It’s a fee-for-service world with declining reimbursements. You do the math:
If a doctor sees 25 patients a day, the first 15 visits are just covering his overhead expense. If a patient fails to keep an appointment, in spite of a confirmation, then the office finances will be decreased.
Therefore, the physician tries to see as many patients as he or she can during the day. This is overwhelming for the doctor, as well as the patients.
In spite of the increasing costs associated with employee expenses, increased staffing and medical malpractice premiums, the reimbursement continues to decrease.