By far the biggest problem is how we (physicians) get paid. We are paid by the visit, not by the amount of time spent. Therefore, our best efficiency occurs when we always have someone in the queue. An empty queue is a lost opportunity.
The way we pay physicians encourages waiting - not explicitly, but implicitly.
Ask any physician and they will tell you that they try to stay on schedule, but …
1. The second patient of the day was much sicker, or more complex than expected.
2. A hospitalized patient crashed, so I was late getting to the office.
3. The third patient of the day was 15 minutes late, throwing my entire schedule off.
4. A patient called in acutely ill and I had to squeeze them into the schedule - throwing my entire schedule off.