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
    Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


    1. 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. 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.


    3. 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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