After Hours: What’s Behind the Long Wait Times to See the Doctor? (From the Archives)

Summary

Full Measure After Hours: Detailed Summary of "What’s Behind the Long Wait Times to See the Doctor?"

Podcast Information:

• Title: Full Measure After Hours
• Host: Sharyl Attkisson
• Episode: After Hours: What’s Behind the Long Wait Times to See the Doctor? (From the Archives)
• Release Date: February 6, 2025

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Introduction

In this archival episode of Full Measure After Hours, host Cheryl Akison delves into the increasingly concerning issue of prolonged wait times for medical appointments in the United States. Drawing on expert insights from Dr. Ativ Mehrotra, a physician and professor at Harvard Medical School, the discussion unpacks the multifaceted causes behind these delays and explores potential solutions to alleviate the crisis.

Rising Wait Times: An Alarming Trend

Cheryl Akison opens the conversation by highlighting the personal and widespread frustrations associated with extended wait times to see healthcare professionals. She references the unmet promises of the Affordable Care Act (Obamacare), noting that while insurance coverage has expanded, the overall costs have surged due to increased premiums and taxpayer-funded subsidies for insurance programs like Medicare and Medicaid. This financial strain coincides with a surge in chronic health conditions, exacerbating the demand for medical services.

Key Statistics Presented:

• New Patient Appointments:

  • 2004: Average wait time was just over four weeks.
  • 2022: Increased to five weeks and one day (26 days).

• Specialist Appointments:

  • Cardiologists:
    • Washington, D.C., Houston: 4.5-5 months
    • Seattle: 5.5 months
    • Miami, Atlanta: 5.5 months
    • New York City: 9.5 months
  • Gynecological Exams:
    • 2004: 2.3 months
    • 2022: Nearly 8 months
  • Dermatologists (Skin Cancer Checks):
    • 2004: 2.3 months
    • 2022: 10 months
  • Orthopedic Surgeons (Knee Injuries, San Diego):
    • 2004: 1.6 months
    • 2022: Over 11 months

Expert Insights from Dr. Ativ Mehrotra

Technological Advancements and Systemic Changes ([04:38]): Dr. Mehrotra acknowledges the dual-edged nature of current transformations in the U.S. healthcare system. While technological innovations like telemedicine and patient portals are enhancing access and changing day-to-day healthcare experiences positively, negative trends such as healthcare consolidation and private equity acquisitions are diminishing the quality of patient care. This has led to widespread frustration among Americans, contributing to longer wait times.

Demand vs. Supply Dynamics ([05:28]): Dr. Mehrotra explains that the crux of the wait time issue lies in the imbalance between the supply of physicians and the growing demand for healthcare services. Factors driving increased demand include:

• Aging Population: Older adults typically require more medical attention.
• Expanded Insurance Coverage: More insured individuals seeking care.
• Shift Toward Specialization: A significant rise in referrals to specialists from primary care physicians, thereby increasing the demand for specialized medical services.

Nationwide Impact and Regional Disparities ([06:55]): While one might expect regions with higher physician densities to experience shorter wait times, Dr. Mehrotra notes that even areas like Boston, New York City, and Florida face severe delays. This indicates that the problem is not solely about physician availability but also about how medical practices are managed and how healthcare is delivered across different regions.

Medical Practice Styles and Training ([12:11]): The conversational focus shifts to the lack of standardized training regarding patient follow-up within medical education. Dr. Mehrotra points out that personal practice patterns developed during residency influence how often physicians schedule follow-up appointments, contributing to inefficiencies in appointment availability for new patients.

Contributing Factors to Extended Wait Times

1. Increased Demand for Specialized Care:

   • Over the past decade, referrals to specialists have more than doubled, placing additional strain on specialist availability.

2. Cascade Effect of Medical Testing ([14:19]):

   • Routine tests often lead to a series of follow-up appointments and procedures, consuming valuable resources without always benefiting patients. Dr. Mehrotra emphasizes the need for more judicious use of diagnostic tests to prevent unnecessary appointments.

