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The Waiting Room Problem
Waiting is where trust leaks out of a visit. Research links longer waits to lower confidence in the clinician and lower willingness to recommend. The psychology of waiting explains why, and a few habits fix most of it.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
Long waits do more than annoy patients. In a study of more than 11,000 surveys from 44 clinics, longer waits were linked to lower scores on every measure, including confidence in the care provider, and the chance of a top likelihood-to-recommend rating fell from about 77% at a 10-minute wait to about 53% at an hour. Waits in the exam room hurt more than waits in the lobby. A classic service-management essay explains why: unexplained, uncertain and anxious waits feel longer. Membership practices promise time, so a long wait breaks the promise directly. Stay within five minutes, explain any delay before the patient has to ask, and when you are late, start with an apology and their name.
“Patients don't expect perfection. They expect to be told the truth about their time. A two-sentence apology and an honest update will do more for your reputation than any ad you'll ever buy.”
Do waits really affect how patients judge the clinician?
Yes. In an AJMC study of 11,352 surveys, longer waits were associated with lower confidence in the provider and lower perceived quality, not just lower satisfaction.
Go to the full answer ↓Is it worse to wait in the lobby or the exam room?
Scores were more sensitive to exam room waits. The authors suggest keeping patients in the waiting area rather than moving them early into a room.
Go to the full answer ↓Why does a 20-minute wait sometimes feel like an hour?
Because uncertain, unexplained and anxious waits feel longer. Part 2 lists the principles.
Go to the full answer ↓What should I say when I'm running late?
"I'm sorry, [first name]. Thank you for waiting." Then briefly explain. One concierge physician changed her whole schedule after a patient sent her a bill for her time.
Go to the full answer ↓What standard should we set?
Part 5: stay within five minutes, update every patient before they have to ask, and never let a patient wait alone in an exam room without a time estimate.
Go to the full answer ↓Waiting changes how patients judge you
You might think a wait is just an inconvenience. The data say it changes how patients judge the care itself.
Researchers analyzed 11,352 patient surveys from 44 outpatient clinics at a large academic medical center. Longer waits were associated with lower scores on every measure, including confidence in the care provider and perceived quality of care, not just overall satisfaction.1 Practice Insight
Two more findings matter for daily operations. Scores were more sensitive to time in the exam room than to time in the lobby, and the authors suggested that when a clinic falls behind, it may be better to keep patients in the waiting area than to move them early into a room. First-time patients also gave lower scores across the board.1
New members are your first-time patients. Their first wait is part of their first impression.
Why ten minutes can feel like forty
In 1985, service-management writer David Maister published a short essay that service businesses still use. A few of his principles fit a medical office almost perfectly:2 Practice Insight
| Maister's principle | What it looks like in a practice |
|---|---|
| “Unexplained Waits Are Longer than Explained Waits” | A patient sits with no update and starts to wonder if they were forgotten |
| “Uncertain Waits Are Longer than Known, Finite Waits” | “A few minutes” is worse than “about 15 minutes” |
| “Anxiety Makes Waits Seem Longer” | A patient waiting on results is already anxious; silence multiplies it |
| “People Want to Get Started” | Waits before the first human contact feel longest |
| “Unfair Waits Are Longer than Equitable Waits” | Watching someone who arrived later go back first |
| “The More Valuable the Service, the Longer the Customer Will Wait” | Members will wait for you, but only if the wait feels worth it and honest |
Principles quoted from Maister (1985); practice examples are CMT original.2
Membership practices sell time and access. A long, unexplained wait doesn't just irritate a member. It contradicts the very thing they are paying for. That is CMT's editorial view.
The bill for her time
A physician told Michael Tetreault: “Years ago, a patient sent me a bill for her time as I ran 90 minutes late. That’s the day I thought long and hard about my schedule, made some leadership changes and shifts in my practice, and told myself, ‘Never again.’ Honestly, I was more ashamed than angry. She was right. I had disrespected her time.”
Today, when an emergency makes her late, she explains why to every patient for the rest of the day and apologizes, “which, by the way, not many Doctors do, and that’s the key ingredient.”
From No More Waiting Rooms (2024) and Remark-ology (2025).3,
When Michael’s youngest daughter, then eight, needed stitches, they waited more than 45 minutes in an urgent care exam room. He finally propped the door open so staff could hear her crying. She still talks about that visit.
From No More Waiting Rooms (2024).3
After two and a half hours in a hospital physical therapy setting with his daughter and son in the summer of 2022, Michael wrote: “51 minutes in traffic, no validated parking, the Doctor isn’t here today, and no one told me and I missed work for this? How about we start with an apology?”
