When patients are late: Should doctors charge extra?

While patients and physicians operate under oral agreements, business agreements are generally established in writing. In these documents, terms are outlined including contingencies in the event that foreseeable obstacles or disputes develop. Oftentimes, the two parties do not agree that a contractual term has been violated. This is when the fun begins. With a little luck, the legal profession enters the arena and can speedily resolve the disagreement in a matter of several years after impoverishing both sides.

A common contractual feature is a requirement that goods and services be delivered on time and on budget. A contractor might be subject to a penalty if his project is not completed by the agreed date. This is a reasonable concept and serves as an incentive for on time performance. In real life, this may not be as clean as it sounds.

Customer: “You’re a week late so you owe me half a gazillion dollars.”
Contractor: “It’s not our fault that the city planner delayed us. Go fight city hall.”

Other professions are not subjected to financial incentives to deliver on time. Consider our beloved airline industry where customers are hassled and fleeced before they are herded onto airplanes to sink into a seat narrower than most humans. Air travel has delivered some celestial benefits to us. It has increased our spirituality. We pray that our luggage won’t arrive in the wrong continent. We pray that our bottle of mouthwash in our carry on bag won’t be confiscated. We fervently pray that the passenger seated in front of us will not lean his seat back while our tray table is down which would impale us.

Shouldn’t the airlines be penalized when flights are delayed? At present, they game the system by artificially lengthening the estimated travel time so that many flights will arrive “on time” even when there are delays. When a flight is delayed an hour, what loss do passengers incur? Shouldn’t they be made whole for their loss? Perhaps, an extra bag of honey roasted peanuts would mollify the restive crowd.

On time performance is a live issue in the medical profession.

Do patients deserve to be compensated when physicians are late? Should it depend upon the reason? Is a delay because of a medical urgency non-compensable? Should there be a no fault system where patients are compensated for delays regardless of the explanation?

Stand down readers. This concept might work in both directions. What pound of flesh should be exacted from patients who wander in late or simply fail to show up? The latter occurs even when patients have been contacted the day prior to remind them of their solemn obligation to keep their appointments. It is particularly vexing when a colonoscopy patient fails to show leaving us with nurses, a nurse anesthetist and a doctor with unscheduled time off that could have been used by another patient.

Insurance carriers will not permit physicians to charge patients who leave us flat. It’s in our contract, a document that offers us no relief when these companies don’t deliver.

If you have suggestions on what should be done to late physicians or patients, you are encouraged to do so at this time.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower

Comments are moderated before they are published. Please read the comment policy.

  • MrsDoc

    Consider that a patient who is 15 minutes late may feel that that is just 15 minutes that she will not spend in the waiting room before being seen. When patients routinely wait more than a few minutes before being seen or – this is worse – wait more than 15 minutes undressed, shivering in an exam room, you are “teaching” them to be late. Figure out how to “unteach” this.

    • guest

      I agree with this. I try hard to be on time for appointments with my patients and their families and when I am a patient, if I am heading off to see a doctor whom I know routinely runs 1 hours late, I feel much less obligated to show up on time. If the doctor doesn’t respect my time, why should I be punctilious about appearing at exactly the time that will require me to then wait for an hour?

      • MrsDoc

        I am married to a physician so I am sympathetic to the need to attend to unexpected patient emergencies, but increasingly emergencies are handled by fellows or hospitalists. I wish that an office could give real time updates via text so that we can go about our lives and get there just in time. Recently I appeared for an appointment with a physician’s assistant and was told she was running an hour late. I said, that’s fine, I’ll come back in 45 minutes and the desk woman actually tried to tell me that I HAD to wait. I said no, I live near hear and will come back. They said that I could not “stay signed in” if I left. I left and, after considering it, went right back in and said I’m not sick, I can reschedule. Problem solved!

        • NPPCP

          There are no true office physician emergencies anymore. Surgeons, proceduralists, and internists, yes – maybe. But FPs no, never. In my practice, we are always there on time and everyone is seen on time.