3. Mental Health Services Strain:

   • Growing demand for mental health treatments, especially post-pandemic, has overwhelmed mental health specialists, leading to significant delays in care.

4. Inefficient Appointment Management:

   • High no-show rates and ineffective scheduling practices result in underutilized appointment slots, further exacerbating wait times despite apparent physician availability.

Potential Solutions to Mitigate Wait Times

Health System Interventions ([18:17]):

1. Improving Scheduling Systems:

   • Enhancing appointment reminders and implementing more efficient scheduling can reduce no-shows and make better use of available slots.

2. Econsults and Telemedicine:

   • Utilizing electronic consultations (econsults) allows primary care physicians to collaborate with specialists remotely, reducing the need for multiple in-person appointments. Telemedicine platforms and patient portals also offer timely access to medical advice without necessitating physical visits.

3. Policy-Level Changes ([22:12]):

   • Residency Slots Expansion: Increasing the number of residency positions and medical school enrollments can gradually address physician shortages.
   • Incentivizing Quality Care: Implementing payment models that reward health systems based on specialty wait times can motivate institutions to prioritize reducing delays.

4. Adopting Econsults:

   • Health systems adopting econsults can lower the number of unnecessary specialty referrals, thereby improving access and reducing wait times.

Patient-Centric Recommendations ([24:12]):

• Leveraging Telemedicine: Patients are encouraged to utilize telehealth services, especially for non-emergency consultations and mental health support, to access care more promptly.
• Proactive Appointment Management: Patients should communicate their urgency, join waiting lists for cancellations, and utilize telemedicine options where appropriate.

Practical Advice for Patients Facing Long Wait Times

Cheryl Akison inquires about actionable steps patients can take when confronted with prolonged wait times. Dr. Mehrotra acknowledges the limited options but suggests:

• Proactive Communication ([25:25]): Patients should regularly check for appointment cancellations and express the urgency of their need to clinicians when possible.
• Adopting Telehealth Solutions: Embracing telemedicine can provide quicker access to certain types of care, especially mental health services, which have shown efficacy comparable to in-person treatments.

Conclusion

The episode underscores a critical challenge in the U.S. healthcare system: balancing increased demand with sufficient medical supply and efficient healthcare delivery. Dr. Mehrotra emphasizes that while technological advancements offer promising avenues to alleviate wait times, systemic and policy-level interventions are essential for sustainable improvement. Patients, too, can play a role by utilizing available technologies and advocating for more efficient healthcare practices.

Notable Quotes:

• Cheryl Akison ([00:31]): "Excruciatingly long wait times to see the doctor for maybe a basic checkup... What exactly is going on?"

• Dr. Ativ Mehrotra ([04:38]): "The US healthcare system is going through a lot of change right now and I think that the patients unfortunately are suffering from that."

• Cheryl Akison ([10:17]): "It starts to feel like crisis proportions in terms of when do we know we've reached something that someone takes some kind of action to take care of or try to fix."

• Dr. Ativ Mehrotra ([16:02]): "Being more judicious in our testing because of that cascade effect is a really important issue."

• Cheryl Akison ([25:50]): "Does it matter to do anything like that?"

• Dr. Ativ Mehrotra ([25:50]): "It really can't hurt... we'll pull you in right away."

Final Thoughts

This episode of Full Measure After Hours offers an in-depth exploration of the pressing issue of long wait times in American healthcare. By combining statistical evidence with expert analysis, Cheryl Akison and Dr. Mehrotra provide listeners with a comprehensive understanding of the problem and highlight actionable strategies that could mitigate the situation. As the healthcare landscape continues to evolve, such discussions are crucial in driving awareness and fostering solutions that ensure timely and effective medical care for all Americans.

