how long does a doctor visit take

How Much Time Does A Doctor Visit Really Take?

July 4, 2022

First Stop Health

When you or a family member is not feeling well or hurt, finding quick care can be challenging. Doctor’s offices, urgent care centers and emergency rooms are three traditional options for care that are not time-friendly or convenient. Whether it’s travel time, transportation, taking time off work, cost or arranging for childcare, there are many personal factors to consider when seeking care at these institutions.

Transportation is one of the biggest barriers to accessing healthcare. 1 In fact, “Americans spend an average of 34 minutes on the road to a doctor’s office or other medical entity,” totaling more than an hour of travel time to and from an in-person visit. 2 This statistic excludes the time it takes with public transportation. Shockingly, 45% of Americans do not have access to public transportation and 3.6 million people do not get care annually due to limited transportation access. 3, 4

Another personal factor to consider is childcare. The average cost for childcare is $15 and $23 per hour and accessing childcare may not be easy. 5 Due to COVID-19, childcare centers across the U.S. are in short supply. 6

Now that we’ve broken down some personal factors, let’s look at the time it actually takes at a doctor’s office, urgent care center and emergency room.

A Doctor’s Office Visit

While having routine checkups with a primary care physician (PCP) is essential for overall physical and mental health, for non-emergent issues such as a sinus infection, rash or urinary tract infection, the time it takes to get an appointment with a PCP isn’t helpful. On average, Americans wait 24 days to see a PCP in-person. 7

Once in the office, patients wait almost 20 minutes to be seen, even with an appointment. 8 These wait times are sometimes longer and are another deterrent for seeking care. A recent study revealed 30% of patients left their doctor’s office due to long wait times. 8

After the time it takes to get to the doctor’s office and the time spent waiting, 1 in 4 doctors spend just 9-12 mins with a patient. 9 This is an inadequate amount of time for a PCP to cover symptoms and the patient’s history. Rushed appointments strain the doctor-patient relationship, diminishing trust and value-based care. The 15-minute care model is not beneficial to the patient. 10

If an illness emerges during a doctor’s office off-hours, there is typically no way to access care. U.S. adults are the least likely of high-income countries to have a primary doctor to seek care from and are the least likely to have access to care during off-business hours, leading them to seek care at an urgent care center or emergency room. 11 This makes the time to get care even longer.

The end result = 1 doctor’s visit is 2 hours (if you can get in to see a doctor before the average 24-day wait period)

An Urgent Care Center Visit

Much like a visit to a PCP, a trip to an urgent care center will take about two hours or more. But depending on the severity of your illness or injury and the number of other patients (and the severity of their illnesses or injuries), wait times can be much longer. Wait times in an urgent care center can range from 20 minutes to 90 minutes. 12

Unlike a visit with a PCP, urgent care center visits are much more expensive. The average cost of urgent care center visits range from $100 to $150 and costs can be higher or lower depending on insurance coverage, annual deductibles and copays. 13

The end result = 1 urgent care visit is 2-4 hours and costs can be confusing based on insurance coverage

An Emergency Room Visit

Higher-severity cases might bump a minor injury down the list, and emergencies aren’t scheduled. On average, the entirety of an emergency room visit is 2+ hours and costs more than $1,300. 14

Almost 60% of emergency room visits come outside of business hours. 14 So, after enduring the wait time and exam, the wait times roll over to the next day to see the referred doctor or to visit a pharmacy during regular hours.

A doctor should be someone a patient can trust. According to a recent study, 70% of providers told patients to go to an emergency room instead of an urgent care center, even though the patient indicated they would seek care at an urgent care center. 15 In turn, 56% of emergency room visits are completely avoidable and could save a patient thousands of dollars in out-of-pocket expenses. 14

The end result = 1 emergency room visit is 4+ hours, expensive and likely avoidable

Summary

Whether it’s an emergency or a routine trip to your PCP for a simple sinus infection, a doctor’s visit takes much more time than we anticipate. It’s never as quick or affordable as we hope. Plus, a patient must also take into consideration pharmacy wait times and travel times if a medication is prescribed.

As an alternative, First Stop Health Telemedicine and Virtual Primary Care provide fast, convenient solutions to a daunting necessity. You can’t just skip unavoidable medical care, but you can skip worrying about transportation, wait times, co-pays and time off work. First Stop Health members have 24/7 access to free, quality and convenient healthcare. Members can connect to doctors in under 6 minutes for Telemedicine and within 3 days for Virtual Primary Care. Our virtual doctors are board certified in their field of medicine, can treat patients in all 50 states and Washington DC, and have 10 years of post-residency experience, on average.

Learn more about our Telemedicine solution

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265215/
https://www.naplesnews.com/story/news/health/2019/03/03/americans-average-34-minutes-road-see-doctor-study-shows/3020326002/
https://www.apta.com/news-publications/public-transportation-facts/
https://www.aha.org/ahahret-guides/2017-11-15-social-determinants-health-series-transportation-and-role-hospitals
https://www.valuepenguin.com/average-cost-child-care#:~:text=Parents%20in%20U.S.%20cities%20generally,typically%20pay%20more%20per%20hour
https://www.americanprogress.org/article/costly-unavailable-america-lacks-sufficient-child-care-supply-infants-toddlers/
https://medcitynews.com/2017/12/patients-waiting/
https://www.fiercehealthcare.com/practices/ppatients-switched-doctors-long-wait-times-vitals#:~:text=Across%20specialties%2C%20the%20average%20wait,patient%20waits%20depending%20on%20location .
https://www.statista.com/statistics/250219/us-physicians-opinion-about-their-compensation/
https://khn.org/news/15-minute-doctor-visits/
https://www.commonwealthfund.org/publications/issue-briefs/2022/mar/primary-care-high-income-countries-how-united-states-compares
https://www.advisory.com/daily-briefing/2012/12/04/member-asks#:~:text=The%20Urgent%20Care%20Association%20of,as%20long%20as%2090%20minutes .
https://www.debt.org/medical/emergency-room-urgent-care-costs/
https://journals.sagepub.com/doi/10.1177/1062860617700721

Originally published Jul 4, 2022 2:00:00 PM.

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What Happens During a Wellness Visit?

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Jose Luis Pelaez / Getty Images

Importance of a Wellness Visit

What to Expect
How to Prepare

A wellness visit is a health check-up that is typically conducted on an annual basis. It involves visiting your healthcare provider to check your vitals, screen for health conditions , and develop a healthcare plan for your needs.

The aim of a wellness visit is to promote health and prevent disease and disability.

This article explains why annual wellness visits are important, what you can expect during the process, and how to prepare for it.

These are some reasons why wellness visits are important.

Prevent Diseases

Most healthcare visits are categorized under diagnostic care; when you have a health problem, you visit a healthcare provider who assesses your symptoms, diagnoses your condition, and prescribes a treatment plan.

A wellness visit on the other hand is a preventative healthcare measure. The aim of preventative healthcare is to help you maintain good health and prevent health problems before they develop. The goal is to help you live a longer, healthier life.

Wellness visits assess your lifestyle, evaluate health risks, and screen for health conditions, in order to prevent health problems or catch them in the early stages. Instead of waiting to see a healthcare provider once you have a health problem, the idea is to be proactive about your health and work with your healthcare provider to prevent health problems.

People tend to think that it’s fine to skip their annual wellness visit if they’re feeling healthy. However, a 2021 study notes that wellness visits can play a role in catching chronic health conditions early, as well as helping people control for risk factors that could cause them to develop health issues down the line.

Reduce Medical Costs

Wellness visits can help prevent disease and disability, which in turn can help reduce medical costs. According to a 2016 study, a focus on preventive healthcare can significantly reduce medical costs and improve the quality of healthcare services.

What to Expect During a Wellness Visit

A wellness visit may be performed by a healthcare provider such as a doctor, nurse practitioner, clinical nurse specialist, physician assistant, or other qualified health professional.

These are some of the steps a wellness visit may involve:

Family history: Your healthcare provider may ask you detailed questions about your family’s medical history, to determine whether you are at an increased risk for certain health conditions that may be passed on genetically .
Medical history: You may also be asked questions about your personal medical history. It can include information about any current or previous diseases, allergies, illnesses, surgeries, accidents, medications, vaccinations, and hospitalizations, as well as the results of any medical tests and examinations.
Measurements: Your healthcare provider may measure your height, weight, heart rate, blood pressure, and other vital signs. Doing this regularly can help you establish a baseline as well as track any changes in your health.
Cognitive assessment: Your healthcare provider may assess your ability to think, remember, learn, and concentrate, in order to screen for conditions such as Alzhemer’s disease and dementia.
Mental health assessment: Your healthcare provider may also assess your mental health and state of mind, to help screen for conditions such as depression and other mood disorders.
Physical assessment: Your healthcare provider may perform a physical examination to check your reflexes. They may also perform a neurological exam, a head and neck exam, an abdominal exam, or a lung exam.
Functional assessment: Your healthcare provider may assess your hearing, your vision, your ability to perform day-to-day tasks, your risk of falling, and the safety of your home environment.
Lifestyle factors: Your healthcare provider may ask you questions about your nutrition, fitness, daily habits, work, stress levels, and consumption of substances such as tobacco, nicotine, alcohol, and drugs.
Health risk assessment: Based on this information, your healthcare provider will evaluate your health, and determine whether you are at an increased risk for any health conditions.
Health advice: Your healthcare provider may advise you on steps you can take to improve your health, control risk factors, and prevent disease and disability. This may include nutrition counseling, an exercise plan, flu shot and vaccination recommendations, and fall prevention strategies, among other things.
Screenings: Your healthcare provider may recommend that you get screened for certain health conditions such as depression , cholesterol, blood pressure, diabetes, cancer, heart disease, or liver conditions. This may involve blood work, imaging scans, or other screening tests.
Medication review: Your healthcare provider may review your medication and adjust it, if required. This can include prescription medication, over-the-counter medication, vitamins, supplements, and herbal or traditional medication.
Referrals and resources: If required, your healthcare provider will provide a referral to other healthcare specialists. They can also provide other resources that may be helpful, such as counseling services or support groups , for instance.
Medical providers: Your healthcare provider will work with you to create or update a list of your current medical providers and equipment suppliers. This list can be helpful in case of an emergency.
Healthcare plan: Your healthcare provider will work with you to create a healthcare plan that is tailored to your needs. The plan will serve as a checklist that will list any screenings or preventive measures you need to take over the next five to 10 years.

The screenings, assessments, and healthcare plan can vary depending on factors such as your age, gender, lifestyle, and risk factors.

How to Prepare for a Wellness Visit

These are some steps that can help you prepare for a wellness visit:

Fill out any required questionnaires: Your healthcare provider may ask you to fill out a questionnaire before your visit. The questionnaire may include some of the factors listed above. Make sure you do it before your visit, so that you can make the most of your time with your healthcare provider.
Carry your medications: If possible, try to carry your medications with you to show them to your healthcare provider.
Take your medical documents along: It can be helpful to carry your prescriptions, immunization records, as well as the results of any medical tests or screenings you have had, to help give your healthcare provider a more accurate picture of your health status.
Ask someone to go with you: You may want to take a trusted friend or family member along with you for the wellness visit. They can assist you if required, take notes for you, ask questions, and help you remember your healthcare provider’s instructions.
Note down questions and concerns: A wellness visit is a good opportunity to ask your healthcare provider any questions you have about your health and tell them about any health problems or concerns you have. Making a list and carrying it with you to the visit can help ensure that you don’t miss anything.
Check your insurance plan: Most insurance plans cover wellness visits; however, what is covered as part of the wellness visit can vary depending on the plan. It can be helpful to know what preventative services and wellness visits your plan offers. It’s important to check that your healthcare provider takes your insurance and to inform them that you’ll be coming for a wellness visit when you schedule your appointment.

A Word From Verywell

A wellness visit can help you evaluate your health status, understand your risk for specific health conditions, and give you the information and resources you need to improve your health.

After you go for a wellness visit, it’s important that you start implementing your healthcare provider’s advice, take any follow-up appointments necessary, and take steps to improve your health.

U.S. Department of Health and Human Services. Get your wellness visit every year .

University Hospitals. What you need to know about wellness visits .

Liss DT, Uchida T, Wilkes CL, Radakrishnan A, Linder JA. General health checks in adult primary care: a review . JAMA . 2021;325(22):2294-2306. doi:10.1001/jama.2021.6524

Musich S, Wang S, Hawkins K, Klemes A. The impact of personalized preventive care on health care quality, utilization, and expenditures . Popul Health Manag . 2016;19(6):389-397. doi:10.1089/pop.2015.0171

Alzheimer’s Association. Annual wellness visit .

University of Michigan Health. Your yearly wellness visit .

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

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Reasons Why You Spend So Long Waiting at the Healthcare Provider's Office

Reasons for long wait times.

Acceptable Waiting Times
Strategic Scheduling

Deciding Whether to Wait

Tolerating a Long Wait

Patients are often frustrated that they make an appointment for a certain time, they arrive on time, yet they are kept in the waiting room for too long a time before they see the healthcare provider. When you understand why this happens, you can take steps to change it, or make it easier to tolerate.

We lose our patience because we believe the time just has not been scheduled well. But on any given day, healthcare providers may not be sure what services they'll be performing for individual patients, and some patients require more time for their services than others.

Equipment may break down. An obstetrician may be delivering a baby . There may even be emergencies.

Understanding that it's the volume of patients and procedures, not the time spent per patient, that comprises a healthcare providers' income, it's easier to understand why they get so far behind, and why we are kept waiting.

What Is an Acceptable Waiting Time?

An acceptable amount of time to wait will vary by healthcare provider and the type of practice she runs. In general, the more specialized the healthcare provider, the more patient you may need to be. The fewer healthcare providers in any given specialty who practice in your geographical area, the more time you'll have to wait, too.

If you visit an internist who consistently makes you wait an hour, that is too long. If you find a brain surgeon who makes you wait an hour, that may not be unusual.

The fair wait time will also depend on the relationship you have with your healthcare provider . If you have been a patient for many years, and the healthcare provider usually sees you within a few minutes, but one day that stretches to a half-hour, then you know it's unusual. Try to be patient.