          • southerndoc1

            “But FPs no, never.”
            Absolutely, totally not true. We get them on a weekly basis.

          • rbthe4th2

            Actually only one have I seen a doctor with a true emergency. The others tell you to go to urgent care or ER to not disrupt appointments. Most don’t want you using the “patient portal” either. So I don’t buy on it. I think its the shove patients in 10 min. increments, NO health care professional can do that unless its a well patient just checking in, and that’s why they get behind. Not including phone calls from other docs, etc. Oh and one thing I saw is that doctors would get interrupted for signing things in patient appts. Not always, but if they do it outside of that patient visit, that’s it.

          • DoubtfulGuest

            I think they do have emergencies, but also some of this other stuff you mention. Can be a bunch of different factors. Just like with patients being late. For me it was often:

            1. Dropped toothbrush d/t shaking hands
            2. Had to use bathroom again
            3. Did I really turn the stove off? Better check
            4. Forgot meds – have to go back to get
            5. Short of breath sprinting to bus stop –> missed bus

            or

            5. Wrong turn driving to office, somehow ended up the next town over. I knew something didn’t look right…

          • buzzkillersmith

            Say what? Recent cases: Anaphylaxis, diabetic ketoacidosis, pneumonia with hypoxemia, afib with hypotension. I don’t know what world you’re living in..

          • Martha55

            At my doctor’s office, any emergency is sent to urgent care or the ER.

          • Josy Coke

            so you are in your doctor’s office, your doctor is looking you in the face, and your oxygen drops and you start suffocate. You get shipped out the door without being treated or stabilized first? Are you sure that’s what happens? Sounds pretty risky.

          • DoubtfulGuest

            That’s the kind of thing I imagined happens a lot. What’s the minimum amount of time to stabilize a patient in that situation?

          • Josy Coke

            It really depends. Sometimes you can treat the patient in office and get their O2 up and keep it up and avoid an ER trip. Sometimes you go through all of that and still have to take them to the ER. Sometimes it’s a wait and see. This particular guy was in the office for over 2 hours. The doc didn’t stay in the room with him that long, but the doc did have to keep checking on him. We were able to keep him from going to the E.R. and able to send him home stable and ok. Sometimes you put the O2 on them and their stats don’t start to raise, and that’s when you just take them straight to the ER.

          • DoubtfulGuest

            Now that’s information we can use. Too bad medical dramas don’t show this stuff realistically, with a time counter on screen. Hey, TV networks…

          • rbthe4th2

            Yes – on more than one occasion (family wise), I’ve seen breathing/asthma issues, bite/wasp/stings, upper right quad pain, lower abdominal pain, bad headaches … you name it.
            I once said after the 2nd weekend in a row of being sent to the ER, look I am going to get called a frequent flyer, come on, we’re embarrassed.
            I apologized to the ER people and made sure they knew who recommended me to go. I was dang sure not going to take responsibility for that one.

          • guest

            Well, of course you’re not a nurse practitioner. You’re an MD and “practicing at the top of your license.”

          • rbthe4th2

            The world that when you call your doctors office the first thing they say is that if it is a medical emergency dial 911. Then when you talk to the nurse, go to the ER and they’ll check it out: x ray, CT, etc. That’s the world for us. Only 1 doctor I know of takes emergencies and that’s the one I posted about. All other PCP’s, internists, dermatology, opthamology, etc. all say go to the ER, they won’t make an appt. for you unless it is a normal visit. The one time I asked can I get one? They set me over a week out was the soonest.
            Randy

          • DoubtfulGuest

            I think what they’re saying is some people show up for a regular visit but it turns out they have an emergency they didn’t know about? Or they start having an emergency when they get there. It’s not always immediately obvious.

          • querywoman

            I’m with you on this, Buzz. It sounds like you treat real sick people. If all a doctor wants to do is blood pressure and cholesterol screening and Pap smears and mammograms, it’s plannable.

    • Suzi Q 38

      So true.