Transcript

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[Cheryl Akison]

Hi everybody, Cheryl Akkeson here. I hope you enjoy this special from the Archives edition of Full Measure After Hours. Hi everybody. Cheryl Akison here. Welcome to another edition of Full Measure After Hours. Today, what's behind the long wait times to see the doctor? I'll bet a whole lot of you listening have experienced what we're talking about today. Excruciatingly long wait times to see the doctor for maybe a basic checkup, maybe to establish a new doctor or even for important surgery. What exactly is going on? After Obamacare, we were promised everything with our health care system would be better. And while it's true that more people now have insurance coverage, as a result, America's total health bill has skyrocketed. We are paying more in premiums, but also through invisible costs, such as taxpayers paying for all the people getting subsidized on insurance. Yes, some of them are paying a reduced amount, but we're all picking up the slack. We also have to pay more for Medicare and Medicaid. That's insurance for the poor and the elderly. So it may seem like things are somewhat affordable in the moment, because when you pay out of pocket, that amount may not seem too bad. But we're getting hit in a way that's bigger than ever when you're talking about total costs that we're covering in other ways. And in the meantime, with more people having insurance and us paying more than ever, people are getting sicker and sicker with all kinds of chronic disorders. More people are trying to see the doctor and finding they can't get a timely appointment. It's reached crisis proportions in some cities. Here are a few stats. According to surveys, the average wait time for new patient appointments in 2004, way back then, it was widely considered unacceptably long. It was just over four weeks. But by 2022, the last date they have figures for this, the wait had grown a full week longer. Now the average wait for a new patient appointment had grown to five weeks and a day or 26 days. But that's hardly the worst of it. For a heart checkup with a cardiologist, hope nothing's wrong with you because you could find yourself waiting as long as four and a half to five months in Washington, D.C. and Houston, Texas. You could wait about five and a half months in Seattle, Washington. Same in Miami, Florida and Atlanta, Georgia. And you might be waiting nine and a half months in New York City for a heart checkup with a cardiologist in Atlanta, Georgia. The longest wait time for a basic women's gynecological exam jumped from about 2.3 months in 2004 to nearly 8 months in 2022. Hope you're not suffering anything serious when you're waiting for that gynecological exam. In Portland, Oregon to check for possible skin cancer with a dermatologist, the longest wait time went up from about 2.3 months back in 2004 to 10 months in 2022. And in San Diego, California, just try to get an appointment with an orthopedic surgeon for a knee injury. You're going to be in pain for a long time. In 2004, you could find yourself waiting about 1.6 months. But in 2022, that wait time skyrocketed to more than 11 months. Imagine waiting about a year to get an appointment with an orthopedic surgeon for a knee injury. In today's podcast we're going to get some insight into all of that with a physician and professor at Harvard Medical School. He also takes care of patients at the Beth Israel Deaconess Medical Center. He is Dr. Ativ Mehrotra. He studied this issue and has some great insight into what's happening to our healthcare system and maybe what we could do about it. Here's Dr. Marotra.

[Dr. Ativ Mehrotra]

I mean, I think that the US healthcare system is going through a lot of change right now and I think that the patients unfortunately are suffering from that. And some of those changes are positive. We're really seeing how technology can be used to really transform how people get care. And we're before it was always this theoretical idea in the future, but now most Americans, through telemedicine and portals and other things, are actually seeing that their day to day experience getting care is changing. But at the same time we're also seeing some trends that are really disturbing in terms of consolidation in the healthcare system, private equity, buying hospitals and practices. And I think people don't feel like they're getting the same care that they used to. And I think that's a source of understandably great frustration for the Average American. And also the wait time thing we're.

[Cheryl Akison]

About to talk about, what is that you have looked at and studied.

[Dr. Ativ Mehrotra]

Yeah. Most of my work has been on this digital health transformation in the United States. And both what's happening, what are the new ways that people are getting care? What has been the impact of that in terms of quality, spending, access to care, who's actually receiving this new form of healthcare?

[Cheryl Akison]

I feel like it's almost a time from the past to be able to say, hey, I needed to see my doctor and got in to see him today or the next day or on a timely basis. So many people are saying they're having trouble getting basic appointments or even to see specialists. That's a whole new ballgame.

