Of patients and doctors; the social cost

After stating in my previous blog the problem, as good engineers do and I'm one, let's make a gross analysis of the impact of this practice. To start with, except for the San Juan Metropolitan area, public transportation is practically non existent in Puerto Rico. That means that every patient has to take his or her own vehicle. The first obvious consequence is on city traffic and congestion. If you look at the times patients have to go to the doctor’s office to write their name down in the roster, it’s the rush hour in the morning or in the afternoon. That's right doctors, you are helping make traffic worse at rush hour. And in the country with the highest concentration of motor vehicles per capita in the world ...

But the problem becomes even more interesting when we include parking space in the picture. Of course, early birds will get the best spots. The rest will have to drive around for 10 to 15 minutes, at best, looking for someone leaving a parking place on the street or parking lot. Yes, as expected, parking lots are packed all the time, and the vehicular space rotation is very low. Cars will stay parked for several hours and so, your best option is to continue driving until someone leaves an empty space. The 10 to 15 minutes I gave above is my empirical estimate. Now, there are three clear outcomes up to now: unnecessary and increased gas consumption and air pollution, these two caused by driving around searching for a parking place, and parking congestion, not to mention the frustration, anger and stress.

Now, allow me to use my very rusty knowledge about classic telephone traffic (before VoIP and other digital systems) and extrapolate it to parking congestion analysis. I’ll avoid being mathematically formal. When I studied telephone traffic a long time ago, the traffic unit was the Erlang. One Erlang is one call using a telephone line for one minute. Let’s now define a parking congestion unit as one parking spot busy for one hour. For brevity, let's give this unit a name: a "Car-lang". I just came up with this name so that it sounds similar to the telephone traffic unit. Probably, vehicular traffic engineers have an appropriate name for it but I don't know it. With this definition we can say that each patient generates 3, 4 or 5 Carlangs since his or her car will occupy a parking space for 3 to 5 hours, the waiting time in the doctor’s office. Let’s be optimistic and suppose that it’s just 3 hours. Then, each patient generates 3 Carlangs. (Doctors, I’m making you look not too ugly). Suppose a doctor sees 40 patients per day (believe me I know some doctors see more than 40 patients per day). Each doctor is responsible for 120 Carlangs, and I'm being easy on the waiting time and not too bad on the number of patients per day.

Now let’s imagine the doctors gave appointments by date and time (imagination is our only hope for the time being) and let’s use a pessimistic estimate of the waiting time of 1 hour. In this case the parking congestion generated by each patient is 1 Carlang. Assuming again that a doctor sees 40 patients per day each doctor giving real appointments would generate 40 Carlangs. The math is simple. By giving an appointment by date and time the parking congestion is reduced to a third, at least! That means lower parking cost for the patients, significantly reduced congestion and higher vehicular rotation in the parking spots. Guess what else: higher probability of finding a spot, thus reducing driving time searching for a place to park. And since patients need to go at the time of the appointment instead of the rush hour, there is a better distribution of traffic over time of the day in the cities. And the parking issue does not stop here. Even the parking businesses would make more money. Why, you ask? The first hour in a parking lot is most of the time the most expensive. The customers that generate the highest gains are those that leave their car in the lot for less than one hour.

Now let´s analyze the monetary aspect due to time absent from work. If the waiting time is 3 hours the patient for sure has to ask for at least half a day of leave. And this is optimistic. In many cases patients miss a full day of work. Again, I'll go easy on doctors. Assume that each patient is absent half a day, 4 hours. Assuming the patients earn $7 per hour, the cost for the patient's employer or to the patient is $28. If instead of missing 4 hours the patient had to be absent 2 hours, the cost would halve! As I said, this is an optimistic estimate because many patients earn more than $7 per hour and many loose a full day of work. Doctors, in addition to your cost, which is around $30 for non-specialist, which you charge to the insurance company, you are generating a high cost to the system. Your real cost is at best $58 per patient. Of course for a specialist this cost is significantly higher.

The impact does not stop there. There is also a health impact. A reunion of sick people in a waiting room is propitious to share bacterias and virus, in other words, spread infections. Add the stress of a long waiting time and you have low body defenses. The perfect soup to get sicker. And what about diabetic or hypoglycemic patients? They better take some food along or ...

And there is a cost for the doctors too. First they have to pay additional hours to their secretaries since they arrive two to three hours before the doctor does. Second, the waiting room needs to be larger as the number of people in the room is larger. If instead of 15 or 20 people in the waiting room there were only four to six the size of the waiting room would be significantly reduced. Plus the air condition system could be smaller and reduce the electricity bill. And water? Yes, water too. The shortest a person is in a place, the waiting room in this case, the lowest the probability that person is going to use the bathroom.

Surely there must be additional costs due to this hideous practice but I guess I got my message across, so I'll stop here.