      If you are a physician chronically running late, you may get a few patients who figure out this is the “way to go.” Show up late, then the doctor will see you in a few minutes, rather than 30 or 40 minutes late.
      I have waited for physicians who were an hour late at times. Any more than that, I ask for a new appointment.

      I figure that I will sacrifice the wasted trip so that he/she can be more on time for the other patients after me.

      I rarely have to wait a long time for any physician because I usually choose the first appointment in the morning (9:00 AM) or the first one after lunch (2:00 PM). Another favorite is 4:45 PM.

  • DoubtfulGuest

    I was ~ 30 min. late for a colonoscopy. Got a phone call from the nurse:

    “Yes, I’m on my way…I’m just a few doors down in the restroom. I started the prep on time, but I…seem to be delayed in finishing…Sorry.”

    They forgave me.

    Education would go a long way with some people, but not all.

    I have no problem waiting for a doctor. They’re much more likely to have an emergency than I am. Or they’re talking to a patient who really needs that extra time. If it gets to be more than an hour, I start to run out of gas. I try to bring a snack with me, get up and stretch my legs. I expect doctors to understand if I’m not at my best after waiting a long time. I’m not rude, but my thoughts are less organized, I might be a bit anxious.

    I used to run late sometimes. I have a lot of trouble just getting ready. I’ve learned to allow a lot of extra time, about 3x more than I’d like to think it will take. Sometimes people run late because they’re sick. Or have legitimate transportation issues. I don’t know what I think about charging a fee. I can see both sides, but I come down on the side of, the doctor’s time is not more valuable, but you could say it’s more critical. An exception would be with patients who could get in trouble at work or have their pay docked, if they get back late from a doctor visit. I don’t know what the solution is, but I try hard to be punctual these days.

  • Ron Smith

    Hi, Michael. Here is our scheduling policy in the office. When we discuss scheduling, it is always around the central concept of fairness to all patients.

    We don’t charge for late patients…we have a very short few minutes grace period. When parents are allowed to control in a practice, they will exert their will to get what they want, regardless of whether it is fair to other patients.

    When we control the schedule, and we emphasize that our policies are devised to be fair to everyone, then parents learn that the fairness thing works well for everyone.

    We do charge for missed appointments. This is not because we want to, but it provides the necessary incentive to make sure that no parents corner a slot and waste the time that we would have had to see someone who really needed the slot. Often those that are no shows are repeat offenders. I remember one that we ultimately severed the physician-patient relationship after they missed the fifth straight scheduled appointment.

    You can see all our policies posted on my professional web site as well (the URL is at the bottom.)

    —–
    Scheduling Policy
    The purpose of these policies is to ensure that there are enough appointment slots available to take care of the sick children & to safeguard the schedule so that you and your children are in and out of the clinic in a reasonable amount of time.

    You can help us accomplish this by following these requests:

    Please be here 10 minutes early so that you can get through the Check-in process in time for your appointment.

    In order to make sure that we have enough sick-visit slots each day, we have a limited number of well-visit (physical exam) appointments available and those are booked at least 48 hours in advance. So I hope that you will understand that we cannot fit in an extra well-visit exam at the last minute.

    Late arrivals cause an unpleasant ripple effect in the schedule. So please understand that if you are late for your appointment you will likely have to be rescheduled for a later time.

    Please schedule sick-visit appointments for each child that you want seen by the provider. “Squeezing in” an extra exam can be time consuming and can cause a schedule backlog.

    We are endeavoring to make your visits here as pleasant an experience as possible. Thank you for your cooperation.

    —-

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • NPPCP

      Hi Dr. Smith,
      I understand you want to control the schedule and not the patients. So, if they are on time and you are late (you are in control), do they receive a discount for waiting? This would be the right thing to do – especially since you charge for missed appointments.

      • Ron Smith

        Hi, NPPCP.

        We do not discount for that.

        I sense the underlying implication in your question is two-fold. Should providers be penalized for running late? Is the reason they are late because they dawdling, or is it because patients have issues that take longer?

