QuestionWhy does it take so long to get a doctor's appointment?
Hopes&Fears answers questions with the help of people who know what they're talking about. Today, we wonder why must we wade through so much red tape just to be seen by a doctor.
Between the back-and-forth of initial visits, referrals, lab results, insurance issues and other bottlenecks associated with making a doctor's appointment, sometimes the American healthcare system can feel like a secret society—one in which we, the patients, are not privy to its elaborate hierarchy of rules and regulations. And, once a specialist gets involved, it can be weeks before a routine exam is carried out or, more troublingly, a pressing concern is addressed, adding even more anxiety to an already nerve-wracking process.
We asked experts skilled in the language and logistics of healthcare policy to help us understand why long appointment wait times have become the norm, at least in the United States.
Bett Martinez, MEd
Insurance Broker and Consultant, Bett Martinez Insurance Solutions, Inc.
It depends on your insurance plan. HMO has a complex referral system. With PPO, you can generally self-refer. Subsidy means narrow network. In fact, many plans under ObamaCare (PPACA) have narrowed networks for "affordability." This means the specialist you want to see may not be available to you. A prospective "patient" must get deep in the billing department to find out if the office will take their insurance. Get names!
There's also the isuse of office setup. Some doctor's offices are more efficient than others, so you may get the runaround if it's not set up well. Find the person who has been there the longest and is customer service-oriented, but isn't exhausted.
Specialists are busier than general practitioners. If the one you want to see knows more than others, or people are led to believe they know more than others, then that particular MD will be in demand.
Also, as the price goes up, the availability goes down. There are ways of getting around this. One of my clients, whose daughter sees a well-known thyroid specialist in San Francisco, has also hired a doctor down the hall who has access to him, to ask questions, when she needs something quickly.
Clients, themselves, can be in too much of a hurry. Recently, I heard about a family who wanted to know the results of a cancer biopsy for their relative by phone, in order to skip the co-pay. They sweet-talked a person at their primary doctor's office into sending the tests, which showed the tumor to be benign. Unfortunately when the specialist had a look, he found something not to his liking, sent the tests out for a more careful review, and sure enough, cancer was found. Of course, the family was devastated, especially as they learned this by phone instead of having a nice sit-down in a timely fashion with the doctor who could lay out the situation, including a treatment plan.
Sometimes the patient wants no delay, but being in a rush can create havoc. We want swift reassurance, as in the case of one two-year-old who suffered a fall and hit her head, which got very bloody. The parents opted to take the child to the emergency room instead of going to urgent care or waiting for their pediatrician. The doctor looked at the child and determined that stitches to her lip would be more traumatic than letting the wound heal naturally. They gave her a popsicle. The bill was over $500, and the parents were astounded. But it's the knowledge they were after, and the speed, which came with a steep price tag.
The medical waiting game by the numbers
THE PERCENTAGE of Americans who waited two or more months to be seen by a specialist.
THE AVERAGE LENGTH a Canadian waits to be assessed and treated by a specialist.
THE MEDIAN WAIT AND TREATMENT TIME in an emergency department, combined.
THE AVERAGE WAIT TIME in a metropolitan emergency room
THE AVERAGE WAIT TIME in a suburban emergency room
THE AVERAGE LENGTH of a doctor's appointment.
THE NUMBER OF concerns patients share per primary care visit.
Source: The Commonwealth Fund International Profiles of Healthcare Systems, The Fraser Institute, Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, CDIC NCHS Data Brief, University of Washington
Co-founder and President, freshbenies
Although some of the causes are natural and some are man-made, the answer remains "supply and demand." Let's say a visit with a nurse averages $70, a visit with a family physician averages $130, and a visit with a specialist averages $250.
On the supply side, some insurance plans, like HMOs, are built to limit access to the specialist. The idea is that you need to visit a nurse or family practitioner first to see if they can solve your issue without you seeing the expensive specialist. These days, there are also smaller network plans that just have fewer providers on the list—which reduces overall plan costs.
Where demand is concerned, the average wait time to see a physician is 18.5 days. But there are fewer specialists than general practitioners. As such, you often need to wait longer to see one. Also, if they are handling more complicated or longstanding health issues, their schedules just get filled up with fewer patients.
As an alternative, there is increasing value in using an online medical service, with the ability to email specialists and get a response on many issues within a few hours.
Hospital Psychosis is a term used in an acute care setting describing a usually temporary condition often seen in elderly patients. Those suffering from dementia or memory impairment are at an increased risk. Signs and symptoms include disorientation, agitation, paranoia, delusional thoughts, combative behavior, hallucinations and nightmares.
Source: My Elder Care Consultant
Michael Chernew, PhD
Leonard D. Schaeffer Professor of Health Care Policy and Director of Healthcare Markets and Regulation (HMR) Lab, Department of Health Care Policy, Harvard Medical School
Doctors are expensive, busy, and not always needed —particularly when it comes to specialists.
So, it is more efficient and often better healthcare policy to manage the use of physician services. For example, areas with more primary care have better outcomes and lower costs. The tone of the question implies that access to specialists whenever patients want is always a good thing. I think the evidence would suggest otherwise.
ILLUSTRATION: Yulia Goldman