[Dr. Ativ Mehrotra]

Yeah. And I think you hit upon a really important issue. Both seeing your regular doctor, your primary care doctor, Americans increasingly are having difficulty getting in in a timely manner today, tomorrow, as well as specialty wait times. Those have gone up quite a bit over the last decade or so. And so what you're describing from, and I hear from my friends and family also, why does it take so long to get to see, to see a doctor or schedule an appointment?

[Cheryl Akison]

Not all that long ago, we heard stories about this in other countries. We would say, oh, the Canadians are coming here for healthcare because they have to wait so long to see a doctor. They have to wait months and months or a year for a surgery. It now feels like we're approaching something like that. Can you say why this is happening or explain some of the factors behind it?

[Dr. Ativ Mehrotra]

Yeah. So first, I think you're correct. And when people have done surveys of people in different industrialized nations, it is what we're, what we're describing. The average American in terms of getting into their regular doctor in a timely manner has about the same difficulty as in other industrialized nations, or in some cases, it's worse here in the United States. So I think just to echo what you're saying, I mean, in terms of what's driving this, there's obviously at its heart, it's a supply demand issue. The supply of physicians in the United States per capita has been stagnant or gone up just a little bit, but the demand for health care has gone up. Some of that is because our population is aging and an older adult needs more health care on average than a younger adult or a child. Another aspect of this is we in the United States have made a big push to expanding insurance. And so now when you have insurance, you can go get care. So that means more Americans can actually go and get care, which is good, but that increases demand. And also maybe something that people don't recognize as much is the style of healthcare has changed. And what I mean by that is what we would have previously just had your primary care doctor handle, increasingly we have a specialist handle. One study found that if over a decade, the fraction of primary care appointments where the primary care doctor referred to a specialist more than doubled, well, that means a large amount of demand out there in terms of more specialty needs. And that, again, is some of it is driven by the complexity of healthcare. There's so much to know. And how can the average primary care doctor know all the nuances on many conditions? And I also think that's on the patient side where previously they might have been okay, having their primary care doctor handle a problem, but now there's an expectation, no, no, I'm going to go see a specialist for that problem. And so that's also driving that increased demand for specialty care. So I think a combination of increased demand is really largely contributing to the.

[Cheryl Akison]

Problem we're describing from the patient's viewpoint. Do you have any stats or has someone collected facts over time that shows how long waits for a typical appointment used to be compared to what we're facing today?

[Dr. Ativ Mehrotra]

Yeah, there are some numbers. Merritt Hawkins, for example, does a secret shopper study every couple years and what they're describing. And then they do that in different markets in the United States. For some, you know, I have a knee problem or I got a rash, I got to go in. And what they're documenting in those secret shopper studies is a substantial increase. If I remember exactly, it's about a 35% increase in the wait time to an appointment in the United States.

[Cheryl Akison]

Another trend I've noticed and I've heard from other people as well. There are places that won't even take appointments. They are so booked out into the future. And I know Mayo Clinic had this issue because we called to try to get an appointment for something and they said, not only can we not get you now, we can't put you on the waiting list and don't even call in six months because that's too soon. That's sort of like it starts to feel like crisis proportions in terms of when do we know we've reached something that someone takes some kind of action to take care of or try to fix.

[Dr. Ativ Mehrotra]

Yeah, and I think that is, you know, where I hear it most is a person moves to a new town, they need to get a new primary care doc, and they start calling around and so many of the primary care practices say we're close to new patients, and that is a source of enormous frustration. And then you go to your insurance book and you look at the different primary care doctors listed, but many of them are full. And I think that really highlights the difficulty here. But I also want to bring up another complexity, why it's not just about the supply of physicians. Because if that was the case, then we were to go around the country, and in areas of the country where there are a lot more physicians per capita, for example, where I live in Boston, Massachusetts, or New York City or Florida, where we have more doctors per capita, we would expect in those areas of the country, it would be pretty easy to get into a doctor. And in other areas of the country that have fewer physicians, it would be much harder. And that's not what we see. We see across the country, even in those areas that have more physicians per capita, we see more terrible wait times. Again, for example, where I live in Boston. So I think it also, I just wanted to emphasize that point and one of the other complexities here is, is style, and that different regions of the country have different propensity to make a referral or how they practice. For example, if I'm a cardiologist, how often do I have my patients come back? That's going to vary from doctor to doctor and from region of the country to another region of the country. So I think I just wanted to bring that up because just getting more doctors, the market will help. But we also have to address this difference in style and how medicine is practiced in different parts of the country, because that also plays a role in the wait times that patients are suffering from.