Make Appointments Strategically

To reduce your waiting time, use these tips when making an appointment:

Try to get the earliest appointment in the morning or the first appointment after lunch. During each of those times, you'll avoid a backed-up group of patients and you have a better chance of spending less time in the waiting room .
When you make your appointment, ask which day of the week is the lightest scheduling day. Fewer patients on that day will hopefully mean shorter wait times.
When you book your appointment, make sure the healthcare provider won't just be returning from a vacation or conference, or a period of time out of the office.
If the healthcare provider sees children as patients, then try not to book your appointment on a school holiday.
If possible, avoid Saturdays or evenings.

Once you get to the office for your appointment, ask the person at the check-in desk how long they think you'll be waiting. Then decide whether you want to wait that long and whether or not seeing that healthcare provider is worth that wait. If not, then reschedule.

If you're told the wait will be 15 minutes, then speak up on minute 16. The squeaky wheel does get the grease. You don't have to be loud or demanding, but being firm and definite is fair. Politely ask what the hold up is, and how much longer you'll need to wait. Again, decide whether the wait time is acceptable.

If the wait time you've experienced or you anticipate is unacceptable, then find a healthcare provider that doesn't make patients wait so long. This is possible for a primary care healthcare provider or a specialist you see on a regular basis for a long-term or chronic condition. It may not be possible for a sub-specialist or a healthcare provider who is in great demand.

You'll have to decide if that particular healthcare provider is worth the wait. You may have no choice.

Making a Long Wait More Tolerable

Your wait time will be less stressful if you are prepared to wait:

Leave yourself plenty of time. Don't create more stress for yourself by scheduling something else right on the heels of your appointment. If you have a 10 a.m. meeting, you may not want to schedule an appointment beforehand.
Take a good book, your knitting, and entertaining phone apps (plus earbuds) to pass the time.
Expect the appointment in total, wait time included, to last far longer than you think it will. If it's shorter, then you'll be pleasantly surprised. But if you account for a long period of time, ahead of time, then it won't be so frustrating to wait.

By Trisha Torrey Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system.

How to get in to see primary care physicians and specialists — quickly

The average wait for an appointment with a physician for new patients is 26 days, according to a 2022 survey of 15 metropolitan areas.

Consumer Reports has no financial relationship with any advertisers on this site.

Need to see a doctor right away? Today, that can be challenging.

The average wait for an appointment with a physician for new patients is 26 days, according to a 2022 survey of 15 metropolitan areas by the physician recruiting firm Merritt Hawkins. That’s the longest it has been since the company began doing the survey in 2004. In addition, 22 percent of adults 65 or older waited six days or more for a doctor’s appointment when they were sick, according to a 2021 survey of 11 high-income countries by the Commonwealth Fund , a nonprofit group. Only Canada had a higher percentage of long waits.

One of several likely reasons is that the number of doctors leaving the workplace is increasing without enough new ones to replace them. A poll of more than 600 medical groups, released last year by the Medical Group Management Association , found that 40 percent reported they had a doctor leave or retire early — because of burnout.

And the shortfall of doctors is projected to only grow, especially for those in primary care. There, we may see a deficit of up to 48,000 doctors by 2034, the Association of American Medical Colleges says . “It’s very concerning for older adults,” says Terry Fulmer, president of the John A. Hartford Foundation in New York, which works to improve care for older adults. Many “need primary care to stay on top of any kind of chronic disease.”

But certain steps may help you get appointments when you need them or find a new doctor when the time comes.

How to get faster primary care

For a condition that’s annoying but not critical, first call your doctor or access your primary care physician’s online scheduling tool, if there is one, to see how quickly you can snag a spot. But that doesn’t always work, so try the following if you’re too sick to wait even a couple of days:

Put your name on a waiting list. Doctors’ offices often get last-minute cancellations. So book the appointment you’re offered but ask to be put on a waiting list. If you can be flexible about dates and times, tell the office staff so that they contact you with anything that opens up.

Be ready to act fast. Make sure you’re clear on how the practice fills appointments that open up at the last minute. For instance, will they phone you, text you or message you on the patient portal? “Usually, you don’t have much time before they move on to the next patient, especially if it’s a same-day or next-day cancellation,” Fulmer says.

See someone else in the practice. You can ask whether another physician there has a more open schedule. But if the office has a nurse practitioner or physician assistant, you may find that you can get an appointment with one of them pretty quickly. State laws vary, but generally, nurse practitioners and physician assistants can do many of the same things a doctor can , including diagnosing and managing a variety of medical conditions and writing prescriptions.

Plus, “their education often emphasizes patient-centered care, which means they may listen more,” says Peter Hollmann, a geriatrician and chief medical officer for Brown Medicine in Providence, R.I. Case in point: A 2021 review of 13 studies, published in the International Journal of Nursing Studies Advances , found the care given by NPs in primary care was equal to — and sometimes superior to — that of doctors.

Use your doctor’s network. The hospital or medical system your provider is affiliated with may help you find a same-day appointment with a different doctor (and practice). Check online, using the name of the facility and “same-day appointments.”

Get video care on demand. If you’d rather not leave home and cannot quickly get a telehealth visit with your doctor, ask university hospitals, medical centers, health insurers or telehealth companies to help you “meet” with another medical provider online. These are often same-day appointments. When we checked the Yale New Haven Health website , for example, it had available openings within the hour.

Try a convenient care clinic. You can go to a nearby urgent care clinic , a walk-in facility staffed by doctors and nurse practitioners. Another option is a convenient care clinic, which are walk-ins staffed by nurse practitioners and physician assistants. They’re often in chain pharmacies. Both types of facilities should send notes and recommendations to your primary care doctor after the visit, but it’s wise to confirm that they do.

How to see a specialist sooner

Can’t get an appointment with a new specialist as soon as you’d like? Book the first available opening and ask to be put on a waiting list. Consider these strategies, too:

Lean on your primary. Instead of struggling to book an appointment with a busy specialist on your own, ask your primary care provider for assistance, says R. Sean Morrison, chair of the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai Hospital in New York. He or she can talk to the specialist’s office and explain why you should be seen in a timely way or determine whether another specialist who is more available may be just as appropriate.

Ask about an e-consult. In some cases, your primary care doctor may be able to discuss your health problem with the specialist. These doctor-to-doctor consultations are typically done online and may yield helpful information before your appointment or cancel the need for an in-person visit.

Check other locations. If the specialist you want to see has multiple offices, ask if there is more availability in one of the other places.

Call your health plan. If you’re having a hard time getting in to see a specialist (or any provider), contact your health plan’s member services department, says Michael Hochman, an internist in Los Angeles. “Health insurance companies have service-level standards, which includes the expectation that you can get in to see a specialist within 30 days if you need to,” he says. They may be able to help you find a different specialist your PCP is comfortable with who can see you sooner.

Use waiting time well. Ask your PCP if doing certain tests ahead of time might help the process move more quickly once you see a specialist. “If you do need to wait for a while, it’s ideal to get at least some of the work-up done before, so the specialist already has all that information in hand when they see you,” Morrison says.

How to find the right new doctor

If you’re looking for a new PCP — because the strategies here have not worked well enough, or your current doctor is leaving the profession or retiring — three steps can ease the way.

Cast a wide net. Ask your friends, family members and neighbors whom they go to and if they’d recommend them, Hochman says. Also, check with specialists you see and anyone you know who works in health care. Contact the practices that sound appealing.

Check availability. First, find out whether the doctor you’re interested in is taking new patients and accepts your insurance. (Using the name of a health-care professional or current patient may help if the doctor you decide on has a waiting list for new patients.) Then, in addition to considering how convenient the location is, the Department of Health and Human Services recommends inquiring about office hours (including nights and weekends), how long it typically takes to get appointments, whether virtual appointments are available and who can see you if your doctor is unavailable. You’ll also want to see whether the practice has nurse practitioners and physician assistants, and which hospital system the doctor is affiliated with.

Look for an age-friendly philosophy. That you want a doctor who is knowledgeable and respectful goes without saying, but as the years pass, it’s also wise to seek age-friendly care . This doesn’t always mean geriatricians; they are few and far between. The truth is, if you’re in relatively good health, you may not need a geriatrician, Hochman says. Instead, ask if the practice focuses on the 4Ms: what matters (your goals and priorities); medication safety and appropriateness; mentation (cognition and mood); and mobility (ways to keep you moving).

If you’re finding it hard to get into a new practice, you might even consider looking for a geriatric nurse practitioner or advanced practice registered nurse to serve as your PCP, Fulmer says. The 2021 review in the International Journal of Nursing Studies Advances found good evidence that nurse-based care — including geriatric care — improved overall patient care and outcomes.

Copyright 2023, Consumer Reports Inc.

Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. CR does not endorse products or services, and does not accept advertising. Read more at ConsumerReports.org .

15-Minute Visits Take A Toll On The Doctor-Patient Relationship

By Roni Caryn Rabin April 21, 2014

Republish This Story

Joan Eisenstodt didn’t have a stopwatch when she went to see an ear-nose-and-throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes.

“He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone,” said the 66-year-old Washington, D.C., consultant, who was suffering from an acute sinus infection.

15-Minute Visits Take A Toll On The Doctor-Patient Relationship

Joan Eisenstodt didn’t have a stopwatch when she went to see an ear, nose and throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes (Photo by Christopher Powers/USA TODAY).

When she started protesting the doctor’s choice of medication, “He just cut me off totally,” she said. “I’ve never been in and out from a visit faster.”

These days, stories like Eisenstodt’s are increasingly common. Patients – and physicians – say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements.

It’s not unusual for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they’ve been asked to see patients every 11 minutes.

And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care — some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems.

“Doctors have one eye on the patient and one eye on the clock,” said David J. Rothman, who studies the history of medicine at Columbia University’s College of Physicians and Surgeons.

By all accounts, short visits take a toll on the doctor-patient relationship, which is considered a key ingredient of good care, and may represent a missed opportunity for getting patients more actively involved in their own health. There is less of a dialogue between patient and doctor, studies show, increasing the odds patients will leave the office frustrated.

Shorter visits also increase the likelihood the patient will leave with a prescription for medication, rather than for behavioral change — like trying to lose a few pounds, or going to the gym.

Physicians don’t like to be rushed either, but for primary care physicians, time is, quite literally, money. Unlike specialists, they don’t do procedures like biopsies or colonoscopies, which generate revenue, but instead, are still paid mostly per visit, with only minor adjustments for those that go longer.

And many doctors may face greater financial pressure as many insurers offering new plans through the health law’s exchanges pay them even less, offering instead to send them large numbers of patients.

This fee-for-service payment model, which still dominates U.S. health care, rewards doctors who see patients in bulk, said Dr. Reid B. Blackwelder, president of the American Academy of Family Physicians, who practices in Kingsport, Tenn.

“Doctors are thinking, ‘I have to meet my bottom line, pay my overhead, pay my staff and keep my doors open. So it’s a hamster wheel, and they’re seeing more and more patients … And what ends up happening is the 15-minute visit,” he said.

Struggling For Control

Dr. Richard J. Baron, president of the American Board of Internal Medicine, said that patients and physicians often wrangle over control of that visit – a “struggle for control” over the allocation of time

Sometimes the struggle is overt – as when a patients pulls out a long list of complaints as soon as the doctors comes in.

Sometimes, it’s more subtle. When Judy Weinstein went to see her doctor in Manhattan recently, she knew she would get only 20 minutes with him – even though it was an annual physical, and she had waited nine months for the appointment.

So when the doctor asked if he could have a medical student shadow him, she put her foot down.

“I said, ‘Y’know, I would prefer not. I get 20 minutes of your divided attention as it is – it’s never undivided, ever – and I need to not have any distractions. I need you focused on me.’“

How did visits get so truncated? No one knows exactly why 15 minutes became the norm, but many experts trace the time crunch back to Medicare’s 1992 adoption of a byzantine formula that relies on “relative value units,” or RVUs, to calculate doctors’ fees.

If you must know, the actual formula is : (Work RVU x Geographic Index + Practice Expenses RVU x Geographic Index + Liability Insurance RVU x Geographic Index) x Medicare Conversion Factor.

That was a switch for Medicare, which had previously paid physicians based on prevailing or so-called usual and customary fees. But runaway inflation and widespread inequities dictated a change. RVUs were supposed to take into account the physician’s effort and cost of running a practice, not necessarily how much time he or she spent with patients.

The typical office visit for a primary care patient was pegged at 1.3 RVUs, and the American Medical Association coding guidelines for that type of visit suggested a 15-minute consult.

Private insurers, in turn, piggybacked on Medicare’s fee schedule, said Princeton health economist Uwe Reinhardt. Then, in the 1990s, he said, “managed care came in and hit doctors with brutal force.”

Doctors who participated in managed care networks had to give insurers discounts on their rates; in exchange, the insurers promised to steer ever more patients their way.

To avoid income cuts, Reinhardt said, “doctors had to see more patients – instead of doing three an hour, they did four.”

Rushed Doctors Listen Less

How doctors structure the precious 15-minute visit varies – often quite dramatically. Generally, they start by asking the patient how they are and why they came in, trying to zero in on the “chief complaint” — the medical term for the patient’s primary reason for the visit.

But most patients have more than one issue to discuss, said Dr. Alex Lickerman, an internist who has taught medical students at University of Chicago and is director of the university’s Student Health and Counseling Services.

“The patient is thinking: ‘I’m taking the afternoon off work for this appointment. I’ve waited three months for it. I’ve got a list of things to discuss.’

“The doctor is thinking, ‘I’ve got 15 minutes.’ There is almost a built-in tension,” Lickerman said.

Studies show that doctors’ visits have actually not gotten shorter on average in recent decades. The mean time spent with a physician across specialties was 20.8 minutes in 2010, the latest year available , up from 16.3 minutes in 1991-1992 and 18.9 minutes in 2000 , according to the National Center for Health Statistics; that includes visits with internists, family docs and pediatricians, which all increased by about two and a half minutes.

In 1992, most visits – about 70 percent — lasted 15 minutes or less; by 2010, only half of doctor visits were that short (the data is from the National Ambulatory Medical Care Survey , an annual nationally representative sample survey of visits to physicians).

This doesn’t necessarily mean the patient experience is improving. Medical schools drill students in the art of taking a careful medical history, but studies have found doctors often fall short in the listening department. It turns out they have a bad habit of interrupting.

