Long Waits for Doctor Visits

Need to see a doctor? Get ready to wait.

A survey of physician practices in 15 metropolitan areas last year found that the average wait time for a new patient to see a physician in five medical specialties was 18.5 days.

Wait times in the Washington area were slightly better than average: 17.8 days across all specialties. That was better than Boston, where the average wait across the five specialties was 45.4 days, but not nearly as good as Los Angeles at 12.2 days. The wait to get an appointment with a family doctor in the District was just 14 days, down from 30 days in 2009; but to see a cardiologist, the report said, it would take 32 days on average, nearly twice as long as in 2009.

The specialties surveyed were cardiology, orthopedic surgery, dermatology, obstetrics-gynecology and family practice.

“We have too few providers, which is creating a significant access problem,” says Travis Singleton, senior vice president of Merritt Hawkins, which conducted the survey. The Texas-based consulting firm spoke with 1,399 medical offices between June and November of 2013 — before the new federal health law expanded coverage — in the five areas of specialization. Researchers called the practices and asked for the first available appointment for a new patient needing routine care, such as a heart checkup or a well-woman visit.

The longest waits generally were in Boston, where new patients waited an average of 72 days to see a dermatologist and 66 days to see a family doctor. The shortest waits were in Dallas, where the average was 10.2 days for all specialties, with just five days to see a family doctor.

Boston also had the highest doctor-to-population ratio of the 15 metropolitan areas: 450 per 100,000 people; New York had 344 doctors and Washington 320 per 100,000, the report said. The average for the entire country is 226 doctors per 100,000 people.

The good news is that wait times decreased overall, down from an average of 20.4 days in 2009 and 20.9 days in 2004. Singleton attributed the improvement to practices’ employing more midlevel providers such as nurse practitioners, better scheduling and an increase in the number of urgent-care centers.

Even Boston, which had eye-popping wait times, has gotten better. The city’s average wait time dropped from nearly 50 days in 2009 to 45.4 days in 2013. That brings it closer to its level of 39 days in 2004, before Massachusetts adopted its version of health-care reform. In the Washington area, the average also showed improvement, from just over 22 days in 2009 to just over 17 days in 2013, though that is still well above the 11.5-day average wait in 2004.

The bad news is that fewer doctors are accepting Medicaid: 45.7 percent of physicians surveyed take Medicaid patients, down from 55.4 percent in 2009. Just 43.1 percent of doctors in the Washington area accept Medicaid, down from 74.7 percent in 2004.

Medicaid acceptance rates varied widely across the country, ranging from 73 percent in Boston to 23 percent in Dallas. As for Medicare, 86.4 percent of physicians surveyed in Washington accept Medicare, compared with 76 percent nationwide.

The rates of Medicaid acceptance are likely to prove problematic as more and more Americans sign up for Medicaid under the Affordable Care Act. “At the end of the day, it doesn’t matter how many physicians you have,” Singleton says. “If no one will take your insurance, you’re going to end in the same place, and that’s probably the ER.” And with more patients covered both by Medicaid and private insurance, he says, wait times are likely to get worse.

But Ken Hertz of the MGMA Health Care Consulting Group, which consults with physician practices, says wait times don’t always increase in proportion to patient volume. As plan deductibles and co-pays have gone up in recent years, patient volume in outpatient settings has actually declined, he says.

And long wait times can be attributed to many things other than patient volume, he adds, including operators not understanding the scheduling system. “Most practices are working diligently to see patients and see them in a timely manner, but there are a lot of moving parts,” he says.

“The successful practices will figure out new ways and approaches to shortening wait times. This isn’t going to be acceptable” in the long term, Hertz says.

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This article was produced by Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.