What Physicians can learn from Dentists

My wife waited two hours to see her family physician today. She did wait … but she had to wait in the hallway, outside of the actual office, because the waiting room was full to capacity. Fire code capacity, not seating capacity.

Her appointment was scheduled for 11 AM this morning but she got a call from the doctor’s receptionist that the appointment had to be moved to 2 PM. It sounds like the doctor cancelled all of her morning appointments at the last minute and merely pushed them all …. into the afternoon.

This is a blog that I have felt compelled to write repeatedly in the past but chose not to because my profession of dentistry lived in the private sector while medicine has been a public health care program in Canada since 1971. I did not think this dichotomy would change in my lifetime but two years ago the government introduced public dental care for all families whose combined income was less than $90,000 CDN. It is modelled on private dental insurance meaning some expensive procedures need prior approval and there would be annual limits.     

The private sector is often the realm where goods and services are delivered in the most expedient and financially efficient way. Government services are often described as incompetent, lazy, and wasteful. But the private sector prioritizes profit above all else and that can be just as problematic. Medical doctors in Canada bill their services to the government and are paid promptly. Dentists have to bill multiple insurance companies and endlessly fight with them to get the expected compensation and then chase after the patient to collect unpaid balances. 

Despite the hidden clerical demands of a dental practice, dental practices also run far better offices than medical practices.  Being in the private sector, dental practices compete with other dental offices for patients. Every aspect of practice management in a dental office is geared towards the patient experience. The staff is friendly and welcoming.  The dentist is sympathetic and listens.  The office is on time and patients never have to wait. If you’re early, we gratefully offer coffee, tea or juice, current periodicals to read, and TV to watch or maybe play the latest console games for kids. And since patients often pay for dental services or a portion of those fees, customer satisfaction is paramount. 

In Canada, we have a shortage of family physicians nationwide. Every new practice that opens is filled to capacity within a few weeks. Medical offices do not need to advertise. They all have a captive pool of clients that always grows. Patients tolerate every inconvenience and dismissiveness because they don’t want to lose their access to a physician and … it’s free. Or appears to be free.

Most medical practices run an antiquated solo model with a skeleton staff. A better model involves multiple physicians in a group practice able to employee auxiliaries who can perform routine tasks like taking BP, weight and blood glucose thereby improving the efficiency of the patient visit. Some medical practices refuse to innovate or invest in infrastructure. Can you envision a 21^st century practice with no computers and hand written charts???? Computers that can help the physicians write or email drug prescriptions, referrals and lab requisitions as well as make new appointments right there in the consultation room, negating a further visit to the front desk.

By happenstance, my son asked me to make an appointment to see his family physician. He’s starting his career in Ottawa but hasn’t been there long enough to find a new physician so he’s going to see his regular physician on a visit home. I phoned and was informed by their computerized system that phone calls are not answered during the lunch time hour. Presumably this is to give staff a real uninterrupted hour for lunch. Which I think is laudable. But can you not have staff take a staggered lunch so that there is at least one person able to answer the phone during all hours when the practice is open. But that presupposes you have more than just one staff member. Even the smallest dental office has at least 3 additional staff members. I always had two phone lines so that anybody phoning would never have to encounter the dreaded busy signal. Every phone call was answered because every phone call is a potential appointment. 

I phoned back and got a menu. I hit #1 to make an appointment. I was immediately put on hold …. for thirteen minutes. After five minutes I feared that the system had lost my call and I was in that dreaded limbo of never being connected to a human voice no matter how long I waited. But I persisted and finally got through to make that appointment.