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One of the things I enjoy most about summer is having my older daughter back at home, especially now that she's graduated from college. She's abundantly social, which means our dinner table at home tends to feature a revolving cast of friends dropping by to catch up, tell stories about their travel adventures, and talk about what they've been doing since finishing college. Last night, one story in particular stayed with me.
One of her close friends had recently suffered a serious climbing accident while traveling in Western Canada. She described being rescued from the side of a mountain, spending time in a hospital in Vancouver, and eventually making her way home to Philadelphia with a broken arm, a fractured collarbone, a concussion, and some additional bruises and scratches. It was a remarkable story, and thankfully she seems to be recovering well.
What stayed with me, however, wasn't the accident itself. It was what happened after she got home.
Like most people, she assumed that once she was back in Philadelphia -- home to some of the finest hospitals and medical specialists in the country -- finding an orthopedic surgeon would be relatively straightforward. Instead, she found herself running on the familiar hamster wheel of referrals, scheduling calls, and waiting for the next available opening on someone's calendar. Nothing about the experience was dramatic. In fact, that was precisely the point. It was the sort of experience that has become so mundane in healthcare that many of us have almost stopped noticing it.
As I was thinking about this further last evening, it occurred to me that almost everyone I know seems to have a story like this. A few years ago, my wife was told she would have to wait months to see an endocrinologist here on the Main Line before ultimately finding an outstanding young physician at the University of Pennsylvania. Friends from our club routinely talk about delays getting in to see neurologists, dermatologists, and urologists. Even my own brother Jesse Pines's career was shaped, in part, by waiting. After spending hours in an emergency department during a medical crisis as a teenager, he became fascinated by the problem itself. Today, he is one of the world's leading experts on emergency department crowding and patient flow.
The more I reflected on those conversations, the more I realized that waiting has become one of the defining experiences of modern healthcare. What interests me, though, isn't simply the waiting itself. It's the time between.
The more I began reading about the topic, the more I realized my daughter's friend's experience was hardly unusual. Across much of the developed world, patients are waiting longer to see specialists, waiting longer for elective procedures, and in many cases waiting longer even to receive a diagnosis. As healthcare systems contend with aging populations, increasing chronic and complex disease, workforce shortages, and rising demand, one consequence that is inevitably transferred to patients is standing in line.
The academic literature paints a remarkably consistent picture. Daniel McIntyre and Clara Chow describe waiting not as a single event but as something that occurs repeatedly across a patient's interaction with the healthcare system: waiting for primary care, waiting for specialists, waiting for diagnostic tests, waiting for procedures, and even waiting after arriving at the clinic itself. Their conclusion is notable because it captured something many of us intuitively recognize: waiting is no longer an isolated inconvenience. It has become woven into the healthcare experience.
The same pattern appears in more recent studies. A German survey found that nearly 40% of patients waited more than three weeks for specialist appointments, with particularly long delays in specialties such as dermatology, cardiology, pulmonology, neurology, psychiatry, and orthopedics. In the U.S., surveys tell a similar story. More than 40% of adults report experiencing what they consider unreasonable waits for care, and nearly half of those who encountered those delays ultimately abandoned their attempt to obtain an appointment altogether.
That last finding stood out. Patients didn't simply wait longer. Sometimes that wait time caused them to change course.
One of the things I've learned over many years conducting patient journey and buying process research on behalf of our pharma/biotech clients is that patients rarely experience healthcare as the neat sequence of events we often visualize on a whiteboard.
Journey maps are incredibly useful because they bring structure to complexity. Symptom recognition leads to a primary care physician. A referral leads to a specialist. Testing leads to a diagnosis. Treatment starts, followed by monitoring, follow-up and the fulfillment process. It's a logical progression, and in many respects it's an accurate one.
What the diagram often doesn't reflect as authentically is time - and delays.
Every one of those milestones is separated by days, weeks, or sometimes months. Those intervals often appear as empty space on a slide. From the patient's perspective, they're anything but empty.
That's why I almost always find myself asking physician respondents in marketing research studies a deceptively simple question during buying process or patient journey interviews.
Patients hear the mirror image of that question.
Those aren't really questions about scheduling. They're questions about context. A patient who waits five days for a specialist is living a very different experience than one who waits five months. The clinical pathway may ultimately be identical, but the emotional and behavioral journey often is not.
One thing has become increasingly clear to me over the years: patients don't stop their journey while they're waiting.
Some patients talk with family members. Others search online, ask ChatGPT, visit Reddit communities, or seek recommendations from friends. Some decide to visit urgent care rather than continue waiting. Others schedule telehealth appointments or look for specialists outside their immediate geography. Increasingly, many consumers are turning to DTC companies like Hims & Hers, Ro, Amazon One Medical, or other platforms that have recognized something quite simple: patients are increasingly unwilling to wait.
The same dynamic doesn't end once treatment begins.
Patients often find themselves waiting for a therapy to work. Someone starting an SSRI antidepressant waits to see whether their mood improves - and that can take a while. A patient beginning a biologic wonders when symptoms will finally begin to ease. Families affected by rare diseases often spend years waiting for a diagnosis, only to begin another period of waiting once treatment starts, hoping that this long-awaited therapy will finally change the trajectory of the disease.
Waiting, it turns out, isn't simply about access. It can be part of treatment itself.
None of this is intended to suggest that waiting is a new variable in commercial strategy or patient journey work. Those of us working in commercial strategy, I&A, and forecasting have always understood that access, referrals, and healthcare capacity shape the way patients move through care.
My sense is simply that these intervals have become increasingly important.
When we map patient journeys today, we aren't simply trying to understand what happens. We're trying to understand what happens while patients are waiting for the next thing to happen. Those periods increasingly influence where people seek care, how they gather information, which alternatives they consider, and sometimes whether they remain on the original pathway at all.
The patient journey isn't simply a sequence of events. It's a sequence of events separated by time.
And as healthcare continues to evolve, with AI increasing at the ready, I suspect we'll spend more time paying attention to those intervals. Not because waiting is new, but because what happens during those intervals has become increasingly consequential.
The milestones will always matter. But increasingly, so will the time between.
