Why is it so frustrating to see a doctor these days—and can anything be done to make it easier?
Despite years of efforts to improve efficiency and access, wait times to see a doctor have only gotten worse, amid a shortage of physicians in almost every specialty. One survey found the average time to secure a new-patient appointment is approaching one month in 15 of the largest cities in the U.S., and another survey found more than a third of Medicare patients are waiting more than a month to see a doctor.
At least half of patients report experiencing “operational friction”—long hold times on the phone to reach a scheduler, difficulty getting a timely appointment and trouble accessing follow-up information, according to surveys from patient-experience firm Press Ganey. Patients complain of endless time in the waiting room and little face time with the doctor once in the exam room. Digital patient portals—which are supposed to help make scheduling, follow-up and communication easier—have been hard to navigate for both patients and physicians.
“People are almost expecting it to be an ordeal every time they need to make a doctor’s appointment,” says Dr. Thomas Lee , chief medical officer at Press Ganey and an internist and cardiologist at Brigham and Women’s Hospital in Boston. “It’s a perfect storm of factors leading to people asking, ‘Can I trust this system to take care of me?’ ”
One of the biggest reasons for the frustrating waits is a shortage of doctors across the country—making it tougher to get an appointment and increasing the amount of time wasted in office waiting rooms. Federal data show the U.S. is short 12,945 primary-care practitioners, indicating that less than half of primary-care needs are being met.
And while the rate of total clinicians in primary care including nurse practitioners and physician assistants has grown, the workforce isn’t growing fast enough to meet needs, according to a recent report from the nonprofit Milbank Memorial Fund.
According to the American Medical Association , plummeting Medicare-payment rates for doctors over the past two decades have pushed many independent physician practices toward financial ruin, while burnout has driven doctors out of the field or led them to cut hours. The number of doctors who say they will accept new Medicare patients has fallen. Some doctors are shifting to concierge practices, charging annual fees for membership that puts their care out of reach of many patients.
All told, the AMA estimates more than 83 million people in the U.S. live in areas without sufficient access to a primary-care doctor, and many specialists are in short supply as well. A large portion of doctors are nearing retirement. The Health Resources and Services Administration Administration projects a shortage of close to 140,000 doctors in primary and specialty care in 2036. The Association of American Medical Colleges recently released a more optimistic shortfall of 86,000 doctors, but that’s based on hypothetical future growth in spending on medical residency positions, which isn’t ensured.
At the same time, consolidation is upending the traditional delivery of healthcare. More practices are being purchased by large hospital systems, private-equity companies, retail drug chains and insurers. Having a doctor who is part of a larger health system can help with care coordination and improve access to specialists for patients who are in their networks but could also lead to longer waits for those who aren’t.
Still, amid all the frustration, there are some promising solutions that could make getting medical care less of an ordeal. Some are in their early stages, while others are at a point where they already are making a difference. Here’s a look at some of those potential solutions.
Making it simpler to schedule
Medical offices can be notoriously hard to reach, with patients finding it tough to break through automated telephone menus. Hackensack Meridian Health Care in New Jersey created a centralized patient-access center to take the burden of scheduling off individual doctor’s offices. Using a combination of calls, texts and emails, the center has reduced both the time people spend on hold and the time it takes to get an appointment, according to Chief Executive Robert Garrett . For instance, last year it shortened the average hold time on calls by 26% to 28 seconds, compared with a national average of 126 seconds.
Doctor’s offices are also making it easier to book, cancel and reschedule appointments online with intelligent-scheduling systems. “How come we can book airlines and a hotel without talking to someone but can’t book a doctor’s appointment?” says Dr. John Farley , chief medical officer of Complete Health, a Jacksonville, Fla., primary-care group that owns 29 practices. Complete is adopting a new patient-scheduling platform that allows patients to search for and schedule appointments.
Complete also offers walk-in clinics that allow patients to see a doctor who may have a gap open in their schedule, such as a no-show or an appointment that ran shorter than expected. You may not see your regular doctor, but you will see someone in the practice who has your medical records and can see your history, says Farley.
University Hospitals in Cleveland, a health system that employs 3,000 physicians in 700 outpatient locations, last year launched a patient portal that allows patients to handle scheduling needs online. University Hospitals also developed an automated wait-list feature, texting patients at the time they schedule an appointment to ask if they will want to be seen sooner if something opens up. Stacy Porter , the system’s vice president of digital transformation, says that last year, 25,000 patients were moved to earlier appointments using the technology.
Cutting wait time in the office
Medical offices are using electronic-record data to identify staff and scheduling issues that are often at the root of the long waiting-room times, and are adopting time-management strategies to fix them. More practices are creating a “digital front door,” sending texts to patients in advance with links to portals or websites where they can fill out forms, update medication lists and confirm insurance coverage up to a week ahead of time.