A 1999 study of 29 family physician practices found that doctors let patients speak for only 23 seconds before redirecting them; only one in four patients got to finish their statement. A University of South Carolina study in 2001 found primary care patients were interrupted after 12 seconds, if not by the health care provider then by a beeper or a knock on the door.

Yet making the patient feel they have been heard may be one of the most important elements of doctoring, Lickerman said.

“People feel dissatisfied when they don’t get a chance to say what they have to say,” he said. “I will sometimes boast that I can make people feel they ‘got their money’s worth’ in five minutes. It’s not the actual time or lack of time people are complaining about – it’s how that time felt.”

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What to expect at the ER: A guide to navigating the emergency room

Your ER experience and wait time will depend on the severity of your condition.
Reasons to go to the ER might be excessive bleeding, a high fever, a seizure, or chest pains.
If you need to see a doctor immediately, but it's not an emergency, urgent-care is another option.

When you or a loved one arrives at an emergency room (ER) in the US, you should expect to have a nurse briefly assess you shortly after arrival. The nurse will determine the severity of your condition, which will determine your wait time. If you're in serious condition, you may be brought by paramedics or EMTs and be taken directly to a trauma ward, or seen by a doctor immediately depending on your condition.

People in the ER are treated in order of how sick they are, says Eric Chu , MD, an emergency medicine physician at the University of Connecticut School of Medicine.

"For example, if you are brought in after having a cardiac arrest, you will be taken to the resuscitation bay where you will be seen immediately. In other cases, you may walk into the waiting room, be assessed by a nurse, and then depending on your acuity, have to wait until a room is open for you," says Chu.

Average wait times in the ER can range from 25 to 50 minutes , depending on how busy the hospital is. "I think the biggest factor on how long it'll take to be seen in the ER is where you live and which hospital you go to. I have seen patients wait six hours just to be put into a room. It also depends on what time and which day you go. Mondays are notorious for being the busiest day of the week and the weekends are usually the least," says Chu.

Here are some instances when you might need to go to an ER, and what you can expect once you're there.

What to expect at the ER

When you arrive at the ER, a trained emergency nurse will assess your condition and determine the urgency of your situation; this process is referred to as " triage ."

While you're waiting to see a doctor, you may be x-rayed, given medications for your symptoms, or be asked to provide blood or other samples, according to Chu.

"You will be seen by a doctor, physician assistant, or nurse practitioner when you are moved to a room. Treatment or further tests may be done at this time. Consultants, including cardiologists, nephrologists, or neurologists, may also be involved in your care, if required. Then, depending on how sick you are, you may be discharged or admitted to the hospital," says Chu.

When should you go to the ER?

As the name suggests, an ER is essentially for emergencies that could be fatal or cause permanent disability.

You may also need to go to the ER if you or a loved one have been in an accident or have experienced trauma and require immediate attention.

On the other hand, if you're feeling unwell and need to see a doctor immediately, but it's not an emergency, you can go to your primary care doctor if they have a same-day opening or go to an urgent-care clinic .

Many urgent care clinics are open every day, and you can get treated faster and for a substantially lower cost than at an ER. If your symptoms are mild and you can wait a day, you can also visit your primary care physician during clinic hours.

What to bring to the ER

If possible, you should try to gather some essentials before you go to the ER, to help the ER physicians understand your medical history and any allergies you might have.

"Things that are helpful to bring to the ER include your home medication list, the names of your doctors, any paperwork from recent hospital or doctors' visits, and your insurance information (if you have insurance). For example, if you had a recent heart attack, it may be helpful to bring the paperwork from that admission and what medications you have been taking," says Chu.

You should also try and take a trusted family member or friend along with you to help with paperwork and answer any of the physician's questions, if you are too ill to do so yourself.

If you're not going to the ER under acute circumstances, Chu recommends bringing a book or a phone charger, since you could be waiting a long time.

What is the cost of an ER visit?

The cost of your ER visit will depend on the tests conducted, medication and treatment provided, and your health insurance coverage, says Chu. This can vary from hospital to hospital. "One hospital may charge you $30 for a medicine while another may charge you $300," he says. This variation in cost can be due to several factors . For example, larger hospitals, teaching hospitals, or hospitals that provide highly specialized services may charge considerably higher fees.

The average cost of an ER visit is around $1,500 . Sprains, which are among the top causes for ER visits, could cost around $1,100, whereas treating a kidney stone could cost around $3,500. If you have insurance, it may help cover some of this cost, depending on your insurance plan.

Whether your ER visit is covered by insurance can depend on several factors, including whether the hospital or provider are included in the insurance provider's network, says Chu.

"It can also depend on whether your insurance covers certain costs, like an ambulance ride, for example. An ambulance ride that is not covered by insurance can be quite expensive," says Chu. Ambulance rides can range between $224 and $2,204 per transport.

Insider's takeaway

You may need to visit the ER for life-threatening situations. The course of your visit can vary quite a bit depending on your condition. While ERs provide necessary and oftentimes lifesaving services, they can involve long wait times and expensive bills, making urgent care or your primary care provider a better option if the situation isn't an emergency.

Patient Waiting Times: What is Reasonable at Your Medical Practice?

Patients are still complaining about wait times being too long. How does your practice measure up?

Not to beat a dead horse here, but can you guess what the number one complaint in medical offices still is? The wait! You may be thinking, “oh well, what does she know, you go to the doctor, you wait…” That is the attitude that will leave your clinic empty while more progressive clinics handle their patients on time (or close to it) and leave them more satisfied and happy. And you will find that if you are more respectful of your patient’s time, they will be more respectful of yours.

What do you think a reasonable “wait” is? Five minutes? Ten minutes? Twenty minutes? You should be aiming for the fewer-than-10-minute mark, as far as wait in the waiting room, and then less than 20 minutes from the time the patient is placed in the exam room until they see the doctor/practitioner (not the nurse/tech).

Personally anywhere BUT a doctor’s office, my motto is “if you are not 15 minutes early, you are late.” It has taken some time and experience as a patient, nurse, manager, and consultant to realize that it is important to respect people’s (most especially your customer’s) time no matter what.

First you must acknowledge you have a problem. And this problem could be anything from wasting time between patients, to showing up late, to spending too much time chatting with patients. Whatever your “time waster” is, you basically have two choices: Stop it OR schedule your patients appropriately around it.

Over the years, especially in family practice/primary care, the way to earn more was to see more patients. This and the shortage of primary-care practitioners (and some other factors) helped contribute to clinics being stacked full and waits in waiting rooms being longer. Now there are tons of revenue options that help practitioners provide more complete care in their office, and don’t necessarily require stacking patients in quick, five-minute slots and making them wait for hours on end. And the primary-care provider pool is growing, giving patients more options, to find clinics that are glad they are there, and don’t treat them like a number.

In the words of the wonderful Maya Angelou, “when you know better you do better.” Now you do, how are you going to start reducing the wait for your most important asset? Your patients.

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Ambulatory Care Use and Physician office visits

Data are for the U.S.

Percent of adults who had a visit with a doctor or other health care professional in the past year: 83.4% (2022)

Source: Interactive Summary Health Statistics for Adults: National Health Interview Survey, 2019-2022

Percent of children who had a visit with a doctor or other health care professional in the past year: 93.9% (2022)

Source: Interactive Summary Health Statistics for Children: National Health Interview Survey, 2019-2022

Number of visits: 1.0 billion
Number of visits per 100 persons: 320.7
Percent of visits made to primary care physicians: 50.3%

Source: National Ambulatory Medical Care Survey: 2019 National Summary Tables, table 1 [PDF – 865 KB]

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Physician Office Visits at Which Benzodiazepines Were Prescribed: Findings From 2014–2016 National Ambulatory Medical Care Survey [PDF – 376 KB]
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Ambulatory Health Care Data
National Health Interview Survey
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December 15, 2020

How long do doctor visits last? Electronic health records provide new data on time with patients

by Wolters Kluwer Health

How much time do primary care physicians actually spend one-on-one with patients? Analysis of timestamp data from electronic health records (EHRs) provides useful insights on exam length and other factors related to doctors' use of time, reports a study in the January issue of Medical Care . The journal is published in the Lippincott portfolio by Wolters Kluwer.

"By using timestamps recorded when information is accessed or entered, EHR data allow for potentially more objective and reliable measurement of how much time physicians spend with their patients," according to the new research by Hannah T. Neprash, Ph.D., of University of Minnesota School of Public Health and colleagues. That may help to make appointment scheduling and other processes more efficient, optimizing use of doctors' time.

More precise estimates of primary care visit times

Using a national source of EHR data for primary care practices, the researchers analyzed exam lengths for more than 21 million doctor visits in 2017. The study focused on exam lengths and discrepancies between scheduled and actual visit times.

Based on EHR timestamps, the mean exam time was 18 minutes, with a median of 15 minutes. "The mean exam lasted 1.2 minutes longer than scheduled, while the median exam ran 1 minute short of its scheduled duration," Dr. Neprash and coauthors write. The longer the scheduled visit, the longer the exam time.

"However, shorter scheduled appointments tended to run over while longer appointments often ended early," the researchers add. Scheduled 10-minute visits ran over by an average of 5 minutes; in contrast, scheduled 30-minute visits averaged less than 24 minutes.

More than two-thirds of visits deviated from the schedule for 5 minutes or more. About 38 percent of scheduled 10-minute visits lasted more than 5 minutes, while 60 percent of scheduled 30-minute visits lasted less than 25 minutes.

The findings suggest "scheduling inefficiencies in both directions," according to the authors. "Primary care offices' overuse of brief appointment slots may lead to appointment overrun, increasing wait time for patients and overburdening providers." In contrast, "longer appointments are critical for clinically complex patients, but misallocation of these extended visits represents potentially inefficient use of clinical capacity."

The time doctors spend with patients has a major impact on care. Average visit times seem to have increased over the years—yet physicians may still feel pressed to do more in the available time, including documentation, patient monitoring, and prevention/screening steps.

Estimates of medical visit times have been largely based on national surveys, which rely on information reported by office-based practices. For several reasons, these estimates may not accurately reflect the actual time doctors spend with patients in the examination room.

Routine data collected by EHRs provide a new way to measure length of physician visits, Dr. Neprash and colleagues write. Their method excluded visits where EHR data didn't seem to be recorded in real time and accounted for overlapping visits due to "double-booking."

Health systems could use EHR data to track discrepancies between schedules and actual visit lengths, enabling more efficient scheduling for patients with different needs. While acknowledging some limitations and challenges of this approach, the researchers believe their findings "support the development of a scalable approach to measure exam length using EHR data."

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v.42(5); 2007 Oct

Time Allocation in Primary Care Office Visits

To use an innovative videotape analysis method to examine how clinic time was spent during elderly patients' visits to primary care physicians. Secondary objectives were to identify the factors that influence time allocations.

Data Sources

A convenience sample of 392 videotapes of routine office visits conducted between 1998 and 2000 from multiple primary care practices in the United States, supplemented by patient and physician surveys.

Research Design

Videotaped visits were examined for visit length and time devoted to specific topics—a novel approach to study time allocation. A survival analysis model analyzed the effects of patient, physician, and physician practice setting on how clinic time was spent.

Principal Findings

Very limited amount of time was dedicated to specific topics in office visits. The median visit length was 15.7 minutes covering a median of six topics. About 5 minutes were spent on the longest topic whereas the remaining topics each received 1.1 minutes. While time spent by patient and physician on a topic responded to many factors, length of the visit overall varied little even when contents of visits varied widely. Macro factors associated with each site had more influence on visit and topic length than the nature of the problem patients presented.

Conclusions

Many topics compete for visit time, resulting in small amount of time being spent on each topic. A highly regimented schedule might interfere with having sufficient time for patients with complex or multiple problems. Efforts to improve the quality of care need to recognize the time pressure on both patients and physicians, the effects of financial incentives, and the time costs of improving patient–physician interactions.

Time is a scarce resource in a physician's office practice. How physicians use clinic time has important implications for quality of care, patient trust ( Fiscella et al. 2004 ), malpractice suits ( Levinson et al. 1997 ), and is one of the bases of physician payments ( Hsiao et al. 1988 ). Mechanic, McAlpine, and Rosenthal (2001) reported that the average length of a physician visit had increased from 16.3 to 18.3, between 1989 and 1999, based on survey data from the National Ambulatory Medical Care Survey (NAMCS) and the Socioeconomic Monitoring System (SMS). Data from direct observation of primary care office visits by nurse researchers called into question these results, however. Yawn et al. (2003) found that primary care physician office visits lasted about 10 minutes. Further, Gilchrist et al. (2004) found physicians or their office staff over-reported visit length by almost 4 minutes when completing the NAMCS encounter forms.

Patient–physician conversations are complex, multidimensional, and multifunctional ( Mishler 1984 ). Visits vary not only in length but also in the division of time among topics. Patients typically present multiple complaints during an office visit requiring physicians to divide time and resources during a visit to deal with competing demands. A unique and critical role of primary care physicians has been to provide patients with an “advanced medical home” where complex comorbidities are diagnosed and treated. Braddock et al. (1999) analyzed audiotapes of office visits to primary care physicians and surgeons and reported a median of three patient concerns per visit. Beasley et al. (2004) reported an average of 3.9 concerns discussed with elderly patients by family physicians. Studying how physicians use clinical time through examining the contents of the visit is also important to illuminate the process of care ( Donabedian 2005 ). Our review of the literature ( Hsiao et al. 1988 ; Charon, Greene, and Adelman 1994 ; Thompson et al. 2003 ; Heritage and Maynard 2006 ) and personal communications with other researchers lead us to believe that this study is the first to directly measure the actual amount of time spent by patients and physicians on topics occurring during office visits.