        We all know that no matter how we try to appropriately time the required time needs for the average patient something is going to break the best of intentions.

        We apply realistic patient loads to the schedule. We don’t double book. We don’t schedule 40 patients in a day where we can only meet the expected time constraints of 25.

        Our stated goal is to have a patient in the room on time and out in an hour. That means our nurses are attending to patient preliminaries on time.

        Patient flow structure is designed with what we call a facilitator. Her job is do to nothing more than keep us flowing. That means if one of the three of us in our practice hits a snag which threatens to throw us behind, she diverts non-checkups to the other two.

        Her task is to keep patients in on time, keep us on track (and yes she has the authority to boot me in the britches if I am dawdling). She is also trying to get us out by 5pm. Our flow is very streamlined.

        If you would like to see it in action, you are invited to call Linda, my practice manager, quiz her, and even arrange a time to come see how it works and talk to our parents. My office phone is on my web site.

        Warmest regards,

        Ron Smith, MD
        www (adot) ronsmithmd (adot) com

    • Karen Freitag Franz

      Oh my goodness Doctor Smith, you brought back many memories as a nurse in a busy peds office. Especially the parents that would bring five kids to an appt. for one, “could you look at Johny’s throat and is this a plantar wart on Jimm’s foot?”We did well babies on Tuesday and thursday,sick kids Monday and Friday and left all the post lunch appts, for sameday call-ins. We still were never out before 6pm. with the last appt. at 4.

  • rtpinfla

    I work very, very hard to see patients on time for the exact reason that their time is as valuable to them as mine is to me. I always keep an open slot in the morning and one in the afternoon to help buffer when extra time is needed or to work an acute patient in. When patients do show up late, my policy is to “work them in” when I can or they can reschedule. That
    way I can continue to see my other patients on time and I can usually get them in within 45 minutes.
    Sometimes, despite all this, I find myself behind schedule and always apologize for making the patients wait when that happens. That simple act of acknowledgement is always appreciated.

    • SpringTexan

      You are the doctor we all want. My allergist always had some open slots for say acute asthma although it took weeks to see him for a routine appt and I love a doctor like that. My opthalmologist takes about 8 months to get a routine appt scheduled, but when I had something that needed to be looked at he also had an opening right away (and was able to determine that it was NOT a detached retina, hurray). I loooove doctors like you, you are a shining example of the ideal.

  • MKirschMD

    When being on time becomes one of the pay-for-performance ‘quality’ metrics, this may improve physician punctuality. We institute a fee for no shows recently, but it remains to be seen if this will change behavior. As stated, we’re not interested in the fee; we want timely cancellations. Excellent comments all.

    • querywoman

      When I worked in public welfare, thanks to Bill Clinton, I had to verify vaccines. One woman told me she couldn’t afford to pay a Nurse Practitioner $2 for proof.
      I talked to the NP on the phone, who told me she wasn’t interested in the two bucks. She said that if she didn’t charge, they’d be in there every day wanting one.
      I accepted her phone verification.
      As for your no show fee, only you can decide to impose it.
      When my mother was dying of lung cancer, I totally forgot and missed two appointments with my endocrinology chain because I was busy with her. I told her that I would not let that happen again.
      They didn’t charge me, and never even brought it up.

  • buzzkillersmith

    Well, if they could charge me the same for being late as I could charge them, I’d being paying out a heck of a lot of money. Have a little sympathy. Don’t be a jerk.

  • NewMexicoRam

    The #1 reason I get behind? A late patient.

  • head_and_brain

    If you are prepared to charge patients extra for coming late to the appointment, expect patients to ask for the same. I remembered a physician wrote a book called When doctor becomes patient (not the exact title), the doctor, who later became a patient,
    felt humiliated when other doctors treated him like a patient,
    and he wrote he finally came to understand why patients did not feel being respected.

