The future of physician waiting rooms

The COVID-19 pandemic led to a near-overnight revolution in many parts of health care, and nowhere was this seen more than in the waiting room. Now that things have changed, what does the future hold? Medical Economics® sat down with David Berg, president and cofounder of Redirect Health, to discuss the revamped waiting room. The following interview has been edited for length and content.

Medical Economics®: Is there a need to rethink the waiting room?

Berg: It always needed to change because it is hard to manage a waiting room. Sometimes it is too full; sometimes you wait too long. When COVID-19 hit, it had to change.

We had no choice. If it was once an annoying or irritating place to be, the waiting room became a dangerous place to be. We didn’t have the option of ignoring that at the beginning. If you go back to March 2020, when COVID-19 first started, literally over a weekend we had to change the waiting room. [If] we didn’t have COVID-19, I don’t think we would have changed at this point, at least not to the degree we have.

What are some of the issues with the traditional waiting room?

You have to keep it clean and manage the volume in it. And, if doctors are on time, it usually works well. But if a doctor falls behind, then there might be 2 or 3 patients waiting, maybe 4, maybe 5, and that also affects the parking lot. The longer people wait, the more parking spaces you need because you don’t turn over the parking space. There is a logistical challenge to waiting, whether it is waiting for a parking spot or waiting in a waiting room, and COVID-19 simplified that because people could not wait in the waiting room any longer. The parking lot then became part of the waiting room.

How else has COVID-19 changed the way a patient waits for an appointment?

I like to think about it as the entire journey of health care, from start to finish. The waiting room is just 1 thing out of 50 things in the middle of it. We must continue to have the health care journey go from end to end.

The biggest way we had to change was to figure out [which] parts we could do virtually or remotely. How could we do those and separate them from the office visit? For instance, when you pay your co-pay at the front desk, there is no reason that can’t be done over the phone from home. When the nurse or the medical assistant confirms your medications, that can happen over the phone. Many parts of the in-office visit, if we segment them appropriately, can be done beforehand at home—whether it’s chart prep, taking history or verifying meds, like I mentioned, or even just [asking about] the problem: What are you worried about today?

We can do all of that [beforehand]. If you think about it, exam rooms and waiting rooms expanded to include your home, car, or office. So many things we used to do in the exam or waiting room now can happen on your drive in to see us, at work, or the day before at home. We have all heard of drive-through COVID-19 testing, which really didn’t happen before. I got my vaccination sitting in my car. Before COVID-19, both of those things would have been considered highly unprofessional. But it became necessary when exam and waiting rooms became dangerous because of the risk of infection and the uncertainty of the virus.

What can doctors do to make the waiting room experience better for their patients?

The obvious [thing] is to eliminate the amount of time in it. An easy way to do that is letting people sit in their car until you are ready for them. The car becomes the waiting room. Why is that advantageous? Some people like to work while they are waiting, and it could be easier to take a phone call in the car than in a waiting room. Similarly, at home, you have more freedom to do the things you want to do.

Now that people have gotten used to not waiting for doctors, without being able to replace that waiting with something else valuable or necessary in their life—call it emails, texts, or phone calls—I don’t know that people, especially young people, [will] ever go back.

Pre–COVID-19, the number of people who were in doctors’ offices was disproportionately older than younger. When I say older, I mean older than age 40. Older patients are accustomed to going to see a doctor when they need something.

Patients who are millennials are used to getting a lot of things, whether it is pizza or an Uber, from their phones, so it is a normal way of doing things for them. Younger people haven’t used health care to the same degree that older people did pre–COVID-19. When COVID-19 hit, suddenly they didn't have the choice of not seeing doctors because of the need for testing for COVID-19 or vaccinations.

We took care of them, for the most part, virtually. There is very little with COVID-19 you can’t start virtually. Younger people who have been forced to use the health care system because of COVID-19 have experienced a more efficient health care journey than [what] existed 2 years ago for them or anybody else. This includes waiting room, exam rooms, decision-making, and prescribing.

Can the in-office physician learn anything from telehealth regarding their waiting room?

Unlearn how things happened before and start all over again—but start with what makes sense to you. How do you already take care of your kids? How do you already take care of your family? How do you already take care of your neighbor’s family? How do you already take care of your family who is out of state? Look at how you already take care of these people, and you will quickly recognize that rarely do you tell your spouse, “Make an appointment with me, and I’ll see you in 2 weeks.” It just doesn’t happen.

Segment the parts of the office visit into the parts that could be done virtually and the parts that must be done in office. You will learn that about 70% of the time, you can do all of it virtually and need to follow up in the office only if it didn’t work. Other things are more obvious. Maybe you want to listen to the heart [or] the lungs—technology is coming that allows you to do that from home.

It’s not easily available, just as fax machines needed both parties to have the equipment for it to work. It is not that far down the road where we could take care of a lot more things from the home using technology. I would recommend that doctors separate the office visits into what can be virtual and what doesn’t have to be, and do everything they can to front-load the virtual visits.

The challenge is that a lot of the business models are based on fee-for-service, which means a payment mechanism doesn’t exist in the business model for that. But put the business model aside because there will be one soon, and many insurance companies and payers are wising up and are rewarding doctors for taking care of people outside their office. Up to 2 years ago, if you didn’t come in my office, I couldn’t get paid. Every time I helped you over the phone, I was doing it for free and it actually cost me money. The business model has had the chance to change, and COVID-19 has helped that.

What do you see the waiting room looking like in the future?

I think it will be smaller and easier to manage because if we get full, we can use technology to extend the waiting room into the car. That technology was always there, but now it is being used by everybody. In our offices in Phoenix, every patient is used to [waiting] in their car. We ping them via a text, and we take them right back to the exam room. Patients bypass the waiting room except for walking through it. I can’t see how that is not going to be the way of the future. We are starting to see innovative concepts today that blur the line between the waiting room and the exam room with self check-in. When you consider what you can do over your phone from your car sitting in the parking lot, we have really blurred the lines.