The ZocDoc will see you now…
In Boston, the average patient must wait 66 days to receive a simple physical exam. The growing demand for services in the setting of worsening physician shortages has created great difficulty in scheduling care. One man discovered this the hard way after a sudden injury, but is his solution the start of something even bigger?
Medical Malady Surfaces Ingenious Idea
Imagine you’re on the tail end of a redeye flight. As the plane descends and the pressure in the cabin shifts accordingly, you hear a sudden “pop” and feel excruciating pain in your ear. You’ve ruptured your eardrum. After a night fraught with pain—waiting for business hours to resume—you call office after office of otolaryngologists hoping for an urgent appointment, desperately scouring websites and poorly-organized directories for phone numbers, only to learn that virtually every otolaryngologist is booked weeks in advance. The pain is unbearable. After many hours, you are relieved when you finally find a provider who can fit you into their schedule. Four days later.
With millions of previously uninsured Americans now receiving health insurance under the Affordable Care Act, medical practices are experiencing ever-growing demand for their valuable services. Unfortunately for patients everywhere, this demand has put further strain on physicians’ already overbooked schedules, leaving many patients to either delay their care or seek treatment elsewhere (often in overcrowded emergency departments where bills can reach astronomical amounts).[i] The patient described above did eventually make it to the doctor, and soon thereafter founded ZocDoc; an online service that helps instantly connect millions of patients with scarce appointment slots in otherwise busy doctors’ schedules.[ii]
Taking a Lesson from Yelp
Finding the right doctor is no easy task; you must find one who is nearby, practices within a certain specialty, accepts your specific health insurance plan, has openings convenient for your schedule, and is known to provide good care. Patients have traditionally relied on referrals from other doctors (usually requiring an additional visit to their office) or word-of-mouth from friends and family, limiting the effective number of choices at a patient’s disposal. In retrospect, the solution seems obvious—people already use services like Yelp.com to search for nearby restaurants, read customer reviews, and make reservations—why not provide a similar service to find doctors?
Becoming the Middleman
ZocDoc allows customers to “see doctors’ open appointment times and book instantly online, make informed choices with verified reviews, and stay on top of important checkups with tailored reminders.[iii]” The service is provided free to patients (2 million of whom use the services each month) while doctors pay a flat monthly fee[iv] to be listed on the service. The service integrates seamlessly with the doctors’ own scheduling software, displaying openings and bookings in real time. Scheduling is automated, allowing patients to make appointments even after hours, which frees office staff to perform other critical tasks. The service was an instant success, with analysts estimating that the company remains profitable in every market in which it operates.[v]
Many More Symptoms, Many Potential Cures
More than 26% of Americans wait longer than a week for a doctor’s appointment, and the experience in some markets is even more extreme; in Boston, for example, patients wait 66 days on average just for a physical exam.[vi] Although ZocDoc makes the process of searching for and booking appointments much easier, the underlying problem of low availability is expected to worsen—by 2025, it is estimated that there will be a 20% deficit in the physician workforce needed to care for our aging population.[vii] In light of rising demand, doctors are increasingly overbooking patients (similar to airlines and restaurants) in order to accommodate patients when others cancel last minute,[viii] further overcrowding congested waiting rooms. However, these problems open up many opportunities for ZocDoc to further enhance the interface between doctors and patients.
- Schedule optimization: there is significant amount of research being conducted on optimizing physician schedules using sophisticated analytics to decrease lead-time for patient visits.[ix] By leveraging their own valuable data on patient scheduling habits and cancellation patterns, ZocDoc may extend their services from just filling in gaps to optimizing whole schedules (and increasing patient capacities).
- Enhance patient care coordination: a large contributor to inefficiency in the healthcare system stems from duplication of physician efforts—as patients traverse multiple specialties, expensive tests are often repeated and knowledge is not shared between providers.[x] ZocDoc is in the early stages of developing a system to allow doctors to receive a patient’s medical records instantly once a patient has booked an appointment, possibly saving time and effort.
- Telemedicine: a large number of startups are attempting to improve patient access to care by offering virtual visits with physicians using readily available video conferencing tools on smartphones. Partnering with such services could help shunt some of the burden for lower-level complaints away from the crowded waiting rooms.
ZocDoc’s success illustrates how impactful mobile technology can be in helping streamline the delivery of healthcare in an otherwise convoluted system. Development of creative digital solutions to reduce these hindrances are vital to sustaining the equitable provision of healthcare for years to come.
