The reality is that dependent upon the day I can schedule an office day with all intentions of being on time and the first patient comes to me with cancer in the pelvis and I have to discuss complete removal of half of the pelvis. This is not a 15 minute visit and can even be a 1 hour discussion.
The issue of waiting is symptomatic of what is wrong with the prevailing culture in medicine. Like most doctors, I was trained with the same attitude: the beginning and end of my obligation to the patient was to intend to be on time. Therefore, a patient should not be angry if I wasn't on time.
Intention, though, is not enough. No doctor doubt thats simply intending to cure a patient is acceptable. We recognize that it is our responsibility as physicians to be knowledgeable enough to apply the appropriate techniques, medications, etc. to actually treat and hopefully cure the patient.
Similarly, it is not enough to intend to be on time, if we are not knowledgeable about whether our intentions are realistic. If, in actual practice, a doctor is never on time, he or she is scheduling patient appointments inappropriately.
There is a tendency among doctors to believe that "the system" is the way it is because it has to be that way. However, scheduling is not some sort of willy-nilly process that cannot take into account the realities of a doctor's life. It is possible to look at a practice and figure out just how often each day or week a particular doctor has patients that require more time than originally scheduled and build that time into the appointment schedule.
Just by way of example: if examining a doctor's practice reveals that on average he sees a patient a day with an unanticipated complication that eats up an extra hour, then he can build an extra hour into the schedule when there are no appointments.
Yes, yes, yes, I am aware that this lowers income. However, if a doctor is finishing each and every day 1-2 hours behind, the reality is that he is overscheduling for his benefit and to the detriment of the patients.
The unfortunate fact is that most doctors don't know how long the average patient waits, and if you don't know, you can't fix it.