You've felt it. You waited weeks for the appointment, you rehearsed the three things you wanted to ask, and then the visit was over before you finished the first one. Your doctor was kind. She was also typing, glancing at a screen, already half-aware of the waiting room filling up behind you.
It's easy to read that moment as indifference. It almost never is.
What you're feeling in that room is arithmetic, and the numbers are worse than most patients ever hear. Understanding them changes how you think about what a doctor's visit could be, and why a smaller practice isn't a luxury so much as a different kind of math.
The Day Doesn't Have Enough Hours
In 2022, a group of researchers led by Justin Porter published a quietly startling calculation in the Journal of General Internal Medicine. They asked a straightforward question: how long would it take a primary care physician to deliver all the preventive, chronic, and acute care that national guidelines recommend for a typical panel of 2,500 patients?
The answer was 26.7 hours. Not per week. Per day.
The breakdown is almost darkly funny once you sit with it: 14.1 hours of preventive care, 7.2 hours of managing chronic conditions, 2.2 hours of acute visits, and 3.2 hours of documentation and inbox work. There are, of course, only 24 hours in a day, and physicians would like to sleep during a few of them. The same study modeled a team-based approach, where much of the work is shared with nurses and staff, and that version brought the figure down to 9.3 hours. Better, but still a long day layered on top of everything else.
The takeaway isn't that your doctor is failing. It's that the standard primary care panel is mathematically impossible to serve fully, and everyone working inside one is triaging, quietly, every single minute.
The Screen Between You and Your Doctor
A large share of that impossible day is spent not with patients but with the record of them.
In a 2024 analysis in JAMA Network Open, researchers tracked 307 primary care physicians and found they spent a median of 36.2 minutes in the electronic health record for every patient visit. The visit itself was scheduled for 30. Read that again. The paperwork surrounding a single appointment now takes longer than the appointment.
Some of that time has a name. Dr. Christine Sinsky, a physician who has spent years studying this, coined the phrase "pajama time" for the record-keeping that follows doctors home after dinner. An earlier study of family physicians in Wisconsin, reported by the American Medical Association, found they spent nearly six hours of an eleven-hour workday on the EHR, including more than an hour after the clinic had closed for the night.
So when your doctor seems to be talking to a computer instead of to you, it's not distraction in the way it feels. Statistically, that's where a great deal of the job now lives.
Changing the Denominator, Not the Doctor
Here's the part that actually matters. None of these numbers describe a doctor who cares too little. They describe a fraction: the amount of care required, divided by the number of patients one physician is responsible for.
You can't easily change the top of that fraction. Guidelines exist for good reasons, and skipping the preventive work is how small problems become large ones. What you can change is the bottom.
Concierge medicine, sometimes called membership medicine, does essentially one structural thing, and everything else follows from it. It shrinks the panel. Instead of two or three thousand patients, a concierge physician cares for a few hundred. When the denominator drops that far, the arithmetic that produced the 26.7-hour day starts to loosen. There's time to review your history before you walk in, time to sit with you without watching the clock, time to answer a message the same afternoon rather than the following week.
The care itself doesn't become more exotic. It becomes possible. That's the whole idea, and it's far less mysterious than the word "concierge" makes it sound.
What This Means for You
Picture someone here in Lubbock. A small-business owner in her fifties, say, who has been putting off a real conversation about her blood pressure, her sleep, and the fatigue she's been explaining away for the better part of a year.
In a standard practice, that's three separate visits she can't schedule anywhere near each other, each one capped at fifteen minutes, each one ending with a printout and a follow-up she'll have to chase down herself. In a membership practice, it's one unhurried appointment, and then a relationship that carries forward. Dr. Sima Shahbandar isn't racing a full waiting room, because the waiting room isn't full by design.
That's what a smaller panel really buys. Not marble floors, but the ordinary thing you always assumed medicine was: a physician who has the time to genuinely know you. If you've ever left an appointment feeling unfinished, you already understand the value of the alternative. It's the same reason a concierge membership can feel so different day to day, and part of why getting a first appointment has grown so slow everywhere else.
A Standing Invitation
If the arithmetic in this piece felt a little too familiar, that feeling is worth a conversation. We keep our concierge membership small on purpose, so there's room to sit down and talk through whether this kind of care fits your life and your health right now, with no pressure in either direction. You can reach us through our contact page or call (806) 778-4395, and we'll find you a time that doesn't feel rushed. That, after all, is the entire point.
Sources
- The estimate of 26.7 hours per day to provide guideline-recommended care for a panel of 2,500 patients, with 14.1 hours of preventive care, 7.2 hours of chronic disease care, 2.2 hours of acute care, and 3.2 hours of documentation and inbox management, falling to 9.3 hours under team-based care: Porter J, Boyd C, Skandari MR, Laiteerapong N, Journal of General Internal Medicine, published online July 2022, as reported by the American Academy of Family Physicians in How much time is needed to provide primary care?
- A median of 36.2 minutes in the electronic health record per visit against a 30-minute scheduled visit, from a study of 307 primary care physicians across 31 practices: JAMA Network Open, 2024, as reported by the American Medical Association in Primary care visits run a half hour. Time on the EHR? 36 minutes
- An average of 5.9 hours of an 11.4-hour workday spent in the EHR, including 1.4 hours after work, among family physicians in southern Wisconsin, and the origin of "pajama time" with Dr. Christine Sinsky: Annals of Family Medicine, 2017, as reported by the American Medical Association in Family doctors spend 86 minutes of "pajama time" with EHRs nightly
This article is for general educational purposes and is not medical advice, diagnosis, or treatment, and it does not create a physician-patient relationship. Individual results vary, and no outcome is guaranteed. Treatment decisions should be made with a qualified physician who knows your full medical history. Omri Med is a private-pay concierge practice; membership is limited and does not replace health insurance.