[Cheryl Akison]

Who teaches doctors the style? I mean, I'm sure some of it is developed through their own practice and experience. But there must be something. If this is kind of happening across the country with a lot of doctors, where is this coming from? That maybe they're bringing the same patients back more often, or the patients need to come back more often and there's not room for new patients.

[Dr. Ativ Mehrotra]

I mean, I think this is a bit of a dirty secret. There is no. In medical school, there's never a lecture on when you have a patient with high blood pressure, how often do you bring them back? You develop a style or a sort of practice pattern by where you trained. So you see, when you're in residency, for example, you see that your preceptor says, bring them back in a month or three months, and then you adopt that style and slightly adjusted as you go on into practice. So I think that plays a substantial role in there. And I think there has been one way to potentially improve specialty access. And some health systems are trying. This is saying to their specialty physicians, you've been seeing this patient once a year for the last five years, everything's pretty stable. Send them back to the primary care doc and that'll open up a new slot for a new patient. So addressing that style, sort of pushing back because as a doctor it's very, and I understand it that when I see a patient, I'll see you back next year. Cheryl but maybe sometimes it's better to say you're doing really well. If there's an issue, call me, but I don't need to see you. And trying to make that more. I take care of the problem and then they move back to the primary care doc. And that's another interesting way that people are trying to increase specialty access.

[Cheryl Akison]

Now if you don't have thoughts on this, no problem. But my dad, who's a doctor called it the diagnostic pipeline. And some of this is insurance driven and some of it is just driven by technology that we have available that people go to the doctor now and they're even if there's nothing seriously wrong with them, maybe they're put through a battery of tests that require follow ups and new appointments and appointments to do technological things to check this or that. Do you think that's a factor in this?

[Dr. Ativ Mehrotra]

I think you really touched upon a really important point that when you it seems so natural to get a test. And in modern medicine, tests such as laboratory tests, X rays, CT scans, MRIs, all the things we have available to us play such a valuable role. But one of the things that we don't think a lot about and maybe don't focus as much as we should in the, in medicine is the cascade effect of those tests. So you get one test, it's a little abnormal. For example. I'll just give you an example to take it to an extreme. A person comes to me, some doctors will do a yearly urinalysis. Well, maybe the protein level is a little high. Maybe I'll do a follow up test and just see what's going on. Oh, the protein level is a little bit higher. I'm going to do a CT scan of looking at what's going on in the kidneys. Maybe there's something a little funny going on in those kidneys. Maybe I need to do a biopsy. So I'll do a biopsy of that. Oh, the biopsy is totally fine. That's an example of that cascade where there were a lot of appointments there that used up valuable physician resources as well as in the end didn't really help the patient. So being more judicious in our testing because of that cascade effect is a really important issue. And I don't think it gets the attention that we really need to. There has been more and more, more research on that cascade effect, but it's something that we really need to consider. Now. I do want to emphasize these tests are very valuable. In some cases, it's just being a bit more judicious in when it's really important to get that test and maybe not overusing those tests because of the issue we're describing.

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[Cheryl Akison]

I take your point about the aging of America and people living longer and needing more care. It also seems to me just anecdotally that young people are sicker now. There's a lot of chronic illnesses, whether we're talking about, you know, bowel disorders, Crohn's, juvenile diabetes, allergies, that sort of thing. So have you looked at or do you know of anyone who's looked at the impact that not just older people are having on seeing the doctors more often? But are we sicker as a society than we used to be?

