Association for Public Policy Analysis & Management

Many physicians face increasing stress to see more patients in the same or less time. This leads to crowded appointment schedules and increased schedule disruptions. I examine how physicians respond to schedule disruptions, instrumenting for appointment start time with the office arrival time of the physician’s previous patient. I use novel data from athenahealth, Inc., a national provider of electronic health records, medical billing, and practice management services. I find that when primary care physicians fall behind schedule, they truncate appointment duration, perform fewer in-office procedures, and record fewer diagnoses. The likelihood of a patient revisiting the primary care practice within two weeks significantly increases as a function of delayed appointment start time. Physician ordering behavior also responds to a schedule disruption. In particular, physicians who run behind schedule increase antibiotic and opioid painkiller prescribing and increase referrals of a new patient to a specialist. For patients with preexisting prescription drug regimens, physicians running behind schedule are less likely to change the existing course of treatment. These findings suggest possible unintended consequences of the increasing time pressures placed on physicians by policymakers and private payers. Implications may include higher health care spending and lower quality care.