  • Patient Kit

    Twelve years ago, I walked into my orthopedist’s office on a Monday morning in severe pain. He had been treating for me for sciatica. But an x-ray showed that I had a fractured femur, not suspected because I suffered no trauma. Turned out I had a tumor in my bone that caused the break. Benign, thankfully. He had, no doubt, not planned on the time he needed with me that morning and I’m sure I messed up his schedule for the whole day. I went from his office by ambulance to the hospital and he did emergency surgery on me that evening. So, I understand why doctors can be late because of previous patient emergencies.

    At the same time, I had one doctor who I know double booked. We patients, waiting in the waiting room for hours, had plenty of time to talk and compare notes. Everyone agreed that there was an excessively long wait every single time. I stopped going to that doctor.

    As for charging patients for being late, legitimate things happen on our end too that cause us to sometimes be late. I think only repeat offenders should be charged. And I agree with the first commenter who said that doctors who are habitually late, teach us that we might as well be late too. Most people have to take time off from work for doctor’s appointments. Our time is valuable too.

    To sum up, as long as lateness is not a repeated pattern by either doctor or patient, I think we should cut each other some slack. Unforeseen things do happen.

  • leslie fay

    SERIOUSLY? I have never been late for an appointment but i have spent HOURS waiting for doctors. i can’t imagine what the total number of hours would amount to if tallied up. i have had some make excuses but if someone is ALWAYS late it is because they are overbooking. You can see on the sign in sheet how many people have an appointment at the same time as yours. I (briefly) had an orthopedist who was routinely 2 hours late. minimum. His staff tried to tell me it was because he was doing surgery…..unless you are an obgyn that is just B.S. It is total disrepect for patients who are frequantly in pain or just plain miserable or they wouldn’t be there in the first place. I understand that occasionally something happens, and I can live with 15 minutes or so but it should not be routine.

  • Sea Span

    if a patient is late and is going to make the next one late, take an early bird in and make the late one wait till there is more time. they can take the second or third persons slot. we have to make an appointment 2 weeks in advance so if the doc is late, too bad so sad on the patient. hurry up and wait. it would be nice if there were a solution but i don’t think there is. i have to go to doc in a box for anything that requires me to see someone that day. it is like i don’t really have a doctor, he is only good for routine things, i.e. physicals. if i break my arm or have a sinus infection, it is doc in the box. i try hard never to see doctors as i find the whole system totally frustrating. it is not like when i was a child and broke my arm, i was driven to my doctor and he set it. done.

    • Josy Coke

      Maybe you should look around for a new primary care if have to go to “doc in a box” so much.

  • querywoman

    After I worked in public welfare a while, a really low paid person working one-on-one, I developed more empathy for doctors who run late.
    You don’t how much time a patient demands or needs. Then when you have a thousand phone calls, it’s not because you don’t care if you don’t return them all.
    Sometimes, you have to shut down and go home for your own sanity.
    I don’t think you should charge more for a patient being late. Reschedule if you have to.

  • querywoman

    And that’s why real doctors run late.

  • Dinah

    In Maryland, there is currently proposed legislation in the General Assembly that states that if a physician begins the appointment more then 30 minutes after scheduled, it can not be billed for or claims filed for it. If the doc is late, free treatment. In fact, it’s worded such that if the appointment starts late because the patient is late, the treatment is free, the only exception is if the doctor can give the patient an “emergency verification services number” for an earlier emergency. The bill won’t pass, but I find it sad that a lawmaker wants to make a public statement of an adversarial relationship with doctors. Maybe everyone should be on time.

    • Josy Coke

      Are you sure you worded that right? ” it’s worded such that if the appointment starts late because the patient is late, the treatment is free,”

      • Dinah

        The bill as proposed is worded such that any appointment that begins more than 30 minutes after scheduled can not be charged for, with the only exception being if the doctor presents the patient with an “emergency verification services number.” (I have no idea what that is). As written, it would mean if the patient is late, the service is free. I’m sure that was not the intent. I can’t imagine the bill will go anywhere.

        • Josy Coke

          well if “the patient is late” I’ll just show up to every appt late then.