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Sources:
[i] Murray M, Berwick DM. Advanced Access: Reducing Waiting and Delays in Primary Care. JAMA. 2003;289(8):1035-1040. doi:10.1001/jama.289.8.1035
[ii] Cyrus Massoumi (2014). Out of Office: How a Ruptured Eardrum Became My Biggest Idea. LinkedIn, Aug 5 2014. https://www.linkedin.com/pulse/20140805095400-766323-out-of-office-how-a-ruptured-eardrum-became-my-biggest-idea
[iii] ZocDoc official website. (2016). www.zocdoc.com/about
[iv] CNBC. (2012). Off the Cuff. Dec 14 2012. http://finance.yahoo.com/blogs/off-the-cuff/ear-infection-across-country-led-great-idea-172725392.html
[v] Allison Shontell. (2013). Aetna Once Offered To Buy NY Startup ZocDoc For More Than $300 Million And The Founders Walked Away. Business Insider, Sep 5 2013. http://www.businessinsider.com/aenta-offered-to-acquire-zocdoc-2013-9
[vi] Elisabeth Rosenthal. (2014). The Health Care Waiting Game: Long Waits for Doctors’ Appointments Have Become the Norm. The New York Times, July 5 2014. http://www.nytimes.com/2014/07/06/sunday-review/long-waits-for-doctors-appointments-have-become-the-norm.html?_r=0
[vii] Cooper RA. (2004). Weighing the evidence for expanding physician supply. Ann Inter Med. 2004 Nov 2;141(9):705-14. PubMed PMID: 15520427.
[viii] Nick Tate. (2015). Doc Wait Times Costing Patients More Time, Money: Study. Newsmax Health, Oct 19 2015. http://www.newsmax.com/Health/Health-News/doc-wait-times-growing/2015/10/19/id/696980/
[ix] Wiesche L, Schacht M, Werners B. (2016). Strategies for interday appointment scheduling in primary care. Health Care Manag Sci. 2016 Mar 21. PubMed PMID: 27000079.
[x] Stewart BA, Fernandes S, Rodriguez-Huertas E, Landzberg M. (2010). A preliminary look at duplicate testing associated with lack of electronic health record interoperability for transferred patients. Journal of the American Medical Informatics Association : JAMIA. 2010;17(3):341-344. doi:10.1136/jamia.2009.001750.
As an avid user of ZocDoc, I completely agree with your suggestions on growth opportunities for the company. ZocDoc has made finding available doctors extremely easy, but I wonder if this ease of use has also resulted in an increase in wasted time for doctors. Are patients misdiagnosing their ailments and going directly to a specialist instead of seeing an internal medicine doctor to get a referral to the correct specialist? I wonder if ZocDoc can expand its platform to allow for video doctor appointments with in-house ZocDoc doctors who can determine which specialist a patient should visit instead of leaving the guesswork up to the patients. ZocDoc can even monetize this feature to start earning revenue from patients. Like you, I think ZocDoc has great potential to vastly improve the healthcare system; it’s just a matter of getting the hospitals on board.
Thank you for your post. One of the issues with healthcare is that patients often do not know when to go to the doctor. While I agree that ZocDoc has the potential to connect patients with doctors, I wonder if ZocDoc can leverage its digitization capabilities in screening patients before they make an appointment. Patients often diagnose themselves online, which results in either delaying seeing a doctor or seeing the wrong doctor for their symptoms. ZocDoc could incorporate an algorithm that asks a series of questions that can recommend certain types of doctors to the patients based on symptoms. There are a couple of start-ups right now that does this, such as Buoy, which is a technological platform that diagnoses and recommends patients to the right provider.
The statistics of the status quo are indeed very shocking. This is an industry that is ripe for disruption and I’m glad to see Zocdoc doing well at that. I really hope the effort for patient care coordination is successful. Test results are essentially wasted when changing medical care providers and redundant, non value adding procedures have to be made. I wonder how ZocDoc is going to get access to such data as some hospitals or clinics may be territorial with their data, but lets hope they get a lot signed on and create a critical mass where pretty much everybody will have to follow suit.
While I agree that Zocdoc is a useful platform for patients to search for and book appointments more efficiently, I don’t think it has been successful in becoming the “yelp” for doctors – the vast majority of doctors on Zocdoc all have a similar high 4-5 star rating, unlike in Yelp where you do see ranges in ratings from 1-5. Perhaps because there is no incentive for a doctor who receive a lower rating to stay on the platform if there is a cost to being listed, or maybe it is hard for a patient to assess the “true quality” of their care – because unlike a physical good or a restaurant experience, health problems tend to be fairly unique and requiring significant experience to resolve. There have been a number of other startups that aim to solve the issue of credible recommendations, but most have been targeting the corporate sector by establishing a “best doctors” network accessible through an employer insurance plan.
