In the U.S., wait times to see a doctor can be agonizingly long

Opponents of universal health care often predict it would lead to long waits to see a doctor, but patients in the U.S. already face unacceptable delays in getting routine care.

Jam-packed appointment schedules have endured for years. Check out this Business Week story from 2007: "The Doctor Will See You-In Three Months." However, the lack of a national reporting system to track and disclose wait times to the public - a feature in some other countries - has largely obscured the problem here.

With no comprehensive data, journalists rely on a hodgepodge of studies that suggest patients often wait a month or more for a slot on a doctor's schedule.

Eye-opening figures come from a private firm, ECG Management Consultants, which used secret shoppers last year to measure average wait times for new patient appointments in 11 medical specialties in 23 U.S. metro areas.

Graphic by ECG Management Consultants

According to that report, which was covered by Becker's Hospital Review, the average wait for the third next available appointment was 38 days versus an unofficial industry benchmark of 14 days. (According to the authors, the third next available appointment is a common metric for patient access that reduces the effect of late cancellations and other anomalies.)

What's special about two weeks

Of the 253 metropolitan market and specialty combinations in the ECG report, only 16 (6%) had an average wait time that was less than or equal to 14 days.

Houston had the shortest average wait: 27 days. Boston had the longest: 70. (See graphic.) Among the specialties, average waits ranged from 20 days for orthopedic surgery to 68 days for rheumatology.

Waits longer than two weeks are significant because rates of no-shows and cancellations tend to increase after 14 days, "ultimately affecting patient outcomes, provider productivity, and organizations' financial performance," the authors noted.

They mentioned several limitations of their methodology, including the use of nonurgent scenarios that might not match criteria that some practices use to expedite appointments. For example, cardiology practices commonly schedule appointments within 48 hours for patients with time-sensitive symptoms or referrals from an aligned primary care practice.

Excluded from the survey were practices that required a referral, used non-physician providers, or required pre-registration to make an appointment.

The study did not examine potential differences in wait times among people with different types of insurance coverage or no coverage. Wait times are often longer for patients with Medicaid or no insurance than patients with other types of coverage.

Why waiting matters

It's difficult to establish an ideal number of days to wait for a new-patient appointment due to the many nuances of medical practice, the ECG authors wrote. However, they noted some risks associated with delays:

• Manageable conditions such as high blood pressure, glucose or cholesterol may go unchecked, leading to more serious health problems.
• Delays in seeing an obstetrician-gynecologist may put off screening for breast or gynecologic cancer or sexually transmitted disease, potentially leading to later diagnoses and a need for more intensive treatment.
• Long wait times to see a rheumatologist can result in a patient with rheumatoid arthritis missing a dose of biologic medication, possibly reducing the effectiveness of treatment and causing flare-ups.

Not surprising, long wait times can also cause psychological distress.

Ideas for reporting

Private surveys, although not peer-reviewed, can be a jumping off point to report on how long waits affect specific patients and what health care systems and clinics are doing to correct what appears to be a worsening problem.

An earlier survey, AMN Healthcare's 2022 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates, showed that the average wait time for new-patient, non-emergent appointments across five specialties was 26 days, up 8% from the last time the survey was conducted in 2017 and up 24% from when the survey was first done in 2004.

Consumer Reports cited the study in a story that offered tips on how to see a doctor sooner.

One bright spot in the AMN results is that the average wait time in family medicine had dropped 30% from 2017, to 20.6 days. That improvement coincided with growth in retail clinics, urgent care centers, and telemedicine - settings typically staffed by nurse practitioners and physician assistants.

These surveys underscore that geography matters. Physician shortages can be a particular problem in areas where the need is great.

In July, Washington Post science reporter Mark Johnson highlighted a study by researchers at Brigham and Women's Hospital in Boston that found that nearly half of U.S. counties lack a cardiologist; most are rural areas where risk factors such as smoking, diabetes, obesity and high blood pressure are especially prevalent.

His story, "Counties most in need of cardiologists are the most likely to have none," reported that in even some cities with heart specialists, excruciating wait times prompt patients to travel. He quoted a 72-year-old California woman with heart failure, who called her three-hour drive from Sacramento to Stanford to see a cardiologist "more than a hardship."

Resources

• The Complexities of Physician Supply and Demand: Projections From 2021 to 2036 - March 2024 report from the Association of American Medical Colleges.
• Story ideas for covering the worsening pediatrician shortages - recent tip sheet by Lara Salahi, AHCJ's health equity beat leader.