From Remark-ology (2025).4
Nationally, the stakes are bigger than one bad afternoon. In a 2023 Ipsos survey for MDVIP, 26% of adults 26 and older said they had felt rushed or dismissed by a doctor, and one in three had skipped or delayed care because of a bad experience or no timely appointment.5 Population Data
What to say when you're late
Most clinicians who run late skip the apology and jump straight into the problem. It feels efficient. It widens the gap.3
| Instead of | Try |
|---|---|
| Walking in and opening the chart | “I’m sorry, [first name]. Thank you for waiting. How are you today?” |
| “We’re running a little behind.” | “Dr. [name] is about 20 minutes behind because of an urgent case. Would you like to wait, step out for coffee, or reschedule?” |
| Silence in the exam room | A check-in every 10 minutes: “You haven’t been forgotten. About 10 more minutes.” |
| Moving everyone into rooms early | Keep patients in the comfortable waiting area until the clinician is close to ready |
CMT original guidance drawing on No More Waiting Rooms, Maister (1985) and Bleustein et al. (2014).3,
Stay on time within five minutes, and apologize if you're late.
A standard from Remark-ology (2025).4
A waiting standard for a membership practice
Measure it
For two weeks, record arrival, rooming and clinician-entry times for every visit. You can't fix a wait you don't measure.
Update before they ask
Any delay over five minutes gets a specific, honest update from a person, with options.
Protect the exam room
No patient waits alone in a room without a time estimate. Room them when the clinician is close.
Lead with the apology
Clinicians open late visits with an apology and the patient's name. Every time.
- Start the two-week wait log on Monday.
- Agree on one sentence your team will use to update a waiting patient.
- Sit in the waiting room for 15 minutes yourself. What would make the time feel shorter?
When your schedule respects people's time, word of mouth gets easier. Plan who you want to reach next.
Free. No sign-up. Your answers stay in your browser. Step 3 of CMT's Learn, Build, Lead tools. It helps you pick the patient segments that fit your practice, find where they are, plan conversations with local physicians, check that your message sounds like care rather than a pitch, and leave with a 90-day plan.
This brief is educational. Scheduling and panel-size decisions affect clinical safety and practice finances; make them with qualified clinical, legal and financial advisers.
Waits shape judgment
Longer waits are linked to lower confidence in the clinician.
Explain every wait
Uncertain, unexplained waits feel longest.
Apologize first
Name, apology, update. Then medicine.
How this brief was built
This brief draws on an American Journal of Managed Care study of wait times and patient ratings (2014, using 2008 data from one academic medical center), David Maister's 1985 essay on the psychology of waiting lines, a 2023 Ipsos survey for MDVIP, and stories from CMT's books. The physician story in Part 3 appears in both No More Waiting Rooms (2024) and Remark-ology (2025); the physician is not named. The standard in Part 5 is CMT original guidance.
How to read the evidence types
Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.
Randomized trials and systematic reviews.Best for cause and effect.
Large observational studies and government data.Best for trends at scale.
Surveys, smaller studies and expert consensus.Best for real-world experience.
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.
Statutes, regulation and official guidance.Best for what is required.
What we don't know
- How wait times affect retention in membership practices specifically.
- Whether the 2008 academic-center findings hold for small concierge practices with fewer patients per day.
- The effect of in-room updates or apologies on ratings; the evidence here is about wait length, not recovery scripts.
How to cite this brief
External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.
Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.
Related CMT Research Briefs
References
- Bleustein C, Rothschild DB, Valen A, et al. Wait times, patient satisfaction scores, and the perception of care. American Journal of Managed Care. 2014;20(5):393-400. 11,352 surveys, 44 clinics of one academic medical center, 2008 data. www.ajmc.comFunding: not stated
- Maister DH. The psychology of waiting lines. In: Czepiel JA, Solomon MR, Surprenant CF, eds. The Service Encounter. Lexington Books; 1985. Author-hosted text. davidmaister.comFunding: not stated (author-hosted book chapter)
- Tetreault M. No More Waiting Rooms: A Customer Service Road Map to Help Remarkable Medical Offices Navigate Their Way Towards an Irresistible Practice Where Gratitude Is on Repeat. Concierge Medicine Today, LLC; 2024. Stories are the author's own experiences and accounts told to the author.Funding: Concierge Medicine Today (self-published; no outside funder) CMT original
- Tetreault M. Remark-ology: Creating a Remarkable Patient Experience Worth Remarking About to Others. Concierge Medicine Today, LLC; 2025.Funding: Concierge Medicine Today (self-published; no outside funder) CMT original
- MDVIP. Patient frustration surges: Americans struggle with broken healthcare system (Ipsos KnowledgePanel survey of 1,010 U.S. adults 26 and older, December 1 to 10, 2023; margin of error plus or minus 3.2 points). Press release. February 27, 2024. www.mdvip.comFunding: industry (MDVIP press release; survey conducted by Ipsos)
Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.
Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.
Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.
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