As a pediatrician working for NYC Health + Hospitals (H+H), one of the largest public health care systems in the country, I have witnessed firsthand the challenges of providing quality care to patients from all walks of life. Whether they’re American-born or newly arrived children, my colleagues and I are tasked with ensuring they get the medical attention they need. However, recent administrative changes at H+H have put that ability in jeopardy, especially for the most vulnerable. And I fear that other systems may follow H+H’s lead.
In August, H+H announced a drastic reduction in appointment times for new patients in both adult primary care and pediatrics, cutting them from 40 minutes to just 20. For context, industry standard is typically 30 to 40 minutes for outpatient visits, and 40 minutes for specialists based on the complexity and age of the patient. This cut is not just an inconvenience; it’s a crisis in the making.
Take immunizations, for example. In order for children to attend school, they must have up-to-date vaccinations, so figuring out which ones they have had is a priority at every new-patient pediatric visit I conduct. This process can be complex, particularly when a child is from another country. In some cases, parents will share vaccine records via messaging platforms like WhatsApp, but those records often take time to verify, as vaccines may differ from those required in the U.S. Ensuring accuracy and completeness is crucial to prevent potential outbreaks in schools. As a Spanish speaker, I’m able to bridge some of the communication gaps, but many of my colleagues require translators, and the process of understanding which vaccines a child has received and which they still need can take considerable time.
Now, imagine trying to fit this process into a 20-minute appointment. It’s virtually impossible.
When a new patient comes to my examination room, the first visit is about building trust. We gather the patient’s history, try to make them comfortable, and then use the information gathered to formulate a treatment plan. This process is challenging enough with English-speaking patients. For those who speak other languages or come from different health care systems, it’s even more complex. Rushing through these visits not only jeopardizes the accuracy of our diagnoses, but it also compromises the patient’s experience, potentially driving them away from seeking future care.
Yet, H+H’s new policy forces us to rush. It’s unfair to our patients, and it puts everyone at risk — patients, doctors, and the broader community. The potential consequences of inadequate vaccine coverage include increased risks of infectious diseases such as tuberculosis, measles, and other illnesses that modern medicine has already mitigated.
Most of us who became doctors did so because we care deeply about helping people. We value patient care, and we want to provide the best possible outcomes for everyone who comes through our doors. But this new system is a direct attack on that ethos. When we’re forced to rush through appointments, the likelihood of mistakes increases. Misdiagnoses, missed tests, and incomplete assessments can all stem from the pressure to move patients through the system quickly. And when mistakes happen, no matter how small, it’s not just patients who suffer — our medical licenses are on the line as well.
Good medicine isn’t just about issuing prescriptions or ordering tests. It’s about building relationships, making thoughtful recommendations, and working with patients to make informed choices about their care. That cannot happen when we’re forced to cram everything into a 20-minute window.
What we’re facing now is a collision between the demands of the system and the values that guide our profession. Physicians and health care workers are trained to think critically, communicate effectively, and approach each case with care. We are not trained to rush. Slashing appointment times runs counter to everything we’ve been taught and undermines our ability to provide ethical care.
H+H administrators justify this change by saying that there are too many patients trying to enter the system and not enough doctors to see them. That may be true, but cutting appointment times is not the solution. If anything, this policy will make things worse. We need more doctors, not less time with each patient. We’re already seeing more patients than we can handle, and instead of addressing the root issue — hiring more staff — H+H has pushed through a policy that threatens both patient safety and the well-being of medical professionals.
Even more troubling is that these changes were made without consulting the doctors who are on the frontlines of patient care. Decisions about what happens in the exam room should be made between doctors and their patients — not dictated by hospital administrators or financial considerations.
From a financial perspective, this change may seem like a win for the hospital system. The reimbursement rates for new patients are higher than those for follow-up visits, so more new patients means more revenue.
But this short-term financial gain comes at a significant cost. The morale of the staff is plummeting, and patient safety is at risk. If we can’t provide thorough, high-quality care, what happens to our patients? What happens to the trust they place in us?
The solution to overcrowded clinics is not to rush through patient visits, but to invest in the staff and resources necessary to provide the level of care that every patient deserves. We need to rethink this policy before it spreads to other hospitals and health care systems. If administrators in New York City view this as a success, it could quickly set a dangerous precedent nationwide, with initial visits being cut down to just 20 minutes everywhere.
Frances Quee is a pediatrician at Gotham Health Belvis in the Bronx and president of Doctors Council SEIU.
