Shortening Consult Times: The Winners and Losers

Australian optometry data mirror these concerns, identifying lack of time to manage eye health as the leading modifiable cause of professional dissatisfaction. Yet pressures to shorten consultations continue to grow, driven less by clinical need and more by a flawed understanding of commercial efficiency.

The idea that shorter consultations improve productivity overlooks the true drivers of clinical efficiency: workflow design, delegation, and triage. Practices seeking to emulate high-throughput specialist models often conflate shorter durations with better efficiency. But cutting consult time without redesigning systems risks not only clinician wellbeing and patient care – it may also undermine business performance.

This article explores three key questions:

1. Do Australians need faster eye exams?
2. Who benefits or loses when consultation times shrink?
3. What are the hidden costs of prioritising throughput?

Shrinkflation has crept into many parts of daily life – fewer Easter eggs and smaller packaging – but healthcare should not be part of that trend. In eye care, reducing consultation time affects more than scheduling; it impacts clinician welfare, patient outcomes, system-wide healthcare costs, and the long-term sustainability of care delivery.

Do Australians Need Shorter Eye Exams?

In Australia, publicly available Medicare billing data for both long-form (>15 minute) and short-form (<15 minute) optometry billing items show that the provision of longer consultations is increasing at nearly three times the rate of shorter ones (6.1% per year compared to 2.2%; Figure 1). This suggests rising demand for comprehensive eye exams, not shorter ones.

Figure 1. Growth in long- and short-form optometry consultations.
Monthly Medicare billing data from 2015 onward, converted to annualised rates for clarity. Long-form (>15 minutes; green) and short-form (<15 minutes; red) consultation trends are shown. Outliers (1%) excluded, e.g., from COVID-19. Growth in longer consultations substantially outpaces shorter ones, reflecting shifting patient and provider preferences toward more comprehensive care.

Workforce projections on current service-utilisation trends further challenge the rationale for reducing consult time. Australia is expected to maintain an oversupply of optometrists until at least 2040, with the more pressing issue being geographic maldistribution.² In this context, reducing consult length in metropolitan areas serves market competition more than public health demand.

International data also caution against excessively brief primary care visits, which are linked with increased inappropriate management, unnecessary referrals, and higher healthcare costs.¹

Thus, Australia’s current consultation lengths likely already reflect actual system demand. Compressing them risks targeting the wrong problem, at the expense of both clinical quality and long-term system integrity.

Time, when used well, is a strategic asset. Cutting it without redesign is not innovation, but rather clinical shrinkflation. And in the long run, no one wins

Business Bottom-Line

Shorter consultations are fundamentally a commercial strategy. For practices operating within time-based Medicare billing and retail pressures, increasing throughput can improve revenue efficiency, especially when 30-minute consults exceed billing thresholds without additional compensation. In that context, time compression may seem like a logical trade-off between care delivery and business viability.

But whether shorter consults are beneficial depends entirely on how time is saved. Some optometry models have reduced optometrists’ face-to-face time more effectively than others, but only where clear protocols, skilled delegation, and streamlined triage safeguard patient care.³

Real-world examples in ophthalmology illustrate this. A Lean Six Sigma initiative in a tertiary eye clinic improved patient flow not by simply shortening consults, but by removing inefficiencies elsewhere.⁴ Similarly, the United States Veterans Affairs model delivered safe five to seven-minute clinician consults only after a structured 13–18-minute work-up led by highly trained technicians, within around a one-hour total visit.^5,6 In both cases, efficiency came from system redesign, not clinician speed.

Without such safeguards, shorter consults often backfire. In Australian optometry, where clinical and retail care often occur in one visit, compressing time can reduce clinical accuracy, increase revisit rates, and undermine average dispensing value, offsetting any perceived gains in throughout.⁷

What It Means For Patients

While shorter consults may align with certain commercial imperatives, their value must ultimately be judged by their impact on patient care. Time alone does not guarantee quality, but it enables the clinical depth required for accurate diagnosis, shared decision making, and meaningful patient engagement,⁸ particularly in complex or high-needs populations.

Studies show that when time is available, clinicians are more likely to explore lifestyle factors, provide preventive advice, and tailor recommendations – elements strongly associated with higher patient satisfaction and safer care.^7,9

Patients with multiple concerns, chronic conditions, or low health literacy are especially vulnerable to the limitations of brief encounters.¹⁰ In such cases, compressing time may leave patients feeling unheard or inadequately managed.

System-level indicators also favour time-rich care. Practices with a higher proportion of longer consultations report stronger patient enablement⁹ and greater attention to patients’ psychosocial needs.¹¹ In contrast, shorter consultations are linked to higher reconsultation rates and diagnostic omissions.⁷

Shorter consults can still be safe, but only when supported by safeguards such as triage protocols, technician-led pre-testing, and structured workflows.^5,6 Without them, patients ultimately bear the consequences of rushed care.

Hidden Costs

The commercial and clinical risks of shortened consultations can manifest subtly but meaningfully.

Internal audits suggest that when patients feel rushed during their overall ophthalmic visit, average optical spend declines, especially on premium products. Over time, even modest reductions in retail value can erode margins, offsetting any throughput gains.

Reputational damage is another risk. Rushed care diminishes trust and lowers Net Promoter Scores, which increases the cost of acquiring new patients and weakens brand loyalty. Missed diagnoses (such as papilloedema or retinal detachment) carry serious medico-legal consequences, with consultation length often cited in expert review.