In this paper, we took advantage of a unique data set consisting of videotaped elderly patients' visits with their primary care physicians in three distinct organizational settings: salaried group practice in an academic medical center, a managed care group (MCG) practice, and fee-for-service inner city solo (ICS) practitioners with an Independent Practice Association contract. We examined not only the length of visits, but more importantly, the content of visits in terms of units of clinical decision making we refer to as “topics,” operationalized as clinical issues raised by either participant. Our approach was in the spirit of the multidimensional interaction analysis (MDIA) system, which codes an interaction directly from an audiotape of the visit based on topics sequentially introduced by patient or physician. The MDIA lists 36 categories subdivided into five major content areas: biomedical, personal habits, psychosocial, patient–physician relationship, and other ( Charon, Greene, and Adelman 1994 ). We partitioned a visit into similar topics, and took a step further by recording the amount of time spent on each topic by patient and physician. Our approach allows us to examine how much time is dedicated to specific topics, and the factors that influenced how clinical time is allocated.

This paper addresses a series of questions about visits and topics within visits. First, what was the length of a primary care office visit for these elderly patients? Second, how many topics were discussed, and how much time was devoted to each topic? Third, what were the topics of discussion and how did the length of time speaking by patient and physician vary across different types of topics? Lastly, we analyze the influence of patient, physician, and physician's practice setting characteristics on how clinic time was spent using duration (or survival) analysis. Our main goal is to characterize physician–patient encounters in a new way, in order to study how physicians and patients allocate the scarce resource of physician time to deal with the complex set of problems arising in an office visit.

DATA AND METHODS

This paper conducts analyses of videotapes collected for another study based on a convenience sample of office-based physicians and their patients in three types of practices ( Cook 2002 ). The practices included a salaried medical group as part of an Academic Medical Center (AMC) in the Southwest, a managed care group (MCG) in a Midwest suburb, and a number of fee-for-service inner city solo (ICS) practitioners in a Midwestern city. These sites were chosen to include diverse practice forms and representation of patients and physicians from racial minority groups.

Participants

The recruitment effort resulted in a sample of 35 physicians, all of whom had completed their training at the time of the initial study. Patients had to be at least 65 years of age to be eligible for the original study, identify the participating physician as their usual source of care, and provide informed consent. Specifically, patients were identified from their primary care physicians' patient panels provided by office managers of the participating clinics. When these patients came to the participating clinic for a visit, regardless of the nature of the visit (e.g., acute upper respiratory infection, or for routine checkup for diabetes or hypertension), they were invited to participate in the study. If they expressed willingness to participate, informed consent was obtained and their visits were taped. Patient participation rates ranged from 61 to 65 percent at the three sites. The final sample contained 392 videotaped visits. 1 Details of participant recruitment have been reported elsewhere ( Tai-Seale et al. 2005 ).

Compared with national data ( American Medical Association 2001 ), our physician estimation sample is similar in gender composition but has fewer physicians in the extremes of the age distribution. African–American physicians were overrepresented in our data (14 percent, compared with 6 percent nationally). Our patient sample is similar to national data on elderly patients in age distribution, and living arrangement ( U.S. Census Bureau 2001 ) but different in having more educated and fewer married patients ( Federal Interagency Forum on Aging Related Statistics 2000 ).

Videotape Coding

Coding of the videotaped visits consisted of four major components: identifying topics, determining the talk time, coding the dynamics of the talk, and recording additional measures. See Appendix A for details on training of the coders.

Identifying Topics

Coders first carefully reviewed the entire video to determine the nature and number of topics raised during the visit. Following the MDIA grouping ( Charon, Greene, and Adelman 1994 ), a topic was regarded as an issue that required a specific response by the physician or patient. Each patient-raised symptom was treated as a topic unless the patient connected the symptoms within a “common sense” grouping, if so, the grouping was treated as a topic. An example could be that a patient talked about coughing and headache. He mentioned them one after another and indicated his worry about having bronchitis. Applying common sense about upper respiratory infections, the patient had grouped the symptoms of cough and headache together. Rather than coding two separate topics of cough and headache, we combined them into one topic labeled “worried about bronchitis.”

As mentioned earlier, the MDIA has 36 topics and five major content areas. In recognition of the prevalence of depression, anxiety, and other mental illnesses treated in primary care, we formed a mental health content area, which is a subset of the psychosocial content area in the MDIA. We identified 36 topics pertaining to six major content areas: biomedical, mental health, personal habits, psychosocial issues, patient–physician relationship, or other topics. Each topic was assigned a number from a predetermined list of 36 topics ( Charon, Greene, and Adelman 1994 ).

Figure 1 depicts the flow of conversation during one office visit in the data and illustrates how this is grouped into topics for coding. The visit started with the physician noting the camera upon his arrival: “They want to see how I talk to my patients.” The patient smiled and started to tell the physician about her status after the hip fracture. She then told the physician that she had been depressed. The physician empathized by stating that a lot had happened since the death of her husband. She recounted the days preceding her husband's death and her son's reaction to his death. The doctor brought the topic back to her hip. He reviewed the pain medications prescribed for her hip pain (Propoxyphene), and then the antidepressants (Paroxetine and Amitriptyline) that she was taking. She expressed concern over “sleeping too much” and questioned if the medicines were “too strong.” The physician told her that he thought that she was doing just fine and he would not change the medications. He then directed the conversation to her backache. During the course of the discussion on backache, they revisited the hip fracture topic. Lastly, they briefly discussed her gum ache and dentures. After reviewing this encounter, the coders detected five topics: (1) the study, (2) status of hips, (3) depression, (4) backache, and (5) gum pain. The discussion about her husband's death was brought up and addressed within the context of her depression. Therefore, conversations on his death were counted in the depression topic.

An external file that holds a picture, illustration, etc.
Object name is hesr0042-1871-f1.jpg

Flow of Conversation during a Visit

Talk Time and Topic Length

Patient talk time was measured as the length of time the patient spent talking before discussion of the topic concluded. Talk time of a patient's companion if present at the visit was included in patient's talk time. Physician talk time was defined as the length of time the physician spent talking before the topic concluded. As the two took turns talking, each person's talking time before the other started talking was recorded and then added to get the total length of time each person spent talking. Topic length is measured by the sum of the time—in either talking or in silence as long as both patient and physician are in the room—that elapsed between the beginning and the end of all instances of a topic. The sum of the talk time by the patient and physician may be less than the total topic length because at times, both parties sat in silence, 2 the physician viewing or writing in the chart. Figure 1 illustrates how the time variables are coded.

Verbal or Nonverbal Cues

The coders were trained to record uncertainty and verbal or nonverbal cues of emotional distress during discussions of each topic. Expression of uncertainty was indicated by statements that conveyed the idea that the speakers were not sure about the accuracy of their statements ( Gill 1998 ). Hesitations and words or phrases such as, “we don't know …”“may,”“might,”“is it true that …,” and speculative expressions such as “it may be true that …” were taken to suggest uncertainty. Vocalized pauses, which are the ums, uhs , and ahs , the spoken equivalents of throat clearing and false starts, that exist in one's speech ( Wilson 1993 ), were also taken into account in coding uncertainty. The coders were reminded to pay close attention to the context in which these expressions were uttered to distinguish expression of uncertainty from expression of politeness ( Gill 1998 ).

Verbal cues of emotional distress included expressions such as “I'm such a basket case,”“What else is there to live for?” Nonverbal cues of emotional distress include depressed face, downward gaze, self-touching, drooping posture, and slowed speech (suggesting depression) or fidgety hands, darting eyes, and a still upper body (suggesting anxiety) ( Gattellari et al. 2002 ; Eide, Graugaard, and Finset 2004 ; American Psychiatric Association 1994 ). Two binary variables record whether the patient showed either cue while discussing each topic. Because of their correlation, we only included nonverbal cues in the regression analysis.

Survey Data

Surveys of patients and physicians complement the video data. Variables from the surveys were chosen for analysis based on research about how patient–physician interaction is influenced by patient health ( Bertakis et al. 1993 ), gender and race ( Roter, Hall, and Aoki 2002 ; Balsa, McGuire, and Meredith 2005 ), education ( Waitzkin 1985 ), and physician gender ( Roter, Hall, and Aoki 2002 ; Roter and Hall 2004 ). Patient's health status was measured by normed SF-36 scores ( Ware, Kosinski, and Dewey 2000 ). The length of the patient–physician relationship was measured by the number of years the patient had seen the physician ( Waitzkin 1985 ).

Empirical Specification

Topic and visit-level analyses were conducted separately to describe the length of time spent and the determinants of time at both levels. At the topic level, our data contain multiple observations (i.e., topics) for each patient–physician dyad (visit). We used mixed-level data methods to account for the clustering at the dyad level. The dependent variables were patient talk time, physician talk time, and topic length. At the visit level, the dependent variables were visit length, total patient talk time, and total physician talk time.

We used a survival model to analyze the likelihood that the topic or visit would end, given how much time had already been spent on it. To test duration dependence, we use the Weibull proportional hazard function ( Cleves, Gould, and Gutierrez 2004 ). At the topic level

where t is time in seconds; β′ =(β 1 , …, β j , …, β J ) is a parameter vector for covariates. x ′ i =( x i 1 , …, x ij , …, x iJ ) is a data vector; x i represent topics, i= 1, …, K where K is the total number of topics; j= 1, …, J is the index for explanatory variables which included: topic (biomedical, personal habits, mental health, psychosocial, patient–physician relationship, and other issues topic; patient initiation; physician showed uncertainty, patient showed uncertainty, patient showed mood problem nonverbally), site (AMC, MCG, and ICS), patient (age, gender, health status, and education), physician (gender), patient and physician dyad (years patient has seen this physician). (African-American patients and physicians were concentrated in the ICS preventing us from conducting an analysis of race of patient or physician separate from site.)

Therefore, x ij represents the explanatory variable's value for topic i and explanatory variable j . In equation (1) , h 0 ( t ) is the baseline hazard rate which can be modeled as

where s and β 0 are parameters to estimate. s is known as the shape parameter which represents the presence of duration dependence if it is different than 1. β 0 is a scale parameter in the Weibull model. Interpretation of coefficients in the Weibull model as hazard ratios (HR) is not straightforward. We evaluate the quantitative relationship between a change in covariates and the change in length of time at a constant survival probability. We can then calculate the percent change in talk time as a result of an increment in an explanatory variable, (the steps are shown in Appendix B ) which is

equation (3) enables us to calculate, holding constant the survival probability, how changes in key explanatory variables would influence the length of time spent on a topic or a visit.

For the topic level analysis, the nature of the topic was captured by five binary variables representing the major content areas, with biomedical topic as the comparison group. Additional variables include binary variables for initiator of the topic, physician showing uncertainty, patient showing uncertainty, patient showing cue of mood problem nonverbally.

For the visit level analysis, we examined the effects of visit content complexity on talk times. Complexity was measured by the percent of time spent on each of the six groups of topics out of total talk time. 3 In constructing a measure for patient initiation, we created a variable for the share of the topics in all of the topics in the visit that were initiated by the patient. A similar approach was used to create variables for the share of topics in which the physician had shown uncertainty, and the share of topics in which nonverbal cues of mood problems were observed in the patient. Analyses were performed in STATA , version 9 ( STATACorp 2003 ).

The 392 videotaped visits contained 2,557 topics which represented all of MDIA topics with the exception of elder abuse which was not present in our sample. Of those topics, 77 percent of the topics (1,977) were discussed with 27 male physicians whereas 23 percent of them (580) were discussed with eight female physicians.

Univariate and Bivariate Analyses

Average length of visits was 17.4 minutes. The median length of visits was 15.7 minutes. The median talk time by patient was 5.3 minutes, and physician, 5.2 minutes. The median time during which neither part spoke was 55 seconds. (Note: unlike the case of the mean, the sum of the medians is not the median of the sum.) The average number of topics in a visit was 6.5 (median=6, minimum=1, maximum=12; Table 1 ). Owing to the skewness of time variables, we report the medians in descriptive statistics.

Descriptive Statistics by Practice Settings

* Significantly different from AMC, p <.05

We separated out the longest topic (which will be called the “major” topic) from the rest of the topics, which we will call “minor” topics. We noticed a significant reduction between the time spent on major (5.25 minutes) and minor topics. During major topics, patients talked for 2.03 minutes and physicians, 2.31 minutes. The minor topics received 1.1 minutes during which patients spoke for half a minute and physicians, 0.4 minute per topic ( Table 1 ).

Bivariate analyses show that, in comparison with 23.3 minutes spent at the AMC, the length of visit were significantly shorter at the MCG practice (13.4 minutes, p <.01) and the inner city solo practices (ICS; 9.7 minutes, p <.01). Patients at the MCG (4 minutes, p <.01) and ICS (1.8 minutes, p <.01) spoke significantly less than patients at the AMC (8 minutes). Physicians at the MCG also spoke much less (4.7 minutes, p <.01) than their colleagues at the AMC (5.9 minutes). ICS physicians spoke less than half (2.6 minutes, p <.01) as much as AMC physicians. Among the major topics, patients at the AMC spoke significantly longer (3.0 minutes) than patients at the MCG (1.7 minutes, p <.01) and ICS (0.9 minutes, p <.01). Similar patterns existed for topic length but not for physician talk time. It is possible that the manner in which physicians at the MCG and ICS spoke signaled patients to limit their “air time.” The pattern persisted when time was examined across minor topics ( Table 1 ).

The majority of topics (72 percent) pertained to biomedical issues whereas mental health topics composed 2.9 percent. Seven percent of the topics were devoted to personal habits. Twelve percent of topics were about psychosocial matters. Discussion of the patient–physician relationship accounted for 3 percent of the topics while 4 percent of the topics were other topics including small talk. Bivariate statistics on all explanatory variables are presented in Table 1 by practice settings.

Survival Analyses of Talk Duration

Tables 2 and and3 3 show the results from the topic-level and visit-level analyses, respectively, expressed in hazard ratios (HRs). In Table 2 , we present findings on the major topics and minor topics for comparison. Because no visits contained a major topic on the patient–physician relationship, that variable was not included in the analysis of major topics.

Hazard Ratios of Topic-Level Determinants of Patient and Physician Talk, and Topic Durations

Hazard Ratios of Visit-Level Determinants of Patient Talk, Physician Talk, and Visit Duration

A HR >1.0 means that talk is more likely to end, i.e., the talk length is shorter, in comparison with the reference group for categorical variables and an increment in continuous variables. For statistically significant variables, we report a quantitative interpretation of their effects on duration of time according to equation (3) presented earlier. 4

Nature of Topics

Patient talk.