[Dr. Ativ Mehrotra]

I think the place that there's been the most attention to that is in the area of mental illness, where year over year, more and more patients are seeking mental health treatment. And that has been a real positive. We have really decreased the stigma about saying I have depression or I have anxiety or whatever other mental disorder that there is. And that has, I think, been a very positive change in our society. On the other hand, because on average, an adult in the United States is more likely to go get care. That has put a tremendous amount of strain on our mental health specialty clinicians and more, maybe more than almost any other area. In particular, in the pandemic, we've heard so many people Struggling, their children are struggling, their loved ones are struggling, and they just can't get in to see somebody. And I think that is reflective of some of the societal changes we've seen in the mental health area.

[Cheryl Akison]

Whose job do you see it as being the fix? Sort of putting their finger on the pulse of all this and trying to implement some kind of solution.

[Dr. Ativ Mehrotra]

There are in terms of solutions for this problem, I think there are a bunch of them that people. There's going to be no one single fix on this issue and some of it is going to be on the healthcare system, individual doctor's offices, health systems to implement changes, and some of it is going to be larger policy issues. I'll touch upon a couple of those and we can. On the clinician side, there's an interesting paradox, which is, let's say I've used the example of a cardiologist and it's a very valuable resource. It's taking months for people to come in. But on the other hand, when you go to their average day, many of those appointments don't go filled because of no shows, because people schedule appointments months and months ahead of time. And for a variety of reasons, life happens. They forget and they don't cancel the appointment. And so you have this really paradoxical situation where some of those resources are not used effectively. So one of the things that some health systems are trying to do, and I encourage more to do so, is how do you improve the scheduling system, reminders, and how people make those appointments so that we can better take advantage of that. And so we don't have so many free slots going unused. In some doctors, what they'll do is double book or triple book just to. Because they assume some people don't show up. But then when everyone shows up, then people wait and it's a very frustrating situation. Another aspect of this, which is that I've been really intrigued with, is a thing called econsults. And what that means is that so many times when you go to a primary care doc and say there's a rash and the doctor's not sure exactly what's going on right now, they would say to you, why don't you. I'll make a referral to a dermatologist and you'll go see the dermatologist. But a bunch of health systems around the country are implementing a thing called econsult. They say to the primary care doc, look, go to the computer, take a photo of what's going on with the rash, tell me a little bit about what's going on and a dermatologist will look at that within 24 hours and get back to the primary care doc. And sometimes they'll say, oh, this is what's going on. Just do X and you're fine. And the patient never ended up having to go see the dermatologist. So the patient saves a lot of time and the patient gets the care that they need in a timely manner. And they're finding with those kinds of systems that they can reduce the number of specialty referrals by about a quarter and therefore improve wait time. So another way that people can actually get the care that they need, another thing that I'm really excited about is telemedicine and portals. I don't know, a patient portal is just, I think what most people have in the country where they can go to their doctor and just ask them a question right away and get an answer relatively quickly as opposed to waiting for a couple of months if you're already plugged into the practice. And during the pandemic, more and more people are really taking advantage of that and that's a really efficient way for people to get the care they need, at least for some things where they don't need a visit to actually get questions answered. So those are some examples on the health system side that I think are really, really important and just I can go on more. But yeah, about how they can improve the process and therefore decrease the wait time and use this resource more value more efficiently.

[Cheryl Akison]

I mean, the frustrating thing from my standpoint is it relies on nobody in particular to kind of realize and implement changes in a way that doesn't seem to be organized by the American Medical association, whoever might organize it. What about policy? You mentioned maybe some policy things that could be done. Do you mean by federal government or by medical groups doing policies?

