem rushed. A few questions, a quick exam, a glance at the clock and then a rapid-fire plan with little time for discussion – and you leave feeling unheard, hurried and frustrated.
And what if you’re hospitalized? You may face a similar experience.
More than half of U.S. adults say their doctors have ignored or dismissed their concerns, or not taken their symptoms seriously, according to a December 2022 national poll.
It’s easy to blame the doctor. But the reality is, most doctors would like to sit down and have an in-depth conversation with patients and their families. Instead, your unpleasant visit may be the result of productivity pressures and administrative burdens, often shaped by health care systems, payment models and policy decisions that influence how care is delivered.
Patients are increasingly experiencing what’s known as administrative harm – those unintended but very real consequences arising from administrative decisions, made far upstream, that directly influence how doctors practice. Ultimately, these types of interactions affect the care patients receive and their outcomes.
As a doctor and researcher who specializes in business and health care delivery, I’ve studied how organizational decisions have ripple effects, shaping patients’ relationships with their doctor and the quality of care they receive. Patients may be unaware of these upstream administrative decisions, but they affect everything from time allotted for an appointment to the number of patients the doctor has to see and whether a visit is covered by insurance.
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A look behind the scenes
Increasingly, health care organizations and physician groups face intense financial pressures. Many doctors can no longer sustain their private practice due to declining reimbursements, rising costs and increasing administrative burdens; instead, they’ve become employees of larger health care systems. In some cases, their practices have been acquired by private equity groups.
With this shift, doctors have less control over their workloads and the time they get with their patients. More and more, payment models fail to cover the true cost of care. The default solution is often for doctors to see more patients with less time for each, and to squeeze in additional work after hours.
But that approach comes with costs, among them the time needed to build meaningful connections with patients. That negative, impolite tone you may have experienced might be because the doctor has many patients waiting and a full evening ahead just to catch up on writing visit notes, reviewing medical records and completing other required documentation. During the work day, they’re often fielding over 100 messages and alerts daily, including referrals and coordinating care, all while trying to focus on the patient in front of them.
But the consequences go beyond their bedside manner. Research makes clear that doctors’ performance and the quality of care patients receive are affected by their workload. A similar pattern is true with nurses: Their higher workloads are associated with higher death rates among hospitalized patients.
Suppose you’re hospitalized for pneumonia, but because your doctor is caring for too many patients, your hospital stay is longer, which increases your risks of infection, muscle loss and other adverse outcomes. In the doctor’s office, a rushed visit can mean delayed or missed diagnoses and even prescription errors.
About half of U.S. doctors report feelings of burnout, and about one-third are considering leaving their current job, with 60% of those likely to leave clinical practice entirely.
Long work hours also brings higher risks of heart disease, stroke and other health problems for health care professionals. In the U.S., 40% of doctors work 55 hours per week or more, compared with less than 10% of workers in other fields.
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A better way
The administrative harms stemming from upstream decisions are not inevitable. In large part, they are preventable. Overhauling the health care system may seem daunting, but patients and doctors are not powerless.
Patients and their families must advocate for themselves. Ask questions and be direct. This phrase: “I am still really worried about … ” will quickly get your doctor’s attention. If your visit seems rushed, share it with patient representatives or through patient surveys. These insights help administrative leaders recognize when systems are falling short.
Doctors and care teams should not normalize unsustainable work conditions. Health systems need structured, transparent mechanisms that make it easy and safe for doctors and care team members to report when workloads, staffing or administrative decisions may be harming patients.
Even more powerful is when patients and their doctors speak up together. Collective voices can drive meaningful change – such as lobbying for adequate time, staffing or policies to support high-quality, patient-centered care. It is also important for administrative leaders and policymakers to take responsibility for how decisions affect both patients and the care team.
More research is needed to define what safe, realistic work standards look like and how care teams should be structured. For example, when does it make sense for a doctor to provide care, or a physician assistant or nurse practitioner? At the same time, health systems have the opportunity to think creatively about new care models that address clinician shortages.
But research shows that the medical profession can’t afford to wait for perfect data to act on what’s already clear. Overworked and understaffed teams hurt both patients and their doctors.
