Several years ago, we had an exchange student from Norway who needed to see a specialist periodically to have a cyst drained. The day before a big school dance, she told me she needed to go get it taken care of before the dance. As in, that afternoon! I explained to her that in the US you can’t simply see a subspecialist to get a non-emergency procedure done at a moment’s notice. We have these things called appointments. And you have to make them. In advance.
Was this just a cultural difference in expectations based on better medical care access in Scandinavia? (It turns out you can’t just waltz into the ENT office same day in Norway, either.) Or was it typical Millennial insistence on instant gratification? Either way, she asked if maybe she could find someone else to do it. I then explained that her doctor was one of the best, and no, we weren’t going to find just anyone, who might not do as good a job – quality is worth waiting for.
A lot of us in health care tend to rationalize this way. Quality is most important; convenience is just a frill. We feel pretty good if our time to next appointment is “only” a week or two. Yet I routinely get requests from people inside the system who have to wait that long for a family member to see if there is anything that can be done to get them in sooner. I heard a colleague at another hospital talk about how nearly every day she helps friends and “important donors” get quicker access. Not only does this create a two-tiered system of easy access for those with connections while regular folks have to wait, it belies the assertion that convenience isn’t important. Timeliness is one of the six domains of quality espoused by the Institute of Medicine. And while we tend to associate such impatience with the Millennial generation, it appears to be pretty important to the Boomers whom my colleague keeps listed on her phone.
Data from a Healthgrades survey in 2014 suggest that in choosing a physician or hospital, convenient location and hours were cited as factors far more often (56-62%) than outcomes (22-30%). While this may be accelerating, this has been true for some time: a 2000 study from University of Nebraska of factors used in choosing a primary care physician found that wait time for an appointment was as important as whether she/he had any malpractice history, and more important than factors such as the doctor’s training or years of experience.
To the extent that the prioritization of convenience is a bigger issue for the Millennial generation, then those of us in pediatric health care need to be especially ready to address this, as the Millennials are the parents of our patients. And they aren’t willing to wait for what they want.