By August 30, 2007 3 Comments Read More →

Your Dermatologist Might Not be FIFO

Patients get appointments for Botox faster than for moles: study

You might expect that a doctor’s office either takes appointments in terms of:

  • FIFO (first into the queue, first out — first called, first seen) OR
  • Triage priority (more serious or time critical cases first)

Here’s an article with a study that suggests that some dermatologists are giving expedited priority to high-profit Botox customers over those who have concerns about potentially deadly skin cancer.

“The study was conducted last year by telephone with researchers posing as patients, contacting 898 dermatologists in 12 US cities.

In Boston, for example, the median wait for a Botox session was 13 days while it was nine weeks for an examination of a changing mole.”

This was repeated in multiple cities and the study author said:

“It was possible doctors wanted to offer faster access for Botox treatments “because of higher relative payments for cosmetic services,” the study said.”

You might understand Dell choosing to build a huge order of expensive PC’s first over a few smaller orders for a single $399 PC…. that’s profit maximizing. But, as much as healthcare likes they say “they’re different”, this seems like once case where they are NOT different, and maybe they should be.

What do you think? I assume we have mostly patient perspectives here…

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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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3 Comments on "Your Dermatologist Might Not be FIFO"

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  1. Doug B says:

    It sure sounds like prioritizing the business decision over the medical decision. The article stated that it was “unclear why the wait times varied so dramatically.” It would have been nice if they had been able to go to the gemba and ask the dermatologist’s office!

    One possibility may be that there is some constraint in the mole evaluation process that does not exist in the Botox process. Maybe the mole appointment needs a larger block of the doctor’s time, while 95% of the Botox process is handled by a less constrained resource (nurse, physician’s assistant)?

    Having never worked in a doctor’s office, I don’t know much about the process, but my guess would be that they block out certain days for certain procedures, e.g., I’ll do Botox procedures on Tuesdays, Wednesdays and Thursdays, treat acne on Mondays, and look at cancerous moles on Fridays. Therefore, if they have not analyzed their demand correctly and levelled the loads in the correct proportions, the wait for certain procedures will be longer.

  2. Jim says:

    This is quite the interesting point Mark… The last time I needed to see the dermatologist (it wasn’t life threatening but a serious issue that had been going on for a month) and after many phone calls the the earliest appointment was two months away.

    This situation really creates quite the debacle because your alternative at that point is to use the ER which in turn causes more problems like higher costs for the patient, overcrowded ER’s with people who don’t need triage and huge wait times for patients.

    -J

  3. Mark Graban says:

    I had a problem with this first hand, having to get a dermatologist appointment for a problem with my arm. I was quoted times in the terms of MONTHS before I could get an appointment near my house. I ended up driving 30 minutes and seeing a physician assistant instead of the dermatologist.

    Next time, I’ll lie and say “botox.”

    I heard a story on APM Marketplace about the this. A defender of the dermatologists said “well if you think you have cancer, you should INSIST on being seen ASAP, they hold time for emergencies.” Nice, dump it all back on the customer.

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