By the time a new patient hears the words “the doctor will see you now,” it may have taken weeks or even months to get that appointment. Need to see a dermatologist in Boston? The average appointment wait time is a staggering 72 days, according to a recent survey.
“It’s often said what sets apart the American healthcare system is that if someone encounters a problem, they can schedule an appointment and be seen by a doctor at any time,” said Daniel Ehlke, an assistant professor of health policy and management at SUNY-Downstate Medical Center School of Public Health. “But if you look closely at the local level, it usually takes a considerable amount of time to see a doctor.” |
| The Doctor Will See You — In a Few Weeks |
Too Few Doctors
“The physician shortage is the principle reason [for the wait times],” said Phillip Miller, vice president, communications, Merritt Hawkins and Staff Care. “There's a rising demand for doctors, driven by population growth and a growing aging population...[but] at the same time, the number of physicians we train has remained static over the last 25 years.”The Association of American Medical Colleges is projecting a shortage of at least 45,000 primary care doctors in this country by 2020. “It’s an issue we’ve seen grow for decades,” said Ehlke.
Miller attributes the wait times, in part, to the fact that “there are fewer doctors working full-time, so they're seeing fewer patients.” People with chronic illnesses also require frequent and often longer appointments, leaving first-time patients with even fewer options.
“Most primary care doctors have their available timeslots pre-booked with chronic care patients who take longer to see: 20-30 minutes for a routine follow-up versus 10-15 minutes for straightforward cases like a sore throat or twisted ankle,” said George Lowe, MD, FACP, medical director of Maryland Family Care, a group of primary care doctors.
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Timothy A. Pedley, MD, FAAN, president of the American Academy of Neurology, agrees that some appointments simply have to be longer. “Taking care of patients who have dementia due to Alzheimer’s disease, paralysis from a stroke, or very slow movement caused by Parkinson’s disease means that it takes much longer to evaluate and examine many of these patients,” he said.
Advanced Practitioners
Many practices are adding nurse practitioners and physician assistants, who can provide certain medical services when a doctor isn’t available. Ehlke believes most patients welcome the chance to be seen by an advanced practitioner if it means getting an appointment sooner. “Most people just want to be seen by someone wearing some kind of white coat,” he said. “People are pretty used to a similar model used at the dentist’s office, where you spend the majority of the time with a capable dental hygienist and receive the bulk of care from them as well.”Miller agrees that advanced practitioners relieve some of the pressure on medical practices. But, he adds, “It’s really not the answer. The answer is we need to train more doctors.”
The Medicaid Question
The Merritt Hawkins study also tracked Medicaid acceptance rates, and found fewer doctors accepting government-funded health insurance for low-income patients. The average rate of Medicaid acceptance among surveyed physicians was 45.7 percent, down from 55.4 percent in 2009 when the survey was last conducted.“I believe these [Medicaid] patients will suffer greater wait times because most private practitioners either do not participate in Medicaid or have limited the number of Medicaid patients they’ll see in their practice,” said Dr. Lowe.
What You Can Do
Patients often can’t control when they get a doctor’s appointment, but there are things that may help speed it up. Here are some tips:- Convey urgency. “If you emphasize the more severe aspects of what you’re dealing with, you can be leapfrogged over other appointments in some cases,” said Ehlke.
- Be thorough. “It can be helpful for patients or members of their family to write down the history of their illness or problem, and to make it as coherent, focused, and compelling as possible,” said Dr. Pedley. “Then send it to the doctor’s office, usually by e-mail these days, before calling for an appointment. When you call, you can remind the receptionist that you sent a summary…You can ask that person to show it to the doctor in case he wants to see you sooner rather than later.”
- Get a referral. “If the primary care doctor has an established relationship with a specialist, they can ‘make a call’ to get a sooner appointment,” said Lowe. “This happens a lot in my experience.” Pedley agrees that a direct physician-to-physician referral is more effective for several reasons: “A referring doctor usually provides important medical information that is more detailed in justifying the need for an earlier appointment…[and] a doctor is more likely to respond to a colleague’s request, especially if they speak to each other directly, than a receptionist is to a patient or family member she doesn’t know.”
- Ask questions. Inquire about weekend or evening appointments. More offices are trying to accommodate patients’ busy schedules. If you’re not pleased with your appointment, ask the receptionist to call you should something sooner open up.
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