Yet when doctors do have enough time, the interactions feel different – warmer, more patient and more attentive. And as research shows, patient outcomes improve as well.
Marisha Burden is Professor of Medicine–Hospital Medicine at the University of Colorado Anschutz Medical Campus.
JimboXYZ says
Apple a day keeps the doctor away applies ? Honestly, I’d rather never have to be in that moment where the sit down has to happen. Then again their compensation should reflect that, just as it should the execs of the health insurance company. Most docs are too busy pumping the healthcare system for this article to make any sense. Modern medicine is what it is, prolonging what they can’t ever make right anyway. That cavity filled by the dentist. Think of that as the rust bucket car that’s been bondo-ed back together. It’s never going to be a new car ever again. The tooth was filled, it’s never going to ever be what it was prior to the cavity. And that filling ? Yeah the inflation on that material, is it real or just another gouge like the premium for the insurance ? I mean,the entire article is about the business model & economics of it all. So there you have it, Doc has no time to sit for very long with a bedside manner that most folks expect from an era long past. You’re just a Heathcare premium & capitation payment (PMPM) to the healthcare & insurance industry as a whole, 350 million USA population. And if you have more money for the best care, that one is going to get the attention for as long as the payment is there.
DaleL says
Since the typical amount of time with a doctor is short, it helps for the patient to help their doctor. I always bring a typed list of my medications and my current pharmacy. I have another list of concerns and/or symptoms. I make sure to put, in writing, what concerns me the most. I do not trust my nearly 80 year old mind to remember all that I want to say. There are three people in life you should never lie to and they should never lie to you. They are your spouse, your lawyer, and your doctor.
Doctors are people. It is natural for doctors to relate better to patients who are as pleasant, clean, and focused as possible. Health and healthcare is a partnership between the patient and doctor. It is unfair to put most of the burden on doctors and health care system. Even modern medicine can only do so much.
Finally, take all nutrition advice with a heaping dose of skepticism, get off the couch, get outside, walk, garden, whatever.
Laurel says
My husband and I feel very fortunate to be patients of Mayo Clinic, and will continue to be so. It has changed from where we started going there, about 15 or so years ago, but it is still high quality care. I still have the same doctor, who knows me well, though hubby’s doctor, of the same amount of years, is moving and will be replaced. We both have a Care Team, which keeps up with us, and notifies us of follow ups and Medicare visits.
My one complaint is, they moved to an automated phone answering system. Ugh!
For earlier years, we would get Itineraries, that grouped all our tests and doctors’ appointments within the same day. Now, that isn’t so necessary, but if we see a doctor, who feels we need a test, we can often get that test the same day, and the doctor has the results in his/her hands, and we see it online in the portal, within minutes. All information is centralized, and available to all doctors and physician assistants.
There has only been a few times, in all the years, that we had to wait more than 0-15 minutes to be called in. If they are running behind, the front desk attendant will ask if anyone has waited for 15 minutes or more. That’s rare. You have a check in time 15 minutes before your appointment, and often are called in before the appointment time. Their appointment system is different than other places. There is a window for making appointments, like say the dermatologist’s annual checkup, and you cannot make an appointment outside that window, unless you have something that demands attention right away. So, only a set amount of people can get the appointment within that window for non-essential visits. That way, they don’t cram people in. If you need to see them today, or tomorrow, and it’s not an emergency, but there is some concern, you will see the Physician’s Assistant.
It’s been really rare to feel pushed. The doctor will sit with you as long as you have another question. If you don’t, and the doctor is satisfied, the session is over. New scheduling, such as for tests, will happen right then.
The clinic in Jacksonville looks like a luxury hotel! It is comfortable, beautifully decorated, and often has a singer or piano player volunteering. It is quiet, spacious, and no children are tolerated to run around and scream. It is relaxed, and you don’t feel as if you are in a hospital. We feel very secure with the staff, which is very friendly. They do all they can to make you feel secure and comfortable.
Mayo Clinic is a not for profit system. The staff, including the doctors, are on salary. To top it off, it’s the number one hospital in the U.S.!
BillC says
The term “Capitation” explains a lot.