The topic-level analysis showed that, in comparison with patient talk time on biomedical issues, patients talked 85 percent longer on a mental health issue ( p <.01) if it was the major topic, and 42 percent longer otherwise ( p <.01). They spoke the same length on a personal habit topic as on biomedical if it was the major topic, but 21 percent less otherwise ( p <.01). The reverse was true for psychosocial topics: 57 percent longer ( p <.01) versus no difference ( Table 2 ). The visit level analysis showed that patients talked 1 percent longer in response to a 1 percent increase in the time share of topics on mental health or on psychosocial issues ( p <.01; Table 3 ).

Physician Talk

When mental health was the major topic, physicians talked no longer than on biomedical topics. When it was a minor topic, however, physicians talked 27 percent less ( p <.01) than on biomedical topics. Similarly, no difference for a personal habit issue as the major but talk was 40 percent shorter ( p <.01) otherwise. Physicians spent 28 percent less time on psychosocial topics ( p <.01) when they were major topics and 39 percent less time when they were minor topics ( Table 2 ). At the visit level, no significant difference was found in physician talk time based on the time share of topics ( Table 3 ).

Total Length of Topic or Visit

There was only one significant determinant of the length of topics: mental health topics were 37 percent longer than biomedical topics ( p <.01) when they were major topics and the same when they were minor topics. All other minor topics were shorter than biomedical topics ( Table 2 ). At the visit level, time shares of topics did not affect length of visits ( Table 3 ). These results suggest that intravisit time allocation across topics did not influence how long the visit lasted.

Initiator of Topics

At the topic level, patients' talk length was not significantly influenced by their initiation of major topics. They spoke 34 percent longer, however, when they initiated minor topics ( p <.01). At visit level, the share of topics that were initiated by the patient had a small but significant effect: (0.4 percent longer, p <.01; Table 3 ).

Physicians spoke 22 percent less during major topics initiated by patients ( p <.01) but no difference during minor topics. Initiation had no significant effect at the visit level ( Tables 2 and and3 3 ).

Initiation had no significant effects on major topics but patient initiation increased minor topic time by 18 percent. These results imply that, to make up for patients' longer talk, physicians spoke less when patients initiated a major topic. Consequently, neither the length of the topic nor of the visit was affected by patient's initiation of major topics. Patients, on the contrary, spoke more on minor topics that they had initiated and those topics were longer as a result.

Uncertainty and Cues of Mood Problem

Physician uncertainty was associated with 56 percent longer patient talk time ( p <.01) in major topics ( Table 2 ), and 0.3 percent longer ( p <.05) in the visit ( Table 3 ). When uncertain, physicians talked 38 percent longer ( p <.01) on major topics ( Table 2 ), and the major topics lasted 24 percent longer ( p <.01; Table 2 ). Patient uncertainty did not influence time on major topics but was associate with 26 percent longer physician talk time ( p <.01) and 24 percent longer topic length ( p <.01) on minor topics. As for cues of mood problem, physicians spoke 19 percent less with patients who showed nonverbal cues of mood problems during the major topics ( p <.05; Table 2 ). Expression of uncertainty did not increase total visit length.

Physician Practice Setting

In comparison with the AMC, patients talked 26 percent less at the MCG ( p <.01), and 54 percent less at the ICS ( p <.01) during discussion over major topics. Similar effects were found among minor topics ( Table 2 ). Visit-level results were similar with the MCG being 37 percent shorter ( p <.01), and ICS being 62 percent shorter than the AMC ( p <.01; Table 3 ).

Physician talk time did not differ significantly across sites during major topics but was 22 percent shorter among minor topics at the MCG. At the visit level, however, MCG physicians talked 23 percent less than AMC physicians ( p <.05).

Major topics were 20 percent shorter at the MCG ( p <.01) and 28 percent shorter at the ICS ( p <.05). Minor topics were even shorter at both MCG and ICS ( Table 2 ). Visits were 33 percent shorter at the MCG ( p <.01) and 35 percent shorter at the ICS ( p <.01; Table 3 ).

Patient, Physician Characteristics, and Length of Patient–Physician Relationship

Patients with college level or higher education spoke 19 percent longer in major topics ( p <.05) but not on minor topics. Physicians spoke 20 percent longer to female patients during major topics ( p <.01) and 16 percent longer during visits ( p <.01). Physician gender had no effect on talk time.

This study offers several new findings with respect to the amount of time devoted to specific topics in office visits. We found that a very limited amount of time was allocated to topics. A median of only 5 minutes was spent on even the major topic in a visit. We also found that visit length was insensitive to the contents of a visit. Longer time spent on major topics seems to have been compensated by limiting the time allocated to minor topics, therefore leaving the visit length more or less the same. Determinants of topic length differed between major and minor topics. For example, if mental health was the major topic, the topic lasted longer than biomedical topics but was the same length as biomedical topics if it was a minor topic. Likewise, a physician's expression of uncertainty was associated with longer topic length if the topic was a major topic, not so if it was a minor topic. Further, macro factors related to practice settings, e.g., organizational structure and physician payment incentives, appear to have more influence on visit length than micro—within visit factors. Some implications on these findings are discussed below.

Topics and Time Allocation

Primary care visits indeed contain a large number of topics covering diverse subjects. With only about 2 minutes of talk time on even the major topic from each speaker, we could not help but wonder how much is accomplished during such a brief exchange. Future research should assess whether the amount of time for major topics or a particular type of topic was “sufficient” to facilitate effective information exchange and patient-centered care.

While there are typically three to four biomedical topics raised in most visits ( Braddock et al. 1999 ; Beasley et al. 2004 ), a broader definition of topics finds more subjects of discussion. All compete for visit time. Our most intriguing finding is that while time spent by the patient and physician on a topic responds to many factors, time of the visit overall is much less malleable. A physician could adjust to a patient's presentation of a time-consuming problem by either extending the patient's visit and taking a little time away from the many other patients seen in the course of a day, or, keeping this patient's visit about the same by restricting time on other problems the patient might have. It appears from our data that the second strategy predominates. Therefore, if visit lengths are rigidly set, patients with more health concerns that would have required more time for history-taking and counseling could end up receiving less time than they need. Competing time demands during office visits may contribute to lower overall quality for vulnerable older people ( Min et al. 2005 ) if physicians are less inclined to spend the time and cognitive energy to engage in these time-consuming processes.

Incentives in prevailing physician payments favor procedure-based patient care over time-intensive evaluation and management care. Much of what physicians do to help their patients during an office visit would be virtually impossible to be captured in a fee schedule or a pay-for-performance system. Further, psychosocial aspects of health and health care take time to address. For example, issues such as a pending move to nursing home, or a physician's retirement and the handing over of the patient to another physician, tend to be under-represented in medical records. Furthermore, some parts of the conversation aim at building rapport or easing tension, e.g., telling jokes. While most of these subjects do not require medical expertize, they occur frequently during office visits, and probably influence the effectiveness of communication. Overlooking their influence on how clinic time (hence physician effort and resources) is spent, however, may distort incentives for quality effort because they may well represent the emotional labor a physician is performing. As long as physicians are expected to relate to their patients in a personal and empathetic manner ( Suchman 2006 ), they need to be given resources and incentives to develop and sustain such relationships. A payment system that offers physician flexibility in interaction content and time can be very desirable for providing patient-centered care. This could be a fruitful topic for future research, perhaps by sequential analysis of the topics. It could have implications on medical education and continuation of training in effective clinical time management.

Length of Visit and Practice Setting Effects

The average visit length in our sample of elderly patients was 17.4 minutes (median, 16 minutes)—quite close to the visit lengths reported in previous studies ( Braddock et al. 1999 ; Mechanic, McAlpine, and Rosenthal 2001 ), which included both elderly and younger patients. The variations in visit length across practice sites suggest that different patients get dissimilar treatments. Besides influences of financial incentives and organizational cultures ( Wolinsky and Corry 1981 ; Hillman, Pauly, and Kerstein 1989 ), educational mission at the AMC could have caused visits at the AMC to be longer visits. Fortunately, we were able to examine the influence of medical students on the length of visits. A medical student was present in only 12 out of the 147 visits at the AMC and none were at the other practices. The median lengths of these 12 visits (24.8 minutes) were compared with the other 135 visits (23.0 minutes). While they differed by almost 2 minutes, the difference was nonsignificant.

Owing to the small number of sites in the study, however, we view the across site comparisons as descriptive only. Furthermore, findings about the inner city practices are more complex to interpret, due to the unique combination of exclusively African American patient–physician pairs.

In clinical practice today, it appears, visit lengths may be prescribed by physicians' practice settings. Physicians are often held to daily patient volume targets that can also limit the amount of time they spend with each patient. Hence, examining the length of visit may not provide much new information. This observation is supported by the results from our visit-level analyses, which show that the site indicator is the dominant determinant of time at the visit level. Future studies aimed at better understanding of patient–physician interaction can benefit from a more in-depth analysis as was done in this study.

Influence of Patients

Patients who initiated major topics were met with significant reduction in physician talk time during the major topic in the visit. This may suggest that physicians did not view those topics as important as patients did. Similarly, physician talked much less with patients when patients showed mood problems nonverbally. It raises a question about whether physicians feel disinclined to engage patients who appear depressed or anxious. Additional research should be pursued to examine the content and rapport of interaction in these topics.

Similar to previous findings ( Waitzkin 1985 ), patients with at least some college education spoke significantly longer during the major topic in a visit. This suggested that better-educated patients might have prioritized how they would use the visit time so that they could spend sufficient time on the topic that was most important to them. Other patients can be encouraged to plan ahead to make sure that they are heard on pertinent issues. Alternatively, physicians might be less inclined to cut off the talk of a patient with a higher socioeconomic status.

Probably the best-known work related to ours is Roter's Interaction Analysis System (RIAS; Roter 1977 ) which analyzes visits by coding “utterances,” defined as complete thoughts expressed by the patient or physician. As one of the most widely used systems for analyzing patient–physician communication, RIAS provides a wealth of information based on aggregate utterance counts, on communication behaviors pertaining to data gathering, patient education and counseling, rapport building, and partnership building ( Levinson and Roter 1995 ; Roter et al. 1997 ; Roter, Hall, and Aoki 2002 ). The RIAS is oriented to measuring and evaluating communication process ( Wasserman and Inui 1983 ), rather than time or topics discussed, and thus serves a different purpose than our investigation. Our approach directly observes time pressure and competing demands within the visit coming from different issues facing the physician and patient, thereby offering new insights on patient–physician interaction.

This study has some limitations. For example, we do not have information from the medical records which could provide additional information on patient's history, nor do we have data on previous or subsequent visits. Further, the convenience sample limits the external validities of the findings. These limitations are often shared with other research on patient–physician interactions. Additional studies are needed to replicate the approach on other patient age groups and practice settings. The impact of such findings on clinical practice and policy will be stronger if consistent patterns are identified, using this innovative approach to examine how clinical time—a critical resource in health care—is used. Grounding research in the direct analysis of the conduct of patient and physician in the actual of units of clinical decision making, as done in this study, may be a promising approach for future studies.

Acknowledgments

We thank Mary Ann Cook and Marcia Ory for the data, NIMH (MH01935) and NIA (AG15737) for funding the research, and Margarita Alegria, John Z. Ayanian, Howard Beckman, Richard Frankel, Rachel M. Henke, Richard Kravitz, Joseph Newhouse, Richard Street Jr., Suojin Wang, and two anonymous reviewers for helpful comments on an earlier version of the paper.

Disclosures: None.

Disclaimers: None.

APPENDIX A. TRAINING OF CODERS

Training of coders involved over 8 hours of initial didactic instruction, and independent coding of 10 training visits by each coder. Intercoder reliability was calculated after data on the 10 training visits were collected. An additional five training visits were chosen and coded by each coder in a second round of training to improve reliability.

To measure agreement among coders, we calculated intraclass correlation (ICC) for numerical variables. In light of debates on properties of Cohen's κ and its susceptibility to showing low values for uncommon behaviors ( Cicchetti and Feinstein 1990 ; Feinstien and Cicchetti 1990 ; Bakeman et al. 1997 ; Ickes, Marangoni, and Garcia 1997 ), we used both Cohen's κ and percent agreement for categorical variables ( Eide, Graugaard, and Finset 2004 ).

After the second round of training coding, consistency was satisfactory The ICC for visit length was 0.98; total talk time, 0.89; patient talk time, 0.84; physician talk time, 0.86; and number of topics, 0.95. The Cohen's κ and percent agreement for patient showing verbal cue for mood disorder was 0.31 and 92 percent; for nonverbal cue for mood disorder was 0.10 and 90 percent, and for showing uncertainty, 0.06/82 and 1.00/98 percent on patient and physician's expression of uncertainty, respectively. Intrarater ICC ranged from 0.84 to 1 on number of topics, from 0.98 to 0.99 on all other numerical variables.

Following Braddock et al. (1999) , we ensured interrater reliability by randomly selecting 10 percent of the visits to be recoded by a second coder. To ensure intrarater reliability 5 percent of the visits coded by each coder were selected for repeated coding by the same coder. Coding-related questions were resolved through weekly team consultations.

APPENDIX B. DERIVATION OF QUANTITATIVE INTERPRETATIONS OF SURVIVAL ANALYSIS RESULTS

To test duration dependence, we use the Weibull proportional hazard function ( Cleves et al. 2004 ), at the topic level

The exponential of β j has an interpretation as a hazard ratio (HR) which is the change of hazard rate with 1 unit change in the value of the j th covariate.

Suppose at time t 0 the survival probability is S ( t 0 | x 0 ), we want to find a time point t 1 such that the survival probability S ( t 1 | x 1 ) is the same as S ( t 0 | x 0 ), after 1 unit increase in the value of the j th covariate. That is

Solving for t 1 , we have

where β ′ x 0 − β ′ x 1 =[(β 1 x 01 +β 2 x 02 +…+β j x 0 j +…)−(β 1 x 01 +β 2 x 02 +…+β j ( x 0 j +1)+… ]= −β j .

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Because exp(β j )=HR j , where HR j stands for hazard ratio for the j th covariate, we have

Interpretation of coefficients in the Weibull model as HRs is not straightforward. We evaluate the quantitative relationship between a change in covariates and The change in length of time at a constant survival probability. We can then calculate the percent change in talk time as a result of an increment in an explanatory variable, which is

Equation (B5) enables us to calculate, holding constant the survival probability, how changes in key explanatory variables would influence the length of time spent on a topic or a visit.

