Don’t be fooled by a full waiting room—ambulatory care offices are being left behind

Having an empty waiting room might seem like the least of many doctors’ worries right now. While ambulatory visits dropped precipitously at the start of the Covid-19 pandemic, urgent care clinics in particular quickly rebounded as testing services brought long lines of patients to their doors. Primary and specialist care practices endured a longer slump, but are now seeing a surge of pent-up demand in patients with chronic disease for consultations, wellness checks, and treatments.

But practitioners shouldn’t be fooled by this illusion of sound business performance. Neither of these short-term trends represents sustainable revenue. The demand for testing is already waning, and patients are catching up with deferred care. In fact, as normalcy returns, many practices could find their business performance stuttering over the next few years  due to long-established but recently accelerated  trends in patient preferences and care delivery models. It’s these hockey-stick trends that doctors need to be focusing on now—because a new generation of competitors already are.

Today’s patients have expectations that traditional healthcare provider’s offices are ill-equipped to meet. They want faster access to care, more convenience, and greater control over their care delivery through price and experience transparency. In short, they want to shop for their care. And this isn’t just an idle wish—it’s an active choice they are making. With digital-first models redefining the patient experience, traditional medical practices need to evolve quickly to avoid losing their patients for the long term.

Patients are losing their patience with traditional medical offices

In this Amazon age of instant gratification, having what we want and need at our fingertips applies to more than just how we order from Starbucks, or how we get a ride to the airport. It is now part of the fabric of our on-demand society. A follow-the-money approach makes clear exactly what is happening. Over the last three years, investment in digital-first companies that lack brick and mortar assets has doubled every year. This year, we are on track to exceed $28 billion of investment capital fueling the growth of digital-first healthcare companies. No matter where you sit in the ambulatory continuum, whether primary care, a specialist, or urgent care operator, you will face challenges with new digital-first competitors.

Traditionally, primary and specialist care practices have been founded on loyalty to the doctor-patient relationship, with patients willing to wait weeks or even months to see their customary practitioner.  This model may have worked in earlier times, but it’s jarringly out of sync with a digital era defined by instant gratification and consumer-centric services. Survey after survey shows that patients prefer convenient access and transparency of cost and experience over continuity of provider and practice loyalty. People who can have virtually any consumer product delivered to their door in a day or two want an even faster response when their health is at stake. They might try their usual doctor first, but they’ll quickly turn to whoever can see them fastest, whether it’s an urgent care clinic, an online provider, or the digital ad that pops up next to the web search results for their symptoms. That is the moment you have lost your patient to a competitor. Recent data suggest the traits that people value most in a medical practice pertain to access and convenience—being open late, transparent pricing , same-day appointment availability, and offering weekend hours. Only when these baseline needs are met do they turn to the kinds of things that used to come first, like provider pedigree and community reputation.

Decades ago, in response to the developing wave of consumerism in healthcare, urgent care centers began to get traction. Offering no-appointment availability, a wider array of services, and cash pricing, these centers took off and covered the primary care “gap” while offering an alternative to the emergency department. While urgent care centers are better suited for today’s convenience-driven patients, with more active marketing and customer acquisition built into their operations, their fragile patient loyalty leaves them highly vulnerable to disruption. If they’re unable to retain current patients and unable to compete for new ones, their business can vanish quickly. Many urgent care operators are not feeling the economic impact of the rise in consumerism being fueled by our growing on-demand culture. Covid testing, rapid closure of primary and specialty practices to in-person visits, all contributed to sustained patient volumes for urgent care companies that jumped on the testing wagon early and aggressively.  The rest of the ambulatory and outpatient business is now catching up. How they approach this will determine their survival in today’s new world of healthcare consumerism.

The experience patients receive in the typical ambulatory care office—primary, specialist, laboratory, or imaging center—is hardly a compelling competitive proposition. Once upon a time, patients just accepted that they’d have to endure a long wait in a crowded waiting room with outdated magazines and a loud television that just made them feel worse. In fact, strategies around patient retention often included optimizing television channel selection for non stressful subject matter—no news stations. But they’d still be handed the same clipboard every time to fill out the same forms, writing their names again and again on the top of each page. They’d struggle to understand their insurance, fumble for the copayment that is often different with each visit type, and reach the examination room frustrated and demoralized long before the doctor was ready to see them. Why wouldn’t patients leap at the chance of a better model that has stripped out the friction?

Once you stop taking the loyalty of patients for granted, it becomes urgently clear that they’re desperate for a better way of accessing care. And digital-first providers are ready to offer it.

Redefining care for the digital era

The essence of the traditional medical practice is to be the first point of contact for every type of condition, at every stage of life, for every type of patient, with referrals given as needed. A new breed of digital-first companies are taking a more surgical approach. Instead of owning the entire spectrum of health, they target a specific subset—a particular cohort of individuals with a specific disease type, such as migraine headaches, diabetes, or sexual dysfunction. And they don’t want to just own a piece of this business—they want to manage the entire continuum from initial diagnosis to management of complications. This business model might not seem like an immediate threat, but its impact over time should be deeply concerning.

These are exactly the type of long-term relationships that the traditional primary care and specialist practice is built on, but now they’re going to be built by digital competitors—and in the areas of health that matter most to these patients. These companies have incredible reach with sophisticated techniques to intercept your patients in their search for care. Early data suggest they may also be able to provide better outcomes as well. Bit by bit, as patients opt into these digital first delivery models, often through online membership programs, traditional brick and mortar primary and specialty care will end up operating in the ‘last mile’ of care—the point where the digital provider tells patients they really do need an in-patient visit. At that point, the patient is ‘on their own’. Providers in these national digital-first platforms will rarely, if ever, be local and have a full understanding of the referral opportunities, local health system reputation, etc. That’s a bad situation for patients and doctors alike.

Delivering a digital-first experience within a primary care office

With a slight business model recalibration, traditional brick and mortar medical offices really are in the best position to help patients. There is no doubt that substantial value exists in locally delivered healthcare, as opposed to care delivered via a national digital platform. Local industrial and historical knowledge are paramount to quality care within a defined geo. With a local office, and a referral base in the patient’s own community, the doctor can provide a higher level of care across every aspect of the patient’s health. But to accomplish this, doctors have to keep digital-first providers from picking off their patients at the top of the funnel and putting them on a different trajectory leading away from the traditional care office. That means finding a way to meet the expectations of digital-era consumers within their own business model, so that patients never have a reason to look elsewhere. Fundamentally, it is easier for traditional brick and mortar healthcare businesses to move toward a digital “front door” to their practice, than it is for a digital first national organization to offer in-person services and cover the “last mile” of care.

To make this evolution, doctors need to embrace a mindset of consumerization—designing every aspect of the experience they provide around the needs and preferences of their patients. People seeking care shouldn’t have to sit in a waiting room filling out forms and wondering how many other sick people have used that same pen. Instead, have them provide that information online at home, before they come in—and figure out their insurance benefits for them so they don’t have to. Let them relax in their own car until their examination room is ready, and send them a text telling them the provider is ready to see them. Build more time for walk-ins into your schedule so you can offer same-day care. Shift more consultations to telemedicine by intermingling telemed and in-person scheduling. Don’t just tinker around the edges with updated waiting room magazines—work with a trusted business partner to fully modernize your practice and patient experience.

It’s important to remember that most patients are happy with their doctors. They’re not looking for a reason to leave—all things being equal, they’d much rather stay. By providing the same kind of patient-centric experience as digital-first providers, with the added benefits of a local, in-person practice, doctors can give their patients every reason to stay.

Photo: simonkr, Getty Images