- Doctors’ appointment wait times have increased by 30 percent since 2014, likely due to a growing number of insured patients and resulting physician shortages, according to a Merritt Hawkins survey.
The survey of physician practices in 30 mid-sized and large metropolitan areas found that patients face an average appointment wait time of 24 days. This is up from 18.5 days in 2014, 20.5 days in 2009, and 21 days in 2004.
Merritt Hawkins President Mark Smith explained that these findings are a strong indicator of a physician shortage that is negatively impacting patient care access.
“Physician appointment wait times are the longest they have been since we began conducting the survey,” Smith said in a press release. “Growing physician appointment wait times are significant indicators that the nation is experiencing a shortage of physicians.”
Physician shortages likely emerged from the growing number of patients with health insurance coverage, due to the Affordable Care Act. Between Medicaid expansion and the health insurance exchanges, more patients have health insurance coverage, reports indicate.
“Though the fate of the ACA is in doubt as of the publication of this report, a greater percent of Americans now have health insurance than at any time in the past,” the report authors said. “A question arises as to whether a more widely insured population has driven increased demand for physician services and correspondingly longer physician appointment wait times.”
While the report does not claim causation, it does highlight the possibility that an increasing number of patients seeking healthcare is tied to a physician shortage.
That trend is exacerbated in mid-sized cities, the report shows. The average wait time in mid-sized cities with 90,000 to 140,000 inhabitants was 32 days, or 33 percent longer than wait times in large cities.
Patients in mid-sized cities may see longer wait times because they have weaker patient to provider ratios, the researchers posited. Mid-sized cities likely have fewer practicing clinicians to meet patient demand because mid-sized cities also have a smaller overall population.
“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’s methodology has several limitations, the researchers acknowledged. For example, it is difficult to gauge exact physician appointment availability. There are several compounding factors including physician vacation times, unexpected appointment openings, and annual practice utilization variation (i.e. flu or allergy season) that affect appointment availability measures.
However, the researchers maintained confidence in their findings, asserting that the results point to a need to rework provider availability and training.
Increasing the number of practicing non-physician clinicians, such as physicians assistants or nurse practitioners, may be one viable solution to the physician shortage, Smith pointed out.
“More physicians will need to be trained, access to other types of providers expanded, and emerging technologies employed to ensure that health care delayed does not become health care denied,” he said.
The healthcare industry must also re-examine other alternative methods for patient healthcare access, including virtual telehealth care or retail clinics, the report suggested.
As the healthcare system continues to evolve, ways will need to be found to ensure access to physicians, through increases in the number of medical residency positions available nationwide, through the use of innovative staffing models that redistribute some of the work previously handled by physicians to other clinicians, through equitable payments to physicians, through the use of online and mobile technology, and through other methods.
Conversely, other recent research has found that appointment wait times have faced negligible increases in light of the ACA and higher insured rates.
One study published in JAMA Internal Medicine suggested that primary care appointments are still widely available for both Medicaid and privately-insured patients. Long wait times, defined as greater than 30 days, increased by only 3.3 percent for privately-insured patients.
“The appointment availability results should ease concerns that the Affordable Care Act would exacerbate the primary care shortage,” the researchers said. “Primary care practices may be adapting to an influx of new patients with shorter visits and more rigorous management of no-shows.”
However, the small increase in long appointment wait times should not cause worry amongst industry professionals, the researchers said. As healthcare organizations adjust to the increase in covered patients and enact more patient management strategies – including Smith’s suggestion of more non-physician clinicians – these wait times may decrease.