Wait Times for New-Patient Appointments Rise 30%

Ken Terry

March 22, 2017

The time it takes to schedule a new-patient appointment with a physician in 15 major metropolitan areas in the United States has increased by 30% since 2014, according to a survey conducted by Merritt Hawkins, a national physician search firm. The 2017 survey of 1414 physician offices looked at average wait times in five medical specialties: cardiology, dermatology, obstetrics/gynecology, orthopedic surgery, and family medicine.

The firm's report hypothesized that the lengthened wait times are related to the advent of the Affordable Care Act (ACA), which greatly increased insurance coverage and therefore consumer demand for physician services, and the aging of the population.

According to Merritt Hawkins, it now takes an average of 24 days for a consumer to make an initial appointment with a physician in the 15 large urban areas. By comparison, the report said, the average wait time for an appointment in the same markets was 18.5 days in 2014, 20.5 days in 2009, and 21 days in 2004.

Among these metropolitan areas, Boston, Massachusetts, currently has the longest average wait time, which is 52 days. Dallas, Texas, has the shortest wait time at 15 days.

Mid-Sized Markets

For the first time, Merritt Hawkins' 2017 survey also included appointment wait times in 15 mid-sized metropolitan areas (90,000 to 140,000 people). The average wait time for a new-patient appointment in those markets is 32 days, or about a third longer than wait times in the large markets. Yakima, Washington, has an average wait time of 49 days — the longest among the mid-sized cities — and Billings, Montana, has the shortest wait at 11 days.

The physician-to-population ratio is much higher in the large markets than in the mid-sized ones, Mark Smith, president of Merritt Hawkins, noted in a press release. "Finding a physician who can see you today, or three weeks from today, can be a challenge, even in large urban areas where there is a relatively robust supply of doctors, " said Smith. "The challenge becomes even more difficult in smaller communities that have fewer physicians per population."

The survey also asked physicians whether they accept Medicare and Medicaid patients. The average rate of physician Medicare acceptance is 85% in the 15 large metropolitan markets and 81% in the mid-sized markets. The average rate of Medicaid acceptance is 53% in the large cities and 60% in the mid-sized markets.

The breakdowns of wait times by city and specialty in the report show a lot of variations across the United States. For example, the average wait time to see a family physician in the large markets is 29 days, but the wait times for family physicians range from 109 days in Boston to 8 days in Minneapolis.

In the large cities, the average wait time for a cardiologist is 21.1 days in 2017 vs 16.8 days in 2014; in dermatology, the trend is 32.3 days vs 28.8 days; in obstetrics/ gynecology, 26.4 days vs 17.3 days; in orthopedic surgery, 11.4 days vs 9.9 days; and in family medicine, 29.3 days vs 19.5 days.

The report noted that millions of people have gained insurance since the last survey in 2014 and that this has apparently led to increased demand for physicians. The 2006 healthcare reform law in Massachusetts may have also generated extra demand that has resulted in exceptionally long wait times in that state, the report said.

Massachusetts has the highest physician-to-population ratio of any state, the report also noted. While that ample supply of doctors might be expected to shorten wait times, the report pointed out that many Bay State doctors are engaged in research and other academic pursuits.

Physician Shortage?

Merritt Hawkins' Smith said that the survey results show there is a physician shortage in the United States. Darrell Kirch, MD, and Kate Pettelle, MPhil, from the American Association of Medical Colleges (AAMC) made the same assertion in a recent commentary in JAMA.

Dr Kirch and Pettelle argued that the growth and the aging of the population and the anticipated retirement of many physicians will make the current shortage worse as the ratio of physicians to the US population declines.

The AAMC predicts a shortage of 40,800 to 104,900 physicians by 2030. Even if the ACA were repealed, the authors said, that figure would drop by only 6000 to 10,000 doctors.

In a contrasting JAMA commentary, Ezekiel Emanuel, MD, PhD, an architect of the ACA, and his colleagues maintained that there is no current shortage of physicians. The average wait time for a family physician, they wrote, has stayed steady at about 20 days since 2009. In addition, they argued, there is plenty of excess capacity in the primary care workforce, based on the average panel size of generalist physicians.

 Dr Emanuel has disclosed speaking fees from numerous entities, stock ownership in Nuna, and investment partnership in Oak HC/FT. The remaining authors have disclosed no relevant financial relationships.

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