An example of capitation is an HMO that negotiates a fee of $500 per year per member with an approved PCP. For an HMO group comprised of 1,000 members, the PCP would be paid $500,000 per year and, in return, be expected to supply all authorized medical services to those members for that year.
If an individual patient utilizes $2,000 worth of healthcare services, the practice would end up losing $1,500 on that patient. On the other hand, if someone uses only $10 worth of healthcare services, the practice would stand to make a profit of $490.
Providers assume financial risk for the healthcare costs of their patients. If costs exceed the fixed payment, the provider bears the loss. The doctor/practice is under financial pressure to prescribe the least costly treatment or delay it until the next month or or even year.
JimboXYZ says
Capitation is one method the doctors are paid. There has always been the FFS (Fee for Service) component of compensation for the OOP’s (Out of Pocket) costs of any healthcare procedures. And to protect providers from losses, there are Stop Losses in place for the million dollar babies, the crack addict single mother of a 304 that brings an ICU baby into the world. Any doctor practice relying solely on capitation is a failing practice anyway. Trust me on that, I’ve been employed by United Healthcare, Health Choice Network & FL Blue as the working poor for staff.
And don’t get me started on the “Recovery” industry that goes in after claims have been paid out looking to recover the fraud & abuses of Medicare & Commercial healthcare products. There’s a billionaire guy in Miami, FL looking to fund the NCAA UM football program with Claim Recovery profits. And don’t get me started with UM poaching profitable patients from Jackson Memorial Hospital/System (Hospital system bankruptcy) under Donna Shalala less than a decade after the Shapiro Ponzi Scheme, the Clinton partner in crime. UM has had it’s share of scandals, the Shapiro Ponzi Scheme under Shalala’s watch. The rest of us have no sense of humor for being gouged any more.
When insurance premiums are $ 600-$ 1K/month for not seeing patients rarely to never. Insurance is nothing more than a rigged bet that the healthcare solution for the catastrophic healthcare event never happens. When you spend your 8 hours doing claims analysis, you’ll find the mast majority of the human race avoids going to a doctor because it’s just unaffordable. To get the benefits of healthcare insurance is a double edged sword. To get your money’s worth for premium dollar value, nobody wants the diseases of the human race to get the unaffordable cure(s) that is less than being a normal, healthy body of a human being.
Laurel says
HMOs suck. They are bean counter, for profit, healthcare, if you want to call it healthcare.
Deborah Coffey says
Why don’t we determine the country with the best healthcare in the world. Then, do that. Most likely, it will be a single payer system…and, everyone pays into it. Call it socialism if you like, but at the moment, the United States has some pretty bad healthcare outcomes compared to other countries. The arrogance of American exceptionalism is not a virtue.
DaleL says
I did some internet searching. The consensus result is that the best health care systems in the world in order by country are: 1. Taiwan; 2. South Korea; 3. Australia; and 4. Canada. They all have single payer systems.
The life expectancy, at birth for each of these countries is: 1. T=80.56 2. SK=84.33 3. A=83.92 and 4. C=82.63.
The life expectancy, at birth, for the USA is given as 79.3 years. (Wikipedia, UN estimate for 2023)
Clearly, better health care systems do result in a few more years, of average, of life. However, there are many life choices which influence longevity even more. A study in the New England Journal of Medicine found that smoking may shorten a person’s lifespan by up to 10 years.
Alcohol consumption is more complicated. One large study, published in 2024, with a sample size of over 2 million people of European ancestry, found that within the range of error, regular alcohol consumption reduced life expectancy by between 0.3 to 1.89 years. Confounding factors include drinking patterns, wine/beer vs distilled, education level, smoking, genetic issues, etc. “Impact of Alcohol Consumption on Lifespan: a Mendelian randomization study in Europeans”
Anyway, I wish everyone a very Happy, Healthy New Year.
Pogo says
@DC
“Why don’t we determine the country with the best healthcare in the world…”
Done and dusted — and constantly; as measured and quantified, separately, jointly, in aggregate — by the innumerable instruments of government and business of the entire planet; updated in real time in order to balance the books.
“… Then, do that …”
Great idea.
“What Do You Think of Western Civilization?” “I Think It Would Be a Good Idea”
https://quoteinvestigator.com/2013/04/23/good-idea/