Note: equation (B1) here corresponds to equation (1) in the text, equations (B2) – (2) , and (B5) – (3) in text.

1 Nineteen of the visits were multiple visits between a few patient–physician dyads. Sensitivity analyses excluding these visits obtained similar results as the full sample. Results reported here are from all 392 visits.

2 Silences are meaningful social interaction activities that can convey multiple messages. For example, when diagnostic news is bad, silence may be a patient's exhibition of stoicism ( Maynard 2003 ).

3 For example, in a visit covering five topics, two of them focused on biomedical issues. Their combined talk time was 450 seconds, out of a total of 1,020 seconds talk time in the visit. The time share of the biomedical content area would be 44 percent. If one topic was on mental health issues and it took 120 seconds, the share of mental health content time would be 12 percent, and so on.

4 For example, from Table 2 , we see that, among the major topics, the hazard ratio of changing the topic from biomedical to mental health is 0.37, and the estimate of shape parameter s is 1.62. We can calculate percent change in patient talk time by applying equation, HR −1/s −1=(0.37) −1/1.62 −1=85 percent. Therefore, patient's talk time on mental health topics is 85 percent longer than on biomedical topics conditional on a given survival probability.

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Preparing Your Kid for Their First Visit to the Dentist

Dentist visits, like annual physicals, are a regular part of taking care of our health.

Explaining a dentist visit to a child—especially their first visit—should be simple and reassuring, helping them feel comfortable and prepared. It should also encourage checkups throughout their life.

We spoke to Amy Herbert, DDS, MHA , to learn more.

When should a child first see a dentist?

When the first tooth comes in, typically around six months, or by the time the child turns one.

What do all parents ask you about a child’s first dental appointments, and what do you tell them?

Why start going when children are young?

In addition to identifying early concerns, it is good to establish the practice of visiting the dentist and establishing a positive routine. This first appointment helps get a child used to visiting the dentist.

It is also an opportunity to teach a parent about their child’s oral health: various kinds of toothpaste, diet, and nutrition (snacking habits and food and drink choices), and when and how to brush effectively are discussed.

We may also talk about teething, non-nutritive sucking habits (thumb sucking and pacifier use), sippy cups, utensils, and transitioning to table food and regular cups.

After the first dentist visit, you always have someone to call if your child has a dental injury.

Is there a best time or day of the week for the first dentist visit?

Typically, the morning is the best time for young patients, not only because they are fresh and alert, but so is the caretaker!

Try to avoid taking your child to the dentist the same day you take them to the pediatrician or other doctor. It can be too much.

How long does the first dentist visit last?

30 to 45 minutes.

What happens at the first dentist’s visit, and how should a parent or caregiver explain it to a child?

Depending on their age and level of cooperation, the child may be seated on the parent’s lap or in the dentist’s chair on their own. Like all visits, the first visit usually includes an exam of the teeth, jaws, bite, gums, and oral tissues to check growth and development. If needed, a child may also have a gentle cleaning. This includes polishing teeth and removing any plaque, tartar, and stains.

The dentist should show the child and parent or caregiver how and when to properly clean teeth, floss, and brush at home. Sometimes, there may also be X-rays. But typically, they aren’t done until a child has contact between their teeth (they are touching). If there are any issues or concerns, the dentist will discuss treatment options.

What should I say or do for my kid to prepare them?

Here are a few things you might want to cover with your child:

A dentist looks at your teeth and gums to see if everything is okay and healthy.
A dentist—or dental hygienist—cleans teeth with special tools that remove tartar and plaque and floss and polish your teeth to help keep them healthy.
“sugar bugs” (bacteria)
“spinny brush” (handpiece)
“vitamins for teeth” (fluoride treatment)
Use a book to help
Read books together about a character going to the dentist , such as Curious George Visits The Dentist or Peppa Pig’s Dentist Trip .

What age should dental X-rays start?

X-rays usually start when the contact areas (where the teeth touch) are not visible. That’s typically after all primary teeth have come in. This happens at different ages. The schedule of follow-ups is decided based on individual risk and diagnoses.

If the dentist sees signs of decay or other pathology in the primary dentition, they may decide to take radiographs sooner.

Early loss of baby teeth can lead to other oral health issues. Additionally, untreated decay in baby teeth increases the likelihood of a child experiencing cavities in their permanent teeth.

What do all kids ask you, and what do you say?

Is it going to hurt?

To help them relax, we explain what will happen during the exam, show the instruments, and allow them to touch them if they wish. The key is explaining things in a language they can understand: “special pen” instead of the probe; “go for a ride” when manipulating the dental chair.

Preparing children and not surprising them is important.

What’s the best way to pick a dentist for your child?

Many people find their dentist by word of mouth, from their pediatrician, and by treatment philosophy. In addition, the American Academy of Pediatric Dentistry and the American Board of Pediatric Dentists have search tools on their websites.

Amy Herbert, DDS, MHA , is an assistant professor of dental medicine at Columbia.

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The life and music of Amy Winehouse, through the journey of adolescence to adulthood and the creation of one of the best-selling albums of our time. The life and music of Amy Winehouse, through the journey of adolescence to adulthood and the creation of one of the best-selling albums of our time. The life and music of Amy Winehouse, through the journey of adolescence to adulthood and the creation of one of the best-selling albums of our time.

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How Long Is Nursing School? Key Insights To Consider Before Enrolling

Curious about the length of nursing school? Learn what nursing program options the Massachusetts College of Pharmacy and Health Sciences has to offer.

How long does nursing school take to complete? It really depends on several factors, from your desired degree to how much flexibility you have in your schedule. In this article, we'll answer all your questions so you feel equipped to begin your journey to filling one of the many open positions in this essential healthcare field.

How Long Does it Take To Earn a Nursing Degree?

The big question. While there are several types of nursing degrees, ultimately, the majority of students attend nursing school for two to four years to become registered nurses (RNs).

It's important to discuss schedule flexibility and how that impacts the time required to complete a degree program. If you’re able to attend school full-time, you'll have a shorter path to your nursing career. However, if you have other obligations, a part-time program may be ideal and will also extend the length of time needed to earn a degree.

Massachusetts College of Pharmacy and Health Sciences (MCPHS) offers several nursing degree styles, giving you the freedom and flexibility to opt for a program that best suits your needs.

What Are the Different Types of Nursing Degrees?

Let's take a closer look at the nursing degrees available to future healthcare leaders at both the undergraduate and graduate levels.

Undergraduate Nursing School Programs

Bachelor of science in nursing - postbaccalaureate.

A Bachelor of Science in Nursing - Postbaccalaureate program is designed for individuals who already have a bachelor’s degree and wish to gain the skill sets necessary to enter the nursing field. This 16-month program allows students to work alongside professionals during clinical experiences in both classroom settings and within prestigious healthcare centers. The intensive curriculum covers nursing theory, clinical skills, pharmacology, and other essential nursing knowledge areas. Upon completion of this program, learners are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN).

Bachelor of Science in Nursing - Accelerated

A Bachelor of Science (BSN) is an accelerated 32-month program that helps students gain real-world experience while studying and accomplishing nursing courses. The BSN program covers a wide range of materials, from biology and chemistry to pharmacology and community health. What normally takes four years can be accomplished in three, enabling students to jump into their careers even faster than a traditional pathway. Those who complete the Bachelor of Science in Nursing program are eligible to sit for the NCLEX-RN.

Family Nurse Practitioner Bridge Program - (RN to MSN)

Through the Family Nurse Practitioner Bridge Program - (RN to MSN) , students can build on their associate’s degree without needing a bachelor’s degree in nursing. This allows a smooth transition from undergraduate to graduate-level coursework. The three-year, part-time program offers clinical experience as students expand their collegiate nursing education. They widen their understanding of the professional nursing industry and move from the bridge program into the MSN-FNP portion of their study, ultimately allowing them to sit for the Family Nurse Practitioner Board Certification Exam upon completion.

Master and Doctoral Nursing School Programs

Master of science in nursing - family nurse practitioner.

A Master of Science in Nursing - Family Nurse Practitioner (FNP) program is a 24-month, part-time course of study that provides students the flexibility to work while earning a nursing diploma. Like the Bachelor of Science in Nursing - Postbaccalaureate program, the Master of Science in Nursing - FNP path offers students the opportunity to advance their bachelor’s degree with a specialty in family nursing. Students become advanced practice registered nurses who are trained to provide comprehensive healthcare services to individuals and families across a range of ages. From delivering primary patient care services to diagnosing and treating a variety of health care concerns, nursing students learn more about what it takes to become an FNP.

Master of Science in Nursing - Psychiatric Mental Health Nurse Practitioner

A Master of Science in Nursing - Psychiatric Mental Health Nurse Practitioner (PMHNP) program allows learners to achieve a specialty in psychiatric mental health in just 24 months. This part-time, online program helps nursing students build a firm, foundational knowledge of dementia, depression, anxiety, and other psychiatric conditions. Students also dive into the doctor-patient relationship and learn about counseling best practices. After two years, learners are eligible to sit for the Psychiatric Mental Health Nurse Practitioner certification.

Doctor of Nursing Practice

The Doctor of Nursing Practice (DNP) is a program that helps students earn an advanced degree in the hopes of achieving the highest level in the nursing profession. This 24-month, online doctoral program focuses on organization and systems leadership. Those who wish to enter this program must hold a Bachelor of Science in Nursing or a Master of Science in Nursing (MSN) degree, which will give them the foundational knowledge necessary to excel in this course of study. Over four semesters, they'll cover information about local and global healthcare policies, study different methods and procedures in population health, and choose from doctoral-level courses within the School of Nursing.

Additional Nursing-Specific FAQs

What is the most common degree for nurses.

A Bachelor of Science in Nursing is the degree students select most often. Not only is it the first step toward getting a master’s in a professional nursing specialization, but it can also be widely used around the world. It’s an extremely versatile degree that provides a foundation for higher learning following its completion.

What is the fastest way to become a nurse?

MCPHS offers a 16-month Bachelor of Science in Nursing - Postbaccalaureate program, which is the quickest pathway into a nursing career. Another option is the Bachelor of Science in Nursing. MCPHS has an accelerated program option that enables learners to complete their degree in just 32 months—a year or two faster than many other institutions.

How long does it take to become a nurse practitioner?

The length of time required will depend on your existing education. In general, going through the necessary education to become a nurse practitioner (NP) can take anywhere from five to six years, depending on which route you plan to take.

NPs are required to accomplish additional training and education compared to RNs. That's because NPs are responsible for prescribing, diagnosing, and administering patient care, similar to a medical doctor. First, you'll need to earn a traditional BSN degree and follow that with a nurse practitioner degree phrase of your choosing.

Study Nursing at MCPHS

Nursing is much more than a career path at MCPHS: it’s a calling that enables you to do what you love while helping patients live healthier and happier lives. As a learner at one of the first institutions of higher education in Boston, you’re mentored by world-renowned healthcare professionals who are committed to student success. Our school is located near some of the country's top medical facilities, offering advanced clinical opportunities during your studies and after graduation.

Don’t hesitate to connect with one of our admission counselors with any questions about a potential career in nursing or how to get started at MCPHS. Apply today to start your nursing journey.

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Trump's hush money trial begins Monday. Here's what to expect.

Donald Trump will become the first former president to stand trial in a criminal case next week — and he'll do so against the backdrop of a presidential campaign in which he's the presumptive Republican nominee.

Jury selection begins Monday in New York City, and the trial is expected to last six to eight weeks.

Here's a look at what you need to know and what's expected to happen.

How long is jury selection expected to last?

Jury selection is expected to last one to two weeks. Starting Monday, prosecutors and lawyers for Trump will seek to whittle a pool of potentially hundreds of people to 12 jurors and six alternates. Each juror will answer 42 questions designed to discern whether they can be impartial about the polarizing former president. Questions include inquiries about what news sources they follow and whether they've ever attended any Trump rallies or protests. The jurors will be anonymous, meaning their identities will be withheld from the public because of security concerns.

A criminal trial involving Trump's company before the same judge in 2022 took a week to select 12 jurors and five alternates.

What is Trump charged with?

Manhattan District Attorney Alvin Bragg charged Trump with 34 counts of first-degree falsifying business records, a low-level felony. Trump faces a maximum of four years behind bars if he’s convicted.

What is the prosecution alleging?

Prosecutors allege Trump “repeatedly and fraudulently falsified New York business records to conceal criminal conduct that hid damaging information from the voting public during the 2016 presidential election.”

At the heart of the case are allegations of various sex scandals that prosecutors say Trump tried to suppress with the help of his lawyer Michael Cohen and top executives in charge of the National Enquirer. In the final days of the election, Cohen paid $130,000 to one of the women, adult film star Stormy Daniels, to keep silent about her claim she'd had a sexual encounter with Trump in 2006. Trump has denied the allegation.

After he was elected, Trump reimbursed Cohen through a series of checks from his trust that were processed through the Trump Organization and labeled as payments "for legal services rendered" — a claim the DA says was false.

What is Trump’s defense?

Trump has maintained he didn’t do anything wrong, and while he has acknowledged reimbursing Cohen, he has said he didn’t know details about what Cohen was doing.

His lawyers are likely to target Cohen on the witness stand by painting him as a liar who loathes the former president and whose testimony shouldn’t be believed. They’re likely to be aggressive with Daniels, as well, and they’re expected to focus on comments she has made mocking Trump in an effort to portray her as biased and untrustworthy.

Who will testify for the prosecution?

Cohen, who says Trump directed him to make the payment to Daniels, is expected to be a key witness, as is Daniels. Trump's attorneys sought to bar both from testifying, but Judge Juan Merchan gave both the green light to take the stand. Daniels' former attorney Keith Davidson is likely to testify about his negotiations over the payment, a source with direct knowledge of the situation said.

Also expected to testify is Karen McDougal, a former Playboy model who said she had an affair with Trump, a claim he denies. She received money from the Enquirer to keep quiet about her allegations in what prosecutors said was part of a "catch and kill" scheme designed to keep a lid on potential Trump scandals.

