The decision, which was first reported by Politico, will apply to adult primary care, virology, geriatrics and pediatrics across all acute care facilities and Gotham Health sites, according to an internal memo shared with Crain’s. The hospital system will also be lengthening the time between some revisit appointments in order to diffuse the burden on its resources, the memo said.
Since 2021, public hospitals have seen nearly 50,000 more primary care patients, according to H+H spokeswoman Stephanie Buhle. Wait times for the third next available appointment (a common metric because first and second appointments are often free due to cancellations) have gone from 12 days last year to 22 days this year, she said. With 40% of patients missing their appointments, doctors will get additional time back to complete cases, she added.
The influx of migrants to the city has also increased the demand for new primary care appointments at the public hospital system, which primarily serves people who are uninsured or on Medicaid, said Dr. Frances Quee, president of Doctors Council, a union representing 3,000 doctors in New York City and the Chicago area.
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The 20-minute clock will apply not just to the time a patient sees a doctor, but also the time it takes to review a patient’s charts beforehand and write orders and notes afterward, explained Dr. Andrew Goldstein, a primary care physician at Bellevue Hospital in Kips Bay, who was briefed on the change and called it “utterly inadequate.”
Obtaining interpretation services, needed for a large proportion of H+H clientele, also digs into a doctor’s time with a patient. Buhle said the wait time for a Spanish interpreter is now “less than 10 seconds,” though Goldstein noted 10 minutes was not atypical for language services in general.
“I’m not going to rush and put my license on the line,” said Quee, a pediatrician at Gotham Health, Belvis, in the South Bronx.
New patients will end up with longer appointments when they need to see other clinicians, like social workers, behavioral care specialists and imaging, according to Buhle. The hospital will also add more physician assistants to support doctors, including by handling prior authorization. But doctors said many of the tasks required of a first visit could not be delegated and the work of an assistant still requires their review.
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Quee said the decision was made by hospital administrators without consultation with front-line staff. Many doctors were blindsided by the news when they were told recently. H+H administrators will hold two webinars on the changes for patient-facing doctors in early September, according to the memo.
In a town hall last month, H+H President and CEO Dr. Mitchell Katz told members of the Doctors Council that 20 minutes was sufficient for new appointments because patients could be scheduled for a follow-up visit if more time is needed, according to Quee and Goldstein, who is also part of the union. Buhle defended the statement, saying it benefits patients to return after lab results have come in.
“So this was something they were already thinking then,” said Quee, “they’re just bringing it up now.” Goldstein called the proposition “a huge waste of time” and “risky” for patients with health complications who may need more attention.
This story first appeared in Crain's New York Business.
