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In 1985, David Maister wrote a fascinating article about waiting lines—“The Psychology of Waiting Lines”—that I believe is even more relevant today than it was more than 30 years ago. This is particularly true for medical practices in this day and age.

This increase in relevancy boils down to two factors: 1) the greater volume of patients a medical practitioner must see to maintain a certain amount of collections, and 2) the overall “I want it now” mindset of today’s consumer. The convergence of these two factors make the reception area (often called the “waiting area” appropriately enough) a place ripe for potential customer service pitfalls.

Ahead, we’ll apply some of the principles that Maister discussed in his piece to the reception area in medical practice offices. Maister’s principles include:

1. Occupied Time Feels Shorter Than Unoccupied Time
2. People Want to Get Started
3. Anxiety Makes Waits Seem Longer
4. Uncertain Waits are Longer Than Known, Finite Waits
5. Unexplained Waits are Longer Than Explained Waits
6. Unfair Waits are Longer Than Equitable Waits
7. The More Valuable the Service, the Longer the Customer Will Wait
8. Solo Waits Feel Longer Than Group Waits

Of these principles, two of them will be discussed in-depth: 1) Occupied time feels shorter than unoccupied time, and 2) Unexplained waits are longer than explained waits. However, other principles will be mentioned, as most of Maister’s principles relate to one another.


Most practices (unknowingly) are using some of these principles, but they are most likely not accomplishing the goal of making wait times more pleasant. Below are some flaws I see in medical practices today as it relates to the application of Maister’s principles.

Occupied time feels shorter than unoccupied time. The old adage of “a watched pot never boils” captures this first principle. You may have heard about the waiting issue that plagued mid-20th century corporate buildings in metropolitan areas. Long lines formed to get on elevators, and complaints about the wait were very common. The solution: Installation of mirrors around the elevators so people waiting could look at themselves and fix their hair, straighten clothing, etc. Coincidently, the number of complaints decreased with the installation of mirrors. This is a prime example of the first principle in play.

That solution wouldn’t work in today’s world because nobody would even look up to see the mirrors. Instead, eyes would remain glued to the screens of phones, tablets, and other devices. Our ability to occupy our time with mobile devices can be a blessing to a practice—if used correctly. Many medical practices are offering free Wi-Fi for these devices. While that is a great idea, I’ve observed a massive problem with this tactic.

The Wi-Fi provided by offices is usually unable to support all the devices that are trying to connect to it and generally runs extremely slow. Often times it’s slower than the patient’s own cellular phone connection, which is extremely frustrating. This prevents people from getting started (Principle 2). Why would you introduce this “customer service” benefit only to have it immediately frustrate the specific person you are trying not to frustrate? If you currently offer Wi-Fi, or you are planning to offer it, please ensure that your connection has enough capacity to handle peak reception area hours.

The next tool used by many medical practices to occupy patients in the waiting room is the television. The TV has been a staple in reception areas for many years. However, I see a massive flaw in the way this tool is being used in waiting rooms around the country. The flaw—selecting 24-hour news channels for patient viewing. Can we be honest and admit that most of the information coming out of those channels is just meant to scare us because that is what drives higher ratings. Furthermore, you are going to have to pick one news channel to run constantly, which is inevitably going to anger a significant portion of your patient base. Before clicking on the TV, just think about what your patients will see and hear while they sit in your reception area, and tell me whether you think it’s going to make their anxiety go up or down (Principle 3).

Uncertain waits are longer than known, finite waits. When visiting a restaurant with a line of people waiting, most people wanting to eat at that restaurant will ask the hostess how long the wait is to be seated. Once the hostess gives the potential patron an estimated wait time, there is an automatic calculation in the potential patron’s mind of whether this restaurant is worth the given time (Principle 7). If the individual concludes that the service is worth the wait, then you have essentially “primed” this customer into waiting quietly for the amount of time given. The key word here is “quietly.” No (rational) person starts complaining to the hostess after five minutes have passed if he or she is told it will be about a 30-minute wait. This is because the wait has been defined by the hostess from the beginning. Now, the onus is on the restaurant to meet the time standard set by the hostess, however, if the hostess is seasoned in the job, he or she will usually overstate the wait to be seated. So, when the patron’s name is called earlier than expected, he or she is pleasantly surprised and the customer’s opinion of the service is elevated.

How does this situation carry over into a medical practice? Most patients know when they arrive at a medical office there is going to be a wait. In fact, released a 2012 report that stated the average wait time across the country (and across specialties) is 21 minutes. However, waiting 20 minutes can seem like an eternity for many people. This was confirmed by another survey recently performed, asking patients how long they would wait for their doctor. The results, you guessed it — 20 minutes! After 20 minutes, a patient’s patience starts to wear thin.

Furthermore, there is a correlation between longer wait times and negative online comments and reviews about doctors. My personal favorite is that the provider “only spent five minutes in the room,” as if the patient actually had a stopwatch in the room timing the encounter. Most of us realize that this type of comment is based more on perception than reality. However, the patient’s reality is what counts here, and practices need to manage that perception.

To help remedy this situation, front office personnel have to communicate to patients when they arrive if their wait time is going to be longer than normal. This way patients can mentally calculate the value of their wait time to that of seeing their healthcare provider. The good news is that most people put seeing their health care provider high on their priority list, so the wait time is usually deemed worth it. The key is that patients need to be “primed” into sitting quietly for the amount of time provided and accept those terms in the beginning. Now, it behooves the medical practice to have a savvy front office person monitoring the situation, not unlike the seasoned restaurant hostess mentioned earlier. The savvy front office person needs to understand that if the wait time initially communicated to a patient will not be met, there needs to be a proactive discussion with the patient and a new wait time expectation communicated.

Beyond communicating wait times to patients, there need to be internal policies in place to address instances when patients end up waiting excessively long periods of time. In those cases, for example, the front office needs to notify the back office that certain patients have been waiting too long by the practice’s standards. Back office personnel then may need to help alleviate some of the patient’s frustration by communicating how sorry they are for making him or her wait so long and sympathizing with any voiced frustration. Finally, and most importantly, the doctor (or provider) needs to reiterate how much he or she respects the patient’s time and how the practice is always trying to improve the patient experience.

Most people understand that things happen in a medical office, and the chances of a provider being on time 100 percent of the time is not realistic (Principle 6). They just want to know that they are not lost in process, and that you understand that they and their time are important. What they will not stand for is sitting in the waiting room for 30 minutes with no communication. In addition, patients will not tolerate a medical assistant who treats them as if they are an annoyance, and a physician who seems oblivious to what just happened and “only spends five minutes” in the room.

Worth the Wait

To make waiting in the reception area a little less bothersome, keep your patients occupied through the proper use of various tools to make the wait seem less obvious. Secondly, communicate regularly with patients about the expected wait time they are facing. This not only makes them feel like you care, but it also allows them to perform mental calculations on whether you are valuable enough to wait for in the reception area … and my guess is you are!

Jonathan Montoya is a management consultant with the Allergan Practice Consulting Group of Allergan, PLC, a global pharmaceutical company headquartered in Dublin, Ireland. Mr. Montoya consults with medical aesthetic practices in the areas of financial analysis, strategic initiatives, business planning, performance processes, websites, social media, and other general practice management matters.

Mr. Montoya brings strong business acumen and cosmetic practice development experience to the Allergan Practice Consulting Group. He has more than 15 years of industry experience in sales, marketing, training, and consultative business management.

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