There is so much potential to make a huge impact on the way consumers engage with their health care. I heavily rely on ZocDoc for all my medical needs. I dread having to call around different doctor’s offices, wondering if 1) they take my insurance, 2) are taking new patients, 3) when is the next appointment, and 4) will I even like this doctor? ZocDoc also saves your contact information/family’s medical history which can immediately transfer onto a doctor’s office systems and streamlines paperwork. I do agree that the next wave of innovation is enabling a synchronization of a patient’s medical exams/tests/records that can be readily accessible from one doctor’s office to another. Imagine a seamless transition of my dental x-rays from one doctor to next.
Thanks for writing! I completely agree with Catherine on this. While I think that Zocdoc is brilliant in trying to optimize appointment slots, especially given the increased scarcity of doctors, I worry about people judging doctors based on peer reviews rather than healthcare statistics such as successful diagnostics, survival rates, etc. This puts the incentive on doctors to shift services to ensure patients have a pleasant experience, but may not necessarily be the best for patients. What if a doctor wants to recommend that a patient have additional tests, or see a specialist, and the patient views this as irritating, or exploitative, when in reality, this could be something the patient needs?
As many people only highlight the positives of the ACA and of the American population’s increased access to healthcare, I found the ramifications highlighted in your article very interesting as they are not usually mentioned in the media. I didn’t realize how much strain was being placed on the current healthcare system, nor what the additional demand meant for capacity constraints in the future. I agree that ZocDoc seems to present a compelling opportunity to ease some of this strain being placed on the system. However, I echo some of the concerns in the other comments, and wonder how ZocDoc can work to improve patient diagnosis so they are able to connect with the right doctors in the right specialties. It reminds me somewhat of WebMD, where a reader could diagnose themselves of having anywhere from a mild cold or flu to something much more serious. It will be interesting to see how they are able to leverage technology improvements to work through some of these issues, but overall I remain positive on their value proposition gong forward.
I find ZocDoc to be a tremendous idea but feel as though in certain markets they do not do the best job actually delivering on their own customer promise. For example, I have had several ZocDoc appointments canceled on by the physicians. Furthermore, it is not always clear which doctor you will actually be seeing so the rating system then becomes a rather moot point. Additionally, I think sometimes enabling patients to have such freedom over the doctors that they pick leads to incongruities in the service provided, and also at times can lead to wasted time due to a reliance on “self-diagnosis”. So while ZocDoc is a tremendous idea and I continue to use it, there are several key issues it should resolve before addressing any further issues.
This app is doing the best it could under current healthcare system, making appointment scheduling fast and efficient. But the underlining issue with shortage, and inefficient utilization of medical resources is still to some degree contribute to high cost and long wait time when seeking care. But in foreseeable future with AI and deep learning, we are in light of having dr. “watson” to fill in some resource gaps by providing basic diagnostic functions to regions with limited access to doctors and medical facilities.
http://fortune.com/ibm-watson-health-business-strategy/
Ben, thanks for the post! I think ZocDoc is revolutionising the way patients interact with their healthcare teams. One question I have is what happens to patients who have long-term conditions and would like to stick to their physician who knows their case very well? And, is the digital infrastructure available for all different doctors to have access to the patient’s history? Otherwise, a patient having to repeat their history at every doctor’s appointment can become very tedious and not a very good use of time.
Thanks for the post. I am a frequent user of ZocDoc and I love the ease of discovering a new physician in a new city and scheduling my appointments through the system. However, as a few people have mentioned, I believe that ZocDoc can be much more proactive in their relationship with physicians. Though I have my patient information stored on the ZocDoc site, there have been numerous instances in which I am required to fill out the same information again once I arrive at the physician’s office. This, in addition to a lack of coordination regarding medical records across different physician offices, often adds unnecessary time to each appointment and further decreases the efficiency that physicians are able to reach in a given day.
This post also inspired some thoughts about how ZocDoc could expand the reach of its business. While it currently focuses on connecting people with physicians, ZocDoc may also want to look into providing services for licensed alternative medicine practitioners (e.g., reflexologists etc.). There is not a centralized resource that currently supports those practitioners.