David Pecker, a Trump ally who was the CEO of Enquirer publisher AMI at the time, is also expected to be called, the source said. Dylan Howard, another former AMI executive involved in the discussions with Trump and Cohen, may also testify.

Former White House communications director Hope Hicks — who prosecutors have said was involved in phone calls among Trump, Cohen and AMI — and former Trump assistant Madeleine Westerhout are also likely to take the stand, the source said.

Jurors are also expected to hear from Jeffrey McConney, the former controller for the Trump Organization, and Deborah Tarasoff, a former accounts payable supervisor at the company, the source said.

Who will testify in Trump's defense?

Court filings show Trump plans to call Bradley A. Smith, a former Federal Election Commission chair who will testify about the FEC and its function, laws it's responsible for enforcing and definitions and terms that relate to the case. The judge ruled he won’t be allowed to offer his opinion about whether Trump's actions violated election law, as Trump had hoped he would.

Trump, who is the only person who can directly rebut some of Cohen's claims, said Friday that he would "absolutely" testify in the trial. He is not required to take the stand.

Will Trump have to be in court every day?

Unlike the New York civil fraud and E. Jean Carroll defamation trials, the DA's case is criminal, so Trump is required to be in court every day to participate in his defense. The trial is off on Wednesdays, but Trump will have to be in court for the four other days of the court week. The trial days are expected to last from 9:30 a.m. to 4:30 p.m.

Trump has suggested he might do campaign events at night after having attended court during the day.

How many jurors' votes are needed for a conviction or an acquittal?

To reach a verdict, all 12 jurors must agree on whether Trump is guilty or not guilty of a specific charge.

Dareh Gregorian is a politics reporter for NBC News.

Adam Reiss is a reporter and producer for NBC and MSNBC.

The Ultimate Timeline: How Long Does a Kitchen Remodel Take?

Are you planning to embark on a kitchen remodel? It’s no small endeavor. You’re probably asking yourself:

Just how long does a kitchen remodel take?

You’ve probably heard stories about kitchen renovations taking forever. But what’s the real deal? How long should you prepare to have your life (and your cooking routine) disrupted by a kitchen remodel?

Let’s pull back the curtain on the timeline of a typical kitchen renovation and the remodeling stages. We’ll also look into the factors that can slow down the process and some tips on how you can speed it up.

The Standard Timeline

The average kitchen remodel timeline takes anywhere between 6 to 8 weeks from start to finish. This includes the planning phase, ordering materials, and actual construction work. But remember, this is just an estimate – many variables can affect how long your remodel will take.

The Remodeling Stages

To understand the project duration better, let’s break down the different remodeling stages:

The Planning Phase (2-3 Weeks)

Before any work can begin, you’ll spend a couple of weeks planning your kitchen remodel. This includes researching ideas, setting a budget , and gathering quotes from contractors. It’s also the time to finalize your design plans and order any custom materials.

The Demolition Phase (1 Week)

Once everything is in order, it’s time for demolition! Depending on the size of your kitchen and the extent of the changes, this phase can take anywhere from 3 to 5 days. Demolition involves removing old fixtures, cabinets, and appliances.

The Construction Phase (2-4 Weeks)

The construction phase is where the magic happens. This is when your new kitchen starts to take shape. It typically takes around 2 to 4 weeks for all major construction work to be completed. This can involve installing new cabinets, countertops, and flooring, as well as plumbing and electrical work.

The Finishing Touches (1-2 Weeks)

The final stage of a kitchen remodel includes adding finishing touches such as painting, backsplash installation, and adding hardware to cabinets. This phase usually takes 1 to 2 weeks. Once everything is complete, your new kitchen will be ready to use!

Factors That Can Affect the Timeline

As mentioned earlier, many variables can affect how long your kitchen renovation process takes. These include:

Permits and Inspections

Depending on the complexity of your remodel and local regulations, you might need to secure several permits before you can begin. Receiving approval for these permits can take anywhere from a few days to several weeks.

Once the work is done, inspections will be necessary to ensure everything is up to code. This process can also add time to your remodel.

Size of the Project

A small kitchen remodel will take less time than a large one. Adding an island or expanding your kitchen space can add to the timeline.

Custom Designs and Materials

If you’re going for custom cabinetry, countertops, or appliances, it may take longer to get them delivered and installed. For example, if you want glass splashbacks , the lead time can be longer. But they add elegance and functionality to your kitchen so it’s still worth the wait.

Contractor Availability

Your kitchen remodel timeline can also get affected by the availability of your chosen contractor. Good contractors are often booked months in advance, especially during peak renovation seasons.

Once they start, they will stay on your project until it’s complete, but unforeseen circumstances might cause delays. Even a small delay in one task can push the entire timeline back.

Unforeseen Issues

During any renovation, you may encounter unexpected problems that can delay the project timeline. These unforeseen issues could include structural problems or plumbing or electrical issues.

For example, you may need to remove a wall during the remodel and you may discover a structural issue. You will need to address this before moving forward, which can add time to the project.

Furthermore, unexpected budget constraints can also cause delays. If a part of the project ends up costing more than anticipated, you may need to pause the work. You might need to take time to adjust your budget or wait for additional funds.

Tips for Speeding up Your Kitchen Remodel

If you’re looking to reduce the timeline of your kitchen remodel, here are some tips to consider:

The more you plan before starting the project, the smoother and faster the process will be. Make sure to finalize designs and materials ahead of time so there are no delays in ordering.

Don’t Change Your Mind

Be decisive with your choices. Changing your mind midway through the remodel can cause delays and add to the timeline – not to mention extra costs.

Work With Experienced Professionals

Professionals with a proven track record in kitchen remodeling will ensure that the work is done correctly. They can also foresee potential issues that may arise during the process, helping you avoid costly delays.

Moreover, they can offer valuable insights and recommendations based on their experience. They can allow you to make informed decisions about design choices and materials.

Remember, a well-executed kitchen remodel is not just about aesthetics, but also about enhancing functionality. A professional can effectively balance both these aspects.

Therefore, investing in a skilled contractor can ultimately save you time and stress. They can ensure that your kitchen remodel is completed within your completion expectations.

Be Flexible

The remodeling process can be unpredictable. That’s why it’s important to maintain a level of flexibility. This doesn’t mean allowing contractors to move the goalposts but rather being adaptable to changes.

Perhaps a certain material becomes unavailable or a delay is unavoidable due to factors beyond anyone’s control. It’s important to be open to alternate solutions or slight adjustments to the timeline.

Remember, the goal is to get a beautifully remodeled kitchen that you’ll love for years to come. A few extra days can often be worth the wait in the grand scheme of things.

How Long Does a Kitchen Remodel Take? It’s Not That Simple

The question, “How long does a kitchen remodel take?” is multifaceted. The answer is dependent on a range of factors.

Generally, a kitchen remodel can take anywhere between 6 to 8 weeks, but remember, this is just an estimate. Unforeseen issues and changes can extend this timeline. That’s why you need to plan and prepare for all scenarios.

Ultimately, the goal is to create a kitchen that not only looks appealing. You want a kitchen that increases functionality and efficiency for years to come.

Was this article helpful? If so, check out the rest of our site for more.

This article is published by NYTech in collaboration with Syndication Cloud.

The Ultimate Timeline: How Long Does a Kitchen Remodel Take?

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Are ‘Forever Chemicals’ a Forever Problem?

The environmental protection agency says “forever chemicals” must be removed from tap water. but they lurk in much more of what we eat, drink and use..

This transcript was created using speech recognition software. While it has been reviewed by human transcribers, it may contain errors. Please review the episode audio before quoting from this transcript and email [email protected] with any questions.

From “The New York Times,” I’m Sabrina Tavernise. And this is “The Daily.”

[THEME MUSIC]

This month for the first time, the Environmental Protection Agency began to regulate a class of synthetic chemicals, known as forever chemicals, in America’s drinking water. But the chemicals, which have been linked to liver disease and other serious health problems, are in far more than just our water supply. Today, my colleague Kim Tingley explains.

It’s Wednesday, April 17.

So Kim, any time the EPA announces a regulation, I think we all sort of take notice because implicit in it is this idea that we have been exposed to something — something bad, potentially, lead or asbestos. And recently, the EPA is regulating a type of chemical known as PFAS So for those who don’t know, what are PFAS chemicals

Yeah, so PFAS stands for per and polyfluoroalkyl substances. They’re often called forever chemicals just because they persist so long in the environment and they don’t easily break down. And for that reason, we also use them in a ton of consumer products. They’re in makeup. They’re in carpet. They’re in nonstick cookware. They’re in food packaging, all sorts of things.

Yeah, I feel like I’ve been hearing about these chemicals actually for a very long time. I mean, nonstick pans, Teflon — that’s the thing that’s in my mind when I think PFAS.

Absolutely. Yeah, this class of chemicals has been around for decades. And what’s really important about this is that the EPA has decided, for the first time, to regulate them in drinking water. And that’s a ruling that stands to affect tens of millions of people.

So, help me understand where these things came from and how it’s taken so long to get to the point where we’re actually regulating them.

So, they really actually came about a long time ago. In 1938, DuPont, the people who eventually got us to Teflon, they were actually looking for a more stable kind of refrigerant. And they came upon this kind of chemical, PFAS. The thing that all PFAS chemicals have is a really strong bond between carbon atoms and fluorine atoms. This particular pairing is super strong and super durable.

They have water repellent properties. They’re stain resistant. They’re grease resistant. And they found a lot of uses for them initially in World War II. They were using them as part of their uranium enrichment process to do all these kinds of things. And then —

Well, good thing it’s Teflon.

In the 1950s is when they really started to come out as commercial products.

Even burned food won’t stick to Teflon. So it’s always easy to clean.

So, DuPont started using it in Teflon pans.

Cookware never needs scouring if it has DuPont Teflon.

And then another company, 3M also started using a kind of PFAS —

Scotchgard fabric protector. It keeps ordinary spills from becoming extraordinary stains.

— in one of their big products, Scotchgard. So you probably remember spraying that on your shoes if you want to make your shoes waterproof.

Use Scotchgard fabric protector and let your cup runneth over.

Right — miracle product, Scotchgard, Teflon. But of course, we’re talking about these chemicals because they’ve been found to pose health threats. When does that risk start to surface?

Yeah, so it’s pretty early on that DuPont and 3M start finding effects in animals in studies that they’re running in house.

Around the mid ‘60s, they start seeing that PFAS has an effect on rats. It’s increasing the liver and kidney weights of the rats. And so that seems problematic. And they keep running tests over the next decade and a half. And they try different things with different animals.

In one study, they gave monkeys really, really high levels of PFAS. And those monkeys died. And so they have a pretty strong sense that these chemicals could be dangerous. And then in 1979, they start to see that the workers that are in the plants manufacturing, working with these chemicals, that they’re starting to have higher rates of abnormal liver function. And in a Teflon plant, they had some pregnant workers that were working with these chemicals. And one of those workers in 1981 gave birth to a child who had some pretty severe birth defects.

And then by the mid 1980s, DuPont figures out that it’s not just their workers who are being exposed to these chemicals, but communities that are living in areas surrounding their Teflon plant, particularly the one in Parkersburg, West Virginia, that those communities have PFAS in their tap water.

Wow, so based on its own studies, DuPont knows its chemicals are making animals sick. They seem to be making workers sick. And now they found out that the chemicals have made their way into the water supply. What do they do with that information?

As far as we know, they didn’t do much. They certainly didn’t tell the residents of Parkersburg who were drinking that water that there was anything that they needed to be worried about.

How is that possible? I mean, setting aside the fact that DuPont is the one actually studying the health effects of its own chemicals, presumably to make sure they’re safe, we’ve seen these big, regulating agencies like the EPA and the FDA that exist in order to watch out for something exactly like this, a company that is producing something that may be harming Americans. Why weren’t they keeping a closer watch?

Yeah, so it goes kind of back to the way that we regulate chemicals in the US. It goes through an act called the Toxic Substances Control Act that’s administered by the EPA. And basically, it gives companies a lot of room to regulate themselves, in a sense. Under this act they have a responsibility to report to the EPA if they find these kinds of potential issues with a chemical. They have a responsibility to do their due diligence when they’re putting a chemical out into the environment.

But there’s really not a ton of oversight. The enforcement mechanism is that the EPA can find them. But this kind of thing can happen pretty easily where DuPont keeps going with something that they think might really be a problem and then the fine, by the time it plays out, is just a tiny fraction of what DuPont has earned from producing these chemicals. And so really, the incentive is for them to take the punishment at the end, rather than pull it out early.

So it seems like it’s just self-reporting, which is basically self-regulation in a way.

Yeah, I think that is the way a lot of advocacy groups and experts have characterized it to me, is that chemical companies are essentially regulating themselves.

So how did this danger eventually come to light? I mean, if this is in some kind of DuPont vault, what happened?

Well, there’s a couple different things that started to happen in the late ‘90s.

The community around Parkersburg, West Virginia, people had reported seeing really strange symptoms in their animals. Cows were losing their hair. They had lesions. They were behaving strangely. Some of their calves were dying. And a lot of people in the community felt like they were having health problems that just didn’t really have a good answer, mysterious sicknesses, and some cases of cancers.

And so they initiate a class action lawsuit against DuPont. As part of that class action lawsuit, DuPont, at a certain point, is forced to turn over all of their internal documentation. And so what was in the files was all of that research that we mentioned all of the studies about — animals, and workers, the birth defects. It was really the first time that the public saw what DuPont and 3M had already seen, which is the potential health harms of these chemicals.

So that seems pretty damning. I mean, what happened to the company?

So, DuPont and 3M are still able to say these were just a few workers. And they were working with high levels of the chemicals, more than a person would get drinking it in the water. And so there’s still an opportunity for this to be kind of correlation, but not causation. There’s not really a way to use that data to prove for sure that it was PFAS that caused these health problems.

In other words, the company is arguing, look, yes, these two things exist at the same time. But it doesn’t mean that one caused the other.

Exactly. And so one of the things that this class action lawsuit demands in the settlement that they eventually reach with DuPont is they want DuPont to fund a formal independent health study of the communities that are affected by this PFAS in their drinking water. And so they want DuPont to pay to figure out for sure, using the best available science, how many of these health problems are potentially related to their chemicals.