[Dr. Ativ Mehrotra]

So I think first I want to emphasize you made a really valuable point. The U.S. we don't do a lot of top down policy. We have a very. Each health system, each doctor's office is implementing these changes. And there's no one saying you got to do something in terms of making change. I do think there are a couple of places where policy could have a very valuable role. The first is in terms of residency slots. One of the reasons that I told you at its heart is a bit of a supply problem. We haven't really increased the number of specialists per capita relative to demand. And we've kept that relatively tightly restricted and limited the number of international medical grads who can come into our training programs, as well as limited the number of medical schools. We could as a nation decide that we want to train more physicians. It's not going to fix the problem tomorrow. It's going to be a long timeline because it takes a while to train doctors. But that is one area that we could way to improve this problem. Another way is to put pressure on individual health systems to improve specialty wait time. There was a recent congressional hearings last week where they were talking about one of the things we're trying to do in the US Healthcare system is not just pay doctors for providing care, but actually on the quality of care they provide. And one of the ways that we could put pressure on health systems is that when we pay a health system, you would get paid more or less depending on your specialty wait time. So a health system that has very poor specialty wait time, it would hit their bottom line. And the idea would be, is that this would force those health systems to put more resources and tackle this problem as opposed to maybe ignoring it if they don't, you know, they don't prioritize it. So those are two examples of policies that we could address.

[Cheryl Akison]

And from a patient standpoint, is there anything you can recommend a patient can do if they're facing a long wait time? Maybe they're new to an area and they really need to get in to see a primary or a specialist. What advice do you have?

[Dr. Ativ Mehrotra]

I wish there was an easy answer and I've certainly had lots of friends and family. A lot of it is unfortunately people calling and asking around and pulling favors, which is not a very useful piece of advice. My only other thought is that increasingly for some issues, you don't need to go to a doctor in town. So embracing some of these new care options which allow you to see a doctor anywhere in the country when it's feasible. For example, in particular, we talked about mental health treatment. There are a number of different options that are available to people of telemedicine for mental health and that increases the pool of people they can go to. And research has shown that for conditions like anxiety and depression, those treatment options can be just as good as seeing someone in person in your local area. So those are two considerations. I'm not sure they're. But in particular the first one, it's tough.

[Cheryl Akison]

I mean, would you recommend something practical and I don't know if you would. Should they try to leave a message if they can't reach somebody and say when there's no appointments, if you have a cancellation, call me. Or if this is more not an ER emergency, but this is urgent can you work me in? Like, does it matter to do anything like that?

[Dr. Ativ Mehrotra]

Certainly it can't hurt, I guess when your comment really makes me frustrated because that's exactly what the clinic should tell the patient, right? Because I told you already that unfortunately, often there's no shows and there are a bunch of people who want to get in more quickly. It's not that it's not rocket science to tell the patient, hey, we have a waiting list. Sometimes people no show the day before. We'll pull you in right away. But I don't know why health systems and practices don't do that more. It's not that complicated and it would really help people in some cases when they need to get in more urgently. It's not going to fix the problem, but it'll be a partial, at least a little bit of a help in terms of improving things.

[Cheryl Akison]

I hope you enjoyed today's podcast and that if you did, you will leave a great review and share it with your friends. To see the actual story on Full Measure, you can watch on Sunday, March 3rd. To find a list of stations and times, go to cheryl Atkison.com and and click the Store tab. Or you can just watch it live when it feeds on Sunday, March 3rd at FullMeasure News Online at about 9:31 or so a.m. eastern Time. That's when the feed starts and then it's posted at Fullmeasure News thereafter, so you can watch replays right now or anytime. If you like the topics that I cover on this podcast, you'll want to hop on over and listen to my other podcast, the Cheryl Akison Podcast, and you will definitely want to think about pre ordering my new book. It's coming out September 3rd from HarperCollins. It's called Follow the How Big Pharma Misleads, Obscures and Prevails. You can order at HarperCollins online or at Amazon or anywhere that you like to order your books. Visit the Cheryl Atkinson Store by going to cherylakison.com and clicking the Store tab because I have some great products for free thinkers like you. With proceeds going to support independent reporting causes, it's never been more important. Do your own research. Make up your own mind. Think for yourself.