Waiting for Healthcare to Happen

What’s the longest you’ve waited for a doctor appointment?

Every patient has a collection of grievances with the healthcare system. Cost is a big one; so are doctors who don’t listen; having to travel to a hospital far from family is another. But there’s one complaint that seems to be getting worse and worse – waiting weeks or even months to see a doctor.

When Patients Have to Wait Their Turn for Care

Consider the state of appointment waits:

Specialists: Patients can wait months to see a specialist – especially Medicaid patients, since nearly one-third of specialists are unwilling to see them. In Philadelphia, patients wait an average of 51 days to visit an obstetrician-gynecologist for the first time; in rural Texas, patients may need to book dermatology appointments almost a year in advance. Canadian specialists report a median waiting time of 19.8 weeks after referral. An NHS report found that less than half of NHS trusts and foundation trusts currently met the 18 week waiting time standard for elective treatment, and only 38 percent met the 62 day standard for cancer patients.

Primary Care Providers: While patients can often book their PCP within a week or two, that can still be too long a wait for someone suffering from pink eye or a severe flu. Many of these patients head to a retail clinic or urgent care, given that 69 percent of urgent care clinics have a wait time of fewer than 20 minutes – but seeking care from a variety of clinics can fragment the patient’s medical history.

Emergency departments: Depending on the severity of their need, some patients can be treated immediately but many spend hours in the waiting room. Those hours can feel like an eternity for someone suffering from a broken ankle or painful hernia but they can turn out to be wasted time for conditions that could have been treated elsewhere.

Behavioral health and addiction treatment: High demand and limited availability mean that many patients seeking treatment for opioid addiction or alcoholism may have to wait for a detox bed. The lack of behavioral health providers in certain areas can also delay mental health treatment for patients.

These long waits for care aren’t just an inconvenience – they’re a danger. Instead of recovering after speedy treatment, patients may watch their potentially curable illnesses or injuries turn into chronic conditions or irreversible disabilities. The mentally ill or addicted may lose their resolve and relapse or turn away from treatment. Patients too sick to work can sacrifice both wages and their professional standing.

The Rising Provider Shortage

There are plenty of factors that make it tough to see a doctor quickly. Finding a local provider covered by their insurance plan can be difficult for patients; some medical offices are inefficient. But the most common reason is that there just aren’t enough doctors to go around.

Texas is a stark example. 159 of Texas’s 254 counties have no general surgeons, 121 counties have no medical specialists, 30 counties have just 1 doctor and 35 counties have no doctors at all. These shortages can create a cycle where high demand drives physician burnout, which in turn drives some providers out of the medical profession. According to The Association of American Medical Colleges (AAMC), we can expect a shortage of 65,000 physicians in the U.S.  by next year – and 120,000 by 2030. That’s partially because one-third of the providers practicing today will be over age 65 and preparing for retirement by 2025.

Yet there’s another factor in provider shortages: the scarcity of skilled experts in rare or recently discovered conditions. The most advanced specialists often focus intensely on research, limiting their availability for patient care. Consider the case of a young patient who after nearly three years of seeking treatment was finally diagnosed with postural orthostatic tachycardia syndrome (POTS), unnamed as a distinct condition until 1993. Specialists are so difficult to find that patients often have to fly to other parts of the country for appointments. This patient waited four months for an appointment with aa neurologist in a large city with a higher than normal specialist population then waited another eight months to see a leading POTS expert – despite living only a few miles from his office. He was just spread too thin between his clinical research and his waiting list of patients from all over the country to see her any sooner.

Keep in mind that getting the specialist appointment is only the beginning of care for that patient. Once they see a specialist, the patient must often be tested before they can be diagnosed, adding to the wait to finally receive an evidence-based treatment plan and get the care they need.

Telemedicine Delivers Timely Care

Virtual health is often thought of as bridging distance barriers in care. Yet its ability to deliver timely care is just as valuable:

• Virtual appointments can usually be booked within short timeframes. Doctors spend less time transitioning between patients and can offer care after hours; they can also see patients in underserved areas.
• Smarter virtual triage can keep patients out of ER waiting rooms. According to a study by Truven Health Analytics, 71 percent of emergency room visits are unnecessary and avoidable. Telemedicine can deliver the right medical attention while keeping ER beds free for people who need them.
• No-show appointments cost the U.S. as much as $150 billion a year. While it’s almost impossible for a different patient to make it to the office in time for that appointment, they can immediately connect to a patient on a waiting list for a virtual visit.
• Instead of referring patients to a specialist for another visit, PCPs can consult virtually with a specialist while the patient is still in the office.

It’s one of healthcare’s crueler ironies that as more advanced medicine becomes available, patients must often wait longer to receive it. It’s not just the isolated and the disadvantaged who go without care; patients living next to state-of-the-art medical centers are struggling to be treated. Telemedicine can accelerate care delivery for all patients, no matter where they live and no matter how busy their local providers are.