Bluefield Daily Telegraph, Bluefield, WV

National and World

June 13, 2014

Outside the VA, waits for doctors can vary widely

WASHINGTON — It’s not just veterans who sometimes have to wait for health care. Depending on where you live and what kind of care you want, in parts of the country it’s not always easy for new patients to get a quick appointment.

Need routine primary care? The average wait to see a family physician for the first time ranged from 66 days in Boston to just five days in Dallas, according to a survey in 15 large cities by health care consulting firm Merritt Hawkins.

And doctors are bracing for new demand from millions of people newly insured through the federal health care law.

“To say it’s an easy solution to the VA problem — we’ll just have them get care in the community — overestimates the capacity the community has to absorb these folks,” said Dr. Yul Ejnes of the American College of Physicians.

VETERAN WAITS MADE HEADLINES

A government audit shows more than 57,000 veterans have been waiting at least three months for their first appointments at Veterans Affairs medical centers and an additional 64,000 who enrolled for VA care over the past decade never got seen by a doctor. The longest waits for an initial primary care appointment ranged from 145 days in Honolulu to 73 days in Richmond, Virginia.

To help, Congress is moving to allow more veterans who encounter delays to seek VA-paid care, temporarily, from a non-VA doctor. (The VA already had allowed some outside care, although veterans have complained that it’s difficult to access and includes a series of bureaucratic hurdles that must be cleared.)

BUT WHAT’S THE CIVILIAN WAIT?

There are no national statistics. But Merritt Hawkins’ survey, released earlier this year, illustrates there’s variation around the country when it comes to choosing a new physician.

The longest waits overall were in Boston — an average of 45.4 days — while Dallas had the shortest at 10.2 days. But the kind of doctor you need makes a difference, the survey found.

The wait for a first-time appointment with a cardiologist averaged 32 days in the nation’s capital but only 11 days in Atlanta.

Got knee pain? Waits for an initial consultation with an orthopedic surgeon averaged 18 days in San Diego and five days in Philadelphia, Minneapolis and Houston.

For a well-woman visit, waits for a first-time OB/GYN appointment ranged from 46 days in Boston to 10 days in Seattle.

Those are averages. The longest reported wait time was a stunning 256 days for a particular Minneapolis dermatologist. You could wait 129 days for a certain Seattle family practice and 132 days for one San Diego cardiologist, the survey found.

But people frustrated by waits for one doctor often can seek another, depending on their insurance and how far they’re willing to drive. Sure enough, Merritt Hawkins’ survey showed that in multiple cities, there were physicians with appointments available in just one day even for a new patient.

That’s not the only way to measure. The Massachusetts Medical Society’s annual statewide survey found wait times ebb and flow. The wait for a first-time appointment with an internal medicine specialist was 50 days in 2013, up from 44 days the previous year. In contrast, the wait for a family physician dropped to 39 days, from 45 in 2012, and the wait for a gastroenterologist was 33 days, 11 days shorter than the previous year.

WHY THE WAIT?

Partly, there aren’t enough doctors. A graying population that needs more medical care was straining the system even before the new health care law opened the way for more people to start looking for a regular doctor. With older physicians retiring, too, there aren’t enough new ones coming on board to meet growing demand.

Primary care physicians get the most attention, and nearly 20 million people live in areas officially designated in need of more, said Dr. Atul Grover of the Association of American Medical Colleges. But specialists can be hard to find, too, especially in rural areas and in parts of the country where new doctors haven’t kept up with rapid population growth. That includes parts of the Southeast and Southwest, particularly Arizona, Nevada and Texas, he said.

The AAMC estimates that by 2020, there will be a shortage of 45,000 primary care physicians and 46,000 surgeons and specialists nationally.

Pending legislation calls for the VA to hire more doctors. Sen. Bernie Sanders, I-Vt., chairman of the Senate Veterans’ Affairs Committee, said Wednesday that “at the very minimum, there is a need for 700 new physicians in the VA.”

NEW PATIENTS VS. EXISTING  

The busier the office, the less space for a new patient and some doctors simply don’t accept newcomers. Ejnes is a Rhode Island internal medicine physician with 1,500 patients, enough that he only accepts new patients who are family members of existing ones. Some offices close to new patients during busy times of the year, like a bad flu season, and accept them again during slow periods.

“It’s supply and demand,” Ejnes said. “It takes a lot of persistence, a lot of phone calls, to find someone.”

Existing patients get priority for future appointments. Even the VA audit found returning patients usually had shorter waits for a primary care appointment, with some exceptions.

WHAT ABOUT URGENT VISITS?

The American Academy of Family Physicians says 80 percent of its members make provisions for same-day appointments. Half also offer extended hours, with some appointments early or in the evening to catch people who can’t get off work for a doctor’s appointment and those who otherwise would go to the emergency room for a sudden problem, said AAFP president Dr. Reid Blackwelder.

How many patients say they’re able to get quick appointments when they need them? A survey by Medicare overseers found 82 percent of beneficiaries seeking an appointment for an illness or injury never had to wait longer than they wanted.  A Commonwealth Fund survey published last year found almost half of adults in the U.S. got a same- or next-day appointment the last time they were sick, compared with about 70 percent of those surveyed in Germany and New Zealand.

WHAT’S TOO LONG?

The VA has lifted its goal of 14 days to get an appointment, after investigators determined workers falsified records to cover up delays. For private doctors, there are no national standards on waits.

California, however, does have some rules requiring that certain types of health plans ensure their customers get timely access: 48 to 96 hours for an urgent need, and 10 to 15 business days for a non-urgent need.

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