Another cause of prolonged waiting-room times is inefficiency in so-called patient cycle time—the amount of time from when a patient arrives at the office until the completion of the appointment, according to Dr. Jehni Robinson , a family-medicine specialist with Keck Medicine of USC, the University of Southern California’s medical arm, which sees 38,000 family-medicine patient visits a year.
The clinic has been able to reduce its cycle time to less than 60 minutes from 71 minutes since starting a practice overhaul in 2017, assigning staffers to shadow patients to document where delays occurred during a visit.
The clinic began starting clinic times earlier in the day to decrease the volume of patients toward the end of the morning hours, and changed its medical-assistant schedules to ensure they were available to get patients into exam rooms at the beginning of the morning and afternoon clinic sessions. Staffers reached out to patients ahead of the visit to ask about their reason for coming and held morning huddles to determine which patients needed vaccinations or other orders.
If things started falling behind, nurses were encouraged to take on the role of “flow coordinator,” such as by knocking on the door during a patient session to ask if the doctor needed anything—a signal that other patients were waiting.
The clinic’s patient-satisfaction scores on wait time, measured by “See provider within 15 minutes,” increased to 95% from 82%. According to a study led by Robinson, scores were also high in response to “My doctor did not rush me through my appointment” and “The doctor takes the time to hear what I have to say.”
Getting face time with the physician
To make sure patients have adequate time with their doctor, practices are changing the way they schedule appointments, reserving longer appointments for new patients and annual exams, and shorter ones for follow-up visits that may not require as much time. Team-based models are shifting more routine care to nurse practitioners and physician assistants.
“None of us are out to spend less time with the patient, so a lot of what we teach is how to be more efficient and also provide better quality care,” says Dr. Stacey Bartell , a family physician in Michigan who serves as medical director of career and practice for the American Academy of Family Physicians.
To expand their patients’ access to appointments, some traditional healthcare systems are striking partnerships with newer entrants into primary care that employ doctors, such as One Medical, which was acquired by Amazon.com in 2022. A membership-based service, it operates medical offices around the country, working with companies to provide benefits that include both in-person and virtual care. Its partnerships with health systems include commitments to build clinics and set up referral networks between One Medical primary-care doctors and the health system’s specialists.
For example, Hackensack Meridian’s Garrett says its partnership with One Medical includes building 20 new clinics staffed by doctors, who will personally greet patients when they walk in the door, with no waiting time.
Virtual care is also opening up appointments outside the traditional doctor’s hours. Oakland, Calif.-based health system Kaiser Permanente launched its first 24/7 virtual on-demand program that allows members to connect online or by phone to a clinician. Since September 2021, it has conducted nearly 1.4 million phone and video visits, with wait times ranging between immediate access and up to, on average, 42 minutes in 2023. in 2023. Patients with a wait time of more than 15 minutes are placed on virtual hold and contacted directly when it is time for the appointment.
A tech fix for follow-ups
Patient portals were supposed to help in many facets of the patient journey, from making appointments to communicating with doctors and getting test results and referrals. But while federal data show adoption has been steadily rising, surveys indicate patients are often frustrated by the technology and are concerned about understanding their health information.
Federal policies now require health providers to share test results with patients at the same time their doctors get them. But it can cause anxiety when patients see abnormal test results when a clinician hasn’t had time to explain them.
“I’ve had several instances in which the patients have seen something before the physician has even had a chance to call them, and they were very upset,” says Dr. Hardeep Singh , co-chief of health policy, quality and informatics at the Michael E. DeBakey Veterans Affairs Medical Center and a professor at Baylor College of Medicine, both in Houston. The VA developed a rigorous policy with specific timelines for communicating results for both normal and abnormal test results.
At University Hospitals, results such as some lab tests are color-coded in the patient portal to indicate normal and abnormal ranges, and one click leads to information such as the normal level of a blood-sugar measurement known as A1C for a 44-year-old female. As of next month, patients will also have the option to ask not to receive test results until a doctor has reviewed them and can comment.
One reason follow-up can fall through the cracks is that patients now can send messages to doctors through portals, but doctors are getting so many more messages than in the past that they can’t always get to them in a timely manner.
Medical practices are adopting triage techniques to identify which patient messages need attention from a physician and which can be handled by other members of the care team, such as a pharmacist who can answer medication questions or nurses who can help explain lab results. Kaiser Permanente is piloting a program that uses artificial intelligence to examine the contents of messages between patients and physicians to ensure they are sorted appropriately and passed on to the right staff members.
Laura Landro , a former Wall Street Journal assistant managing editor, is the author of “Survivor: Taking Control of Your Fight Against Cancer.” She can be reached at reports@wsj.com .
