Almost overnight, the COVID-19 pandemic has changed many aspects of the American health system as we know it. The impact on inpatient facilities has been significant as those facilities have been caring for many of the sickest COVID-19 patients.
The ambulatory system as well has been profoundly impacted by the pandemic. Many ambulatory practices have seen reductions in patient volumes as patients have avoided doctor’s offices for fear of contagion and elective procedures have all been put on hold. Primary care offices have seen initial declines of about 50% in their visit volumes, while procedure-based orthopedic and ophthalmology practices experienced declines upwards of 85% in some cases.
In NextGen® Advisors’ conversations with clinical leaders, many spoke about the changing role of the waiting room in their organizations. In several instances, practices were avoiding using the waiting room, allowing patients to wait in their cars and only come into the building when texted by the staff that their exam room was ready. All the leaders we spoke to described avoiding use of the waiting room and exam rooms altogether by quickly implementing virtual visit capabilities.
It is clear that the central role that the doctor’s office waiting room has played for over 100 years has been diminished by the COVID-19 pandemic. Doctor’s office waiting rooms were very different in the early 19th century when ambulatory care was delivered in dispensaries, these were early versions of today’s ambulatory clinics. Waiting and patient care all occurred in a large room with little separation between these activities1. In the 1920s, dispensaries’ waiting rooms were often crowded continuously as individual appointments were not allocated, rather patients were expected to arrive at 8:00 a.m. or 1:00 p.m. and wait for hours until they were seen by the doctor. At the time, physicians were very reluctant to switch to a system that provided individual appointments to patients citing reasons such as staffing constraints and patient inability to keep appointments reliably1. Even when individual appointments became the norm, waiting rooms continued to be congested and patients by and large accepted a reality in which they often spent more time in the waiting room than in the exam room. In an article aptly named “The waiting room ‘wait’ from annoyance to opportunity”2 the authors reconciled waiting room time as a constant and proposed utilizing that time for patient education activities. Surveys of primary care offices show how patients feel about their physician encounters and the quality of their health care is directly related to the impression of their time in the waiting room.3 For example, longer waiting times are associated with lower patient satisfaction.
It is still too soon to predict what the long-term impact of the COVID-19 pandemic will be on the delivery of ambulatory care in the U.S. However, many believe that virtual visits are here to stay. It is expected that patients will choose not to return to the doctor’s office waiting room, preferring to interact with their providers virtually from the comfort of their homes when possible. It is also clear that in the future, some patients will still need to be seen in person and waiting rooms might continue to maintain a role in the ambulatory clinical workflow post COVID-19. Waiting rooms clearly will no longer be at the center of this workflow, and both patients and doctors will not be shedding a tear if this turns out to be the case.
1Modern American History (2019), 1–7 doi:10.1017/mah.2019.10
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