Burnout also has financial consequences. Higher turnover and absenteeism drive up recruitment and training costs.¹

Finally, system-level strain increases. Without redesigned workflows, shorter consults lead to higher reconsultation rates, inappropriate prescribing, and unnecessary referrals; burdens that simply shift costs elsewhere in the healthcare system.³

A Safer Road To Efficiency

Efficiency gains in optometry do not need to come at the cost of care quality, clinician wellbeing, or patient safety. Evidence across primary care and ophthalmology shows that sustainable improvements come not from shortening consultation time, but from redesigning systems.

Baseline consult times should be protected. As with the British Medical Association’s call to extend minimum GP consultation lengths,¹² optometry could benefit from similar safeguards to prevent progressive erosion of clinical time.

When shorter consultations are pursued, structural safeguards must be embedded. Every successful high-throughput model^3–6 succeeds by reinforcing clinician decision making, not compressing it. Protocols such as traffic-light triage, highly-trained technician-led pre-testing, and structured clinical checklists (e.g., mandatory tests) are critical.

Outcomes must also be tracked. Metrics like revisit rates, dispensing averages, staff overtime, and satisfaction scores help reveal whether efficiency is genuinely sustainable or illusory.^1,7

Technology can support but not replace clinical time. Poorly integrated digital tools can increase workload. Artificial intelligence should enhance clinician judgment, not substitute it. Importantly, patients continue to prefer human-led care across all disciplines.¹³

Summary: Cutting Time Cuts Corners

Calls to shorten optometry consultations are increasing, but the evidence does not support this trend (Figure 2). Longer consultations remain better aligned with public needs and the expectations of quality care.

Figure 2. Summary of the impact of shorter optometry consultations. Green = positive impact. Red = negative impact. Note*: Throughput gains only materialise when supported by structured triage, delegation, and workflow redesign.

Reducing consultation time without systemic redesign undermines clinician wellbeing, patient outcomes, retail value, and long-term sustainability.

If true efficiency is the goal, the focus should be on optimising the systems that support optometrists’ face-to-face time – through co-design with clinicians and patients, not by top-down imposition from disconnected management. Time, when used well, is a strategic asset. Cutting it without redesign is not innovation, but rather clinical shrinkflation. And in the long run, no one wins.

Dr Matt Trinh is a clinician-researcher focused on retinal pathology. He is committed to advancing ophthalmic practice through research, with particular interests in large-scale imaging, health data analysis, and the integration of computational tools in clinical ophthalmology and vision science.

References 

1. Irving G, Neves AL, Holden J, et al. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open. 2017 Nov;7(10):e017902. doi: 10.1136/bmjopen-2017-017902.
2. Centre for the Business and Economics of Health. Australian Optometry Workforce Projections to 2040. 2025. Available at: optometry.org.au/wp-content/uploads/Policy/Advocacy/Final-Report-Optometry-Workforce-Projections.pdf [accessed Jume 2025].
3. León-García M, Wieringa TH, Montori VM, et al. Does the duration of ambulatory consultations affect the quality of healthcare? A systematic review. BMJ Open Qual. 2023 Oct;12(4):e002311. doi: 10.1136/bmjoq-2023-002311.
4. Kam AW, Collins S, Smith JEH, et al. Using Lean Six Sigma techniques to improve efficiency in outpatient ophthalmology clinics. BMC Health Serv Res. 2021 Jan 7;21(1):38. doi: 10.1186/s12913-020-06034-3.
5. Maa AY, Medert CM, Lynch MG, et al. Diagnostic accuracy of technology-based eye care services: The technology-based eye care services compare trial part I. Ophthalmology. 2020 Jan;127(1):38-44. doi: 10.1016/j.ophtha.2019.07.026.
6. Maa AY, Wojciechowski B, Lynch MG, et al Early experience with technology-based eye care services (TECS): A novel ophthalmologic telemedicine initiative. Ophthalmology. 2017 Apr;124(4):539-546. doi: 10.1016/j.ophtha.2016.11.037.
7. Elmore N, Burt J, Roland M, et al. Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care. Br J Gen Pract. 2016 Dec;66(653):e896-e903. doi: 10.3399/bjgp16X687733.
8. Valverde Bolívar FJ, Pedregal González M, Torío Durántez J, et al. Communication with patients and the duration of family medicine consultations. Aten Primaria. 2018 Dec;50(10):621-628. doi: 10.1016/j.aprim.2017.07.001.
9. Mercer SW, Fitzpatrick B, Watt GC, et al. More time for complex consultations in a high-deprivation practice is associated with increased patient enablement. Br J Gen Pract. 2007 Dec;57(545):960-6. doi: 10.3399/096016407782604910.
10. Gopfert A, Deeny SR, Fisher R, Stafford M. Primary care consultation length by deprivation and multimorbidity in England: an observational study using electronic patient records. Br J Gen Pract. 2021 Feb 25;71(704):e185-e192. doi: 10.3399/bjgp20X714029.
11. Hutton C, Gunn J. Do longer consultations improve the management of psychological problems in general practice? A systematic literature review. BMC Health Serv Res. 2007 May 17;7:71. doi: 10.1186/1472-6963-7-71.
12. The British Medical Association. Safe working in general practice toolkit. Available at: bma.org.uk/advice-and-support/gp-practices/managing-workload/safe-working-in-general-practice [accessed May 2025].
13. Riedl R, Hogeterp SA, Reuter M. Do patients prefer a human doctor, artificial intelligence, or a blend, and is this preference dependent on medical discipline? Empirical evidence and implications for medical practice. Front. Psychol. 2024;15:1422177. doi: 10.3389/fpsyg.2024.1422177.