the Doctor

“Have you ever sat in your doctor’s waiting room, thinking about everything else you could be doing?”

That question opens a short video prepared by researchers of a new study that found people spend an average of 123 minutes to obtain medical care, including clinic and travel time.

Researchers found patients spend about 38 minutes traveling on average and about 86 minutes in their health facility.

The study, published in the Journal of the American Medical Association, also found that both clinic and travel time was significantly longer for racial and ethnic minorities.

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Why Time Is Important

When it comes to medical care, time is of the essence.

Longer travel time or clinic time for certain groups can present obstacles to obtaining care.

Researchers found that the total time burden was 25 to 28 percent longer for racial/ethnic minorities and unemployed people.

For example, clinic time for Hispanic patients is 105 minutes, compared to the 80 minutes on average for non-Hispanic whites and 99 minutes for non-Hispanic black patients.

There are so many known disparities in the U.S. healthcare system that it isn't necessarily surprising to find disparities in time burden as well.
Kristin Ray, University of Pittsburgh School of Medicine

A key note is that increased clinic time doesn’t mean more time with a physician. It simply means more time doing things such as paperwork, paying bills, waiting, or interacting with non-physician staff.

For the researchers, from institutions including the University of Pittsburgh School of Medicine and Harvard Medical School, the findings were not unexpected.

“Unfortunately, there are so many known disparities in the U.S. healthcare system that it isn't necessarily surprising to find disparities in time burden as well,” said study coauthor Dr. Kristin Ray, M.S., of the University of Pittsburgh School of Medicine. “But the amount of extra time that racial/ethnic minorities and the unemployed spend seeking care is significant, and I think requires further thought and attention.”

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The Barriers to Effective Healthcare

Researchers looked at the American Time Use Survey from 2005 through 2012 for more than 108,000 respondents 18 years and older.

The researchers broke out clinic time, travel time, and then the sum of the two for total time.

Clinic time is spent waiting for or obtaining medical care, while travel time is the time respondents spend getting to a healthcare facility.

The study didn’t look at the ramifications longer travel and clinic time have on patients, but researchers are concerned about the overall effects.

“Our study couldn't measure the effect of this time burden on patients, but we worry that longer time burdens may make people less likely to seek care, potentially delaying or completely missing needed care,” Ray told Healthline.

A disturbingly high proportion of patients feel that their doctors do not listen to them or report that they do not understand what their doctors say.
Dr. Karen Scott Collins, The Commonwealth Fund

Other research has found that racial and ethnic minorities and those in low socioeconomic brackets have increased barriers to healthcare access and that those barriers have ramifications such as preventable hospital visits and unmet health needs, according to the Agency for Healthcare Research and Quality.

AHRQ’s 2014 healthcare quality and disparities report found that people in poor households generally experience less access to healthcare and poorer quality healthcare. Barriers include lack of availability, high cost, and a lack of insurance coverage.

Another barrier is communication. A study from The Commonwealth Fund found that minorities have a much harder time communicating with physicians.

"Communication is essential to quality medical care, and a disturbingly high proportion of patients feel that their doctors do not listen to them or report that they do not understand what their doctors say. So even when a patient reaches the doctor's office, they might not receive optimal care," Dr. Karen Scott Collins, vice president at The Commonwealth Fund, said in a news release.

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How Much Waiting Costs

Ray and her team published a related paper in August that quantified the opportunity costs to individuals seeking care.

That paper didn't look at disparities in access to care, but rather the monetary value of time that people spend individually and nationally traveling to, waiting for, and receiving medical care.

Medical Waiting

The study found that this was equal to $52 million in 2010, Ray said.

“There is growing focus on patient-centered care, and I think that understanding patient time burden is an important part of the patient experience. Patient experience isn't just about interactions with the physician, but the whole experience of scheduling an appointment, getting to the appointment, and getting through the appointment,” Ray said.

The American Time Use Survey does not include health status, visit reasons, severity of illness, or insurance status.

But for any patient, excess time burden can create a disincentive to seeking care, according to the study. Improving access to care and the efficiency of care could help.

Things such as reengineering clinic processes to streamline visits and patient-centered scheduling could reduce time burden.

“Making this as efficient as possible is one way of valuing the patient and their time,” Ray said. “By highlighting just how much time burden our current healthcare system is placing on patients — and how unequally this burden is distributed — I hope that this study adds to conversations about how we can improve patient-centered care for all patients.”