  • DoubtfulGuest

    Thank you for mentioning this. I have called almost every time and they are usually very understanding. I try to just allow myself extra time to get ready these days, knowing how spectacularly things can go wrong. But the staff absolutely deserves the courtesy of a phone call if we’re running behind.

  • Teresa Brown

    A doctor who runs late once in a while doesn’t bother me, but when it’s a chronic issue, then I do feel the patients should be compensated in some way. I like my family doc, but I can count on waiting at least an hour past my scheduled appt. before I actually see the whites of her eyes. I am someone who is rarely late, and if I am running late, I call to let whoever is waiting for me know why I won’t be there on time. I remember calling my family doc’s office once to tell them I was running about 15 minutes late; we’d had a patient emergency so I couldn’t just up and leave. Well…you would have thought I’d been caught killing bunnies. “I don’t know if we can accommodate you; you might have to reschedule.” It turned out that I arrived on time and, you guessed it, waited almost an hour past my appt. before I was called back, then another 45 min. before I saw the doctor. I do give my oncologist a lot of latitude when she runs late, because I know there have been times she sat and talked with me longer than what was scheduled.

    • Suzi Q 38

      You make some good points.
      My neurologist spent about 30 minutes with my daughter and me last visit. That had to have made her a bit late for the subsequent appointments.

  • Teresa Brown

    Most doctors’ offices don’t use nurses. Their “office nurses” are generally MAs that are just called nurses. another issue for another time.

    • Josy Coke

      Yeah you probably don’t want to get me started on that because it seems that you don’t know what Medical Assistants are trained to do, and their scope of practice. I see that you were a nursing student 30 years ago. It’s time you roll with the changes.

      • Teresa Brown

        I’ve been a nurse for almost 30y and have worked with MAs off and on. I do know what they’re trained to do. They can be a valuable asset to a practice, but they are not the equivalent of licensed nurses. You don’t stay in this profession as long as I have without “rolling with changes.” As I said, this is a topic for another discussion.

  • Suzi Q 38

    Most of the time, the doctor is late.
    My surgeon was an hour late to my minor surgery.
    What made him late?

    Lunch hour.
    Just guessing, but it is not proper to ask the surgeon why he was so late before my own surgery, LOL.

    • querywoman

      Maybe he ran late before lunch and he is a diabetic who had to eat lunch.

      • Suzi Q 38

        True.
        A bit farfetched, but remotely possible.
        I didn’t complain.

        • querywoman

          It would have been different if he had explained it.
          When I began working in welfare, I was apparently dealing with rising blood sugar levels. I would run late going to lunch, like an hour or more when I ran late with my clients.
          And it wasn’t good for me at all!
          But I didn’t understand.
          Think about it. Suzi Q, whether the doc is diabetic or not, he or she should still eat and care for himself or herself properly to be able to best care for you, even for minor surgery.

  • Janice Lynch Schuster

    All of my doctors charge no-show fees of $50 or more. And several refuse to see folks who show up late. As someone else notes, when I am seeing a doctor who routinely keeps me waiting a long time (eg, more than 15 minutes) I feel no compunction to arrive on time. I once had a provider who paid pts $10 if we waited more than 15 minutes. But just sticking someone in an exam room to wait does not count as being seen on time. I understand that emergencies arise, but in a recent visit to a doctor, she was in tears because her staff had triple-booked every appointment for her entire day. Everyone suffers from that kind of “planning.” Everyone’s time is valuable, no matter what color your coat.

  • rbthe4th2

    Ours will!!! My other half went to the ER with a sinus issue … no lie.

  • rbthe4th2

    Not mine. Believe it or not I was 7 min. late and got blamed the whole time, down from the nurse up to admin, when I asked their procedures if someone was late.
    The doctor was more than one hour late. I won’t go but for anything other than scheduled appts. from now on and give my $$$ elsewhere.

    • Josy Coke

      There is always one… Find a new practice? I work in an extremely rural area, and we even have options here. Plus, you mentioned an urgent care, that should be the place you use for the reasons you mentioned in the other post if there are no other practices to use. Be an advocate for yourself.