And so they ask them to pay for it. And they get together an independent group of researchers to undertake this study. And it ends up being the first — and it still might be the biggest — epidemiological study of PFAS in a community. They’ve got about 69,000 participants in this study.

Wow, that’s big.

It’s big, yeah. And what they ended up deciding was that they could confidently say that there was what they ended up calling a probable link. And so they were really confident that the chemical exposure that the study participants had experienced was linked to high cholesterol, ulcerative colitis, thyroid disease, testicular cancer, kidney cancer, and pregnancy induced hypertension.

And so those were the conditions that they were able to say, with a good degree of certainty, were related to their chemical exposure. There were others that they just didn’t have the evidence to reach a strong conclusion.

So overall, pretty substantial health effects, and kind of vindicates the communities in West Virginia that were claiming that these chemicals were really affecting their health.

Absolutely. And as the years have gone on, that was sort of just the beginning of researchers starting to understand all the different kinds of health problems that these chemicals could potentially be causing. And so since the big DuPont class action study, there’s really just been like this building and building and building of different researchers coming out with these different pieces of evidence that have accumulated to a pretty alarming picture of what some of the potential health outcomes could be.

OK, so that really kind of brings us to the present moment, when, at last, it seems the EPA is saying enough is enough. We need to regulate these things.

Yeah, it seems like the EPA has been watching this preponderance of evidence accumulate. And they’re sort of deciding that it’s a real health problem, potentially, that they need to regulate.

So the EPA has identified six of these PFAS chemicals that it’s going to regulate. But the concern that I think a lot of experts have is that this particular regulation is not going to keep PFAS out of our bodies.

We’ll be right back.

So, Kim, you just said that these regulations probably won’t keep PFAS chemicals out of our bodies. What did you mean?

Well, the EPA is talking about regulating these six kinds of PFAS. But there are actually more than 10,000 different kinds of PFAS that are already being produced and out there in the environment.

And why those six, exactly? I mean, is it because those are the ones responsible for most of the harm?

Those are the ones that the EPA has seen enough evidence about that they are confident that they are probably causing harm. But it doesn’t mean that the other ones are not also doing something similar. It’s just sort of impossible for researchers to be able to test each individual chemical compound and try to link it to a health outcome.

I talked to a lot of researchers who were involved in this area and they said that they haven’t really seen a PFAS that doesn’t have a harm, but they just don’t have information on the vast majority of these compounds.

So in other words, we just haven’t studied the rest of them enough yet to even know how harmful they actually are, which is kind of alarming.

Yeah, that’s right. And there’s just new ones coming out all the time.

Right. OK, so of the six that the EPA is actually intending to regulate, though, are those new regulations strict enough to keep these chemicals out of our bodies?

So the regulations for those six chemicals really only cover getting them out of the drinking water. And drinking water only really accounts for about 20 percent of a person’s overall PFAS exposure.

So only a fifth of the total exposure.

Yeah. There are lots of other ways that you can come into contact with PFAS. We eat PFAS, we inhale PFAS. We rub it on our skin. It’s in so many different products. And sometimes those products are not ones that you would necessarily think of. They’re in carpets. They’re in furniture. They’re in dental floss, raincoats, vinyl flooring, artificial turf. All kinds of products that you want to be either waterproof or stain resistant or both have these chemicals in them.

So, the cities and towns are going to have to figure out how to test for and monitor for these six kinds of PFAS. And then they’re also going to have to figure out how to filter them out of the water supply. I think a lot of people are concerned that this is going to be just a really expensive endeavor, and it’s also not really going to take care of the entire problem.

Right. And if you step back and really look at the bigger problem, the companies are still making these things, right? I mean, we’re running around trying to regulate this stuff at the end stage. But these things are still being dumped into the environment.

Yeah. I think it’s a huge criticism of our regulatory policy. There’s a lot of onus put on the EPA to prove that a harm has happened once the chemicals are already out there and then to regulate the chemicals. And I think that there’s a criticism that we should do things the other way around, so tougher regulations on the front end before it goes out into the environment.

And that’s what the European Union has been doing. The European Chemicals Agency puts more of the burden on companies to prove that their products and their chemicals are safe. And the European Chemicals Agency is also, right now, considering just a ban on all PFAS products.

So is that a kind of model, perhaps, of what a tough regulation could look like in the US?

There’s two sides to that question. And the first side is that a lot of people feel like it would be better if these chemical companies had to meet a higher standard of proof in terms of demonstrating that their products or their chemicals are going to be safe once they’ve been put out in the environment.

The other side is that doing that kind of upfront research can be really expensive and could potentially limit companies who are trying to innovate in that space. In terms of PFAS, specifically, this is a really important chemical for us. And a lot of the things that we use it in, there’s not necessarily a great placement at the ready that we can just swap in. And so it’s used in all sorts of really important medical devices or renewable energy industries or firefighting foam.

And in some cases, there are alternatives that might be safer that companies can use. But in other cases, they just don’t have that yet. And so PFAS is still really important to our daily lives.

Right. And that kind of leaves us in a pickle because we know these things might be harming us. Yet, we’re kind of stuck with them, at least for now. So, let me just ask you this question, Kim, which I’ve been wanting to ask you since the beginning of this episode, which is, if you’re a person who is concerned about your exposure to PFAS, what do you do?

Yeah. So this is really tricky and I asked everybody this question who I talked to. And everybody has a little bit of a different answer based on their circumstance. For me what I ended up doing was getting rid of the things that I could sort of spot and get rid of. And so I got rid of some carpeting and I checked, when I was buying my son a raincoat, that it was made by a company that didn’t use PFAS.

It’s also expensive. And so if you can afford to get a raincoat from a place that doesn’t manufacture PFAS, it’s going to cost more than if you buy the budget raincoat. And so it’s kind of unfair to put the onus on consumers in that way. And it’s also just not necessarily clear where exactly your exposure is coming from.

So I talk to people who said, well, it’s in dust, so I vacuum a lot. Or it’s in my cleaning products, so I use natural cleaning products. And so I think it’s really sort of a scattershot approach that consumers can take. But I don’t think that there is a magic approach that gets you a PFAS-free life.

So Kim, this is pretty dark, I have to say. And I think what’s frustrating is that it feels like we have these government agencies that are supposed to be protecting our health. But when you drill down here, the guidance is really more like you’re on your own. I mean, it’s hard not to just throw up your hands and say, I give up.

Yeah. I think it’s really tricky to try to know what you do with all of this information as an individual. As much as you can, you can try to limit your individual exposure. But it seems to me as though it’s at a regulatory level that meaningful change would happen, and not so much throwing out your pots and pans and getting new ones.

One thing about PFAS is just that we’re in this stage still of trying to understand exactly what it’s doing inside of us. And so there’s a certain amount of research that has to happen in order to both convince people that there’s a real problem that needs to be solved, and clean up what we’ve put out there. And so I think that we’re sort of in the middle of that arc. And I think that that’s the point at which people start looking for solutions.

Kim, thank you.

Here’s what else you should know today. On Tuesday, in day two of jury selection for the historic hush money case against Donald Trump, lawyers succeeded in selecting 7 jurors out of the 12 that are required for the criminal trial after failing to pick a single juror on Monday.

Lawyers for Trump repeatedly sought to remove potential jurors whom they argued were biased against the president. Among the reasons they cited were social media posts expressing negative views of the former President and, in one case, a video posted by a potential juror of New Yorkers celebrating Trump’s loss in the 2020 election. Once a full jury is seated, which could come as early as Friday, the criminal trial is expected to last about six weeks.

Today’s episode was produced by Clare Toeniskoetter, Shannon Lin, Summer Thomad, Stella Tan, and Jessica Cheung, with help from Sydney Harper. It was edited by Devon Taylor, fact checked by Susan Lee, contains original music by Dan Powell, Elisheba Ittoop, and Marion Lozano, and was engineered by Chris Wood.

Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly.

That’s it for The Daily. I’m Sabrina Tavernise. See you tomorrow.

April 18, 2024 • 30:07 The Opening Days of Trump’s First Criminal Trial
April 17, 2024 • 24:52 Are ‘Forever Chemicals’ a Forever Problem?
April 16, 2024 • 29:29 A.I.’s Original Sin
April 15, 2024 • 24:07 Iran’s Unprecedented Attack on Israel
April 14, 2024 • 46:17 The Sunday Read: ‘What I Saw Working at The National Enquirer During Donald Trump’s Rise’
April 12, 2024 • 34:23 How One Family Lost $900,000 in a Timeshare Scam
April 11, 2024 • 28:39 The Staggering Success of Trump’s Trial Delay Tactics
April 10, 2024 • 22:49 Trump’s Abortion Dilemma
April 9, 2024 • 30:48 How Tesla Planted the Seeds for Its Own Potential Downfall
April 8, 2024 • 30:28 The Eclipse Chaser
April 7, 2024 The Sunday Read: ‘What Deathbed Visions Teach Us About Living’
April 5, 2024 • 29:11 An Engineering Experiment to Cool the Earth

Hosted by Sabrina Tavernise

Featuring Kim Tingley

Produced by Clare Toeniskoetter , Shannon M. Lin , Summer Thomad , Stella Tan and Jessica Cheung

With Sydney Harper

Edited by Devon Taylor

Original music by Dan Powell , Elisheba Ittoop and Marion Lozano

Engineered by Chris Wood

Listen and follow The Daily Apple Podcasts | Spotify | Amazon Music

The Environmental Protection Agency has begun for the first time to regulate a class of synthetic chemicals known as “forever chemicals” in America’s drinking water.

Kim Tingley, a contributing writer for The New York Times Magazine, explains how these chemicals, which have been linked to liver disease and other serious health problems, came to be in the water supply — and in many more places.

On today’s episode

Kim Tingley , a contributing writer for The New York Times Magazine.

A single water drop drips from a faucet.

Background reading

“Forever chemicals” are everywhere. What are they doing to us?

The E.P.A. issued its rule about “forever chemicals” last week.

There are a lot of ways to listen to The Daily. Here’s how.

We aim to make transcripts available the next workday after an episode’s publication. You can find them at the top of the page.

Fact-checking by Susan Lee .

The Daily is made by Rachel Quester, Lynsea Garrison, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Chris Wood, Jessica Cheung, Stella Tan, Alexandra Leigh Young, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, M.J. Davis Lin, Dan Powell, Sydney Harper, Mike Benoist, Liz O. Baylen, Asthaa Chaturvedi, Rachelle Bonja, Diana Nguyen, Marion Lozano, Corey Schreppel, Rob Szypko, Elisheba Ittoop, Mooj Zadie, Patricia Willens, Rowan Niemisto, Jody Becker, Rikki Novetsky, John Ketchum, Nina Feldman, Will Reid, Carlos Prieto, Ben Calhoun, Susan Lee, Lexie Diao, Mary Wilson, Alex Stern, Dan Farrell, Sophia Lanman, Shannon Lin, Diane Wong, Devon Taylor, Alyssa Moxley, Summer Thomad, Olivia Natt, Daniel Ramirez and Brendan Klinkenberg.

Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Paula Szuchman, Lisa Tobin, Larissa Anderson, Julia Simon, Sofia Milan, Mahima Chablani, Elizabeth Davis-Moorer, Jeffrey Miranda, Renan Borelli, Maddy Masiello, Isabella Anderson and Nina Lassam.

IMAGES

How Long Does It Take To Become A Doctor? A Complete Guide
How Long Does It Take To Become A Doctor? A Complete Guide
How Long Does It Take to Become a Doctor?
How Long Does It Take To Become A Doctor?
How Long Does It Take To Be A Doctor? [Detailed Breakdown]
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VIDEO

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How to prepare for a Doctor Visit? Do these things before you go

COMMENTS

How Much Time Does A Doctor Visit Really Take?
The end result = 1 doctor's visit is 2 hours (if you can get in to see a doctor before the average 24-day wait period) An Urgent Care Center Visit. Much like a visit to a PCP, a trip to an urgent care center will take about two hours or more. But depending on the severity of your illness or injury and the number of other patients (and the ...
How Long Is the Average Doctor's Visit
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Before your appointment. Depending upon the reason for your doctor's visit, this checklist can help you prepare. Copies of any tests, x-rays, or medical histories relating to your medical problem. Completed medical history questionnaire. A list of all current medications taken on a regular basis, including over-the-counter and herbal medications.
Why Does It Take So Long to Schedule a Doctor's Appointment?
A lack of healthcare providers is a significant contributing factor to longer appointment wait times. According to a white paper by Definitive Healthcare, more than 330,000 healthcare providers left the workforce in 2021 alone, with physicians representing the lion's share. While burnout drove part of the exodus, an aging workforce is another ...
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How to Prepare. A wellness visit is a health check-up that is typically conducted on an annual basis. It involves visiting your healthcare provider to check your vitals, screen for health conditions, and develop a healthcare plan for your needs. The aim of a wellness visit is to promote health and prevent disease and disability.
Why Waiting at the Healthcare Provider's Office Is So Common
Deciding Whether to Wait. Once you get to the office for your appointment, ask the person at the check-in desk how long they think you'll be waiting. Then decide whether you want to wait that long and whether or not seeing that healthcare provider is worth that wait. If not, then reschedule. If you're told the wait will be 15 minutes, then ...
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Patient Waiting Times: What is Reasonable at Your Medical Practice?
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Lena V. Groeger. Lena V. Groeger is the graphics director at ProPublica, where she oversees a team of interactive visual storytellers who create information graphics and graphical stories. lena ...
FastStats
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A physical exam checks your overall health. Your healthcare provider will evaluate the basic function of your organs, address any concerns, update your vaccinations and help you get healthy or maintain good health. Get a physical exam each year. It takes about 30 minutes to complete. Contents Overview Test Details Results and Follow-Up.
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MCPHS offers a 16-month Bachelor of Science in Nursing - Postbaccalaureate program, which is the quickest pathway into a nursing career. Another option is the Bachelor of Science in Nursing. MCPHS has an accelerated program option that enables learners to complete their degree in just 32 months—a year or two faster than many other institutions.
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Are 'Forever Chemicals' a Forever Problem?
So, they really actually came about a long time ago. In 1938, DuPont, the people who eventually got us to Teflon, they were actually looking for a more stable kind of refrigerant. And they came ...