By Sharyl Attkisson | March 4, 2024
As Americans have gotten more health insurance and spent record amounts on health care, the scandalous truth is we’ve become sicker, and we’re dying sooner rather than living longer. While life expectancy in comparable countries continues to rise, it’s declining in the U.S. One sign that our medical system is in critical condition comes in how long some patients are having to wait to see a doctor. Today’s cover story is Waiting Game.
The following is a transcript of a report from “Full Measure with Sharyl Attkisson.” Watch the video by clicking the link at the end of the page.
Like millions of Americans, Danielle Hatfield and her daughter Lydia have chronic health conditions that require constant medical attention. So they were hit hard about a year ago when they learned that their primary care doctor had left the practice.
Danielle Hatfield: My daughter was going through a lot of health issues, as well as myself, at the time, and it was important. Our primary care physician holds most of our main medication prescriptions. And the current, old practice wouldn’t refill our prescriptions without making us come in and see another physician. But then they didn’t have any appointments available. So we’re kind of left high and dry, so a good month and a half.
And then there was the time in 2017 that Hatfield thought she’d found the perfect specialist and waited two long years for an appointment.
Hatfield: I’d waited for this doctor, because she was supposed to be phenomenal, and I had to get a referral to even be able to see her, like she doesn’t accept new patients. Two year wait. Got on, got the appointment. Couple days before, they called me and said, “She’s no longer with the practice.”
Theirs has become a common national experience. Across America, many people are finding it more difficult than ever to get a simple doctor’s appointment.
The average wait for a new patient appointment in 2004 was widely considered unacceptably long — at just over four weeks. But by 2022, the wait had grown a full week longer. And that’s hardly the worst of it.
For a heart checkup with a cardiologist, you could find yourself waiting as long as four-and-a-half to five months in Washington, D.C. and Houston, Texas. Around five and half months in Seattle, Washington, Miami, Florida, and Atlanta, Georgia. And nine-and-a-half months in New York City.
In Atlanta, the longest wait times for a basic women’s gynecological exam jumped from 2.3 months in 2004 to nearly eight months in 2022.
In Portland, Oregon, to check for possible skin cancer with a dermatologist, the longest wait time has risen from 2.3 months to 10 months.
And in San Diego, California, try to get an appointment with an orthopedic surgeon for a knee injury — in 2004, you could find yourself waiting as long 1.6 months, but in 2022, that time skyrocketed to more than 11 months.
Dr. Ateev Mehrotra: Where I hear it most is a person moves to a new town. They need to get a new primary care doc, and they start calling around. And so many of the primary care practices say, “We’re closed to new patients.”
Dr. Ateev Mehrotra is a professor of health care policy at Harvard Medical School.
Sharyl: Not all that long ago, we heard stories about this in other countries. We would say, “Oh, the Canadians are coming here for health care because they have to wait so long to see a doctor. They have to wait months and months or a year for a surgery.” It now feels like we’re approaching something like that.
Mehrotra: Yes, so first I think you’re correct, when people have done surveys of people in different industrialized nations. What we are describing, the average American, in terms of getting into their regular doctor in a timely manner, has about the same difficulty as in other industrialized nations. Or in some cases, it’s worse here in the United States.
Experts say there are countless reasons for the holdup when it comes to seeing a doctor.
The Covid pandemic added to a physician shortage. One estimate finds that one in five health care workers have quit since 2020.
In 2021, there was a net loss of 77,000 doctors. At the same time, America is suffering from chronic disease epidemics, meaning more people making more trips to the doctor. Obamacare, or the Affordable Care Act, in 2010 more than doubled the cost of health insurance, but resulted in more people having insurance policies and taking more trips to the doctor. And the insurance-driven health care system requires patients to follow a strict regimen of expensive and time-consuming exams, tests, and follow-ups in order to get treatment, contributing to what Dr. Mehrotra calls a “cascade” impact on the practice of medicine.
Mehrotra: A person comes to me, and some doctors will do a yearly urinalysis. Well, maybe the protein level’s a little high, maybe I’ll do a follow-up test and just see what’s going on. Oh, the protein level’s a little bit higher, I’m going to do a CT scan of looking at what’s going on in the kidneys. Maybe there’s something a little funny going on in those kidneys, maybe I need to do a biopsy, so I’ll do a biopsy of that. Oh, the biopsy’s totally fine. That’s an example of that cascade where there were a lot of appointments there that used up valuable physician resources, as well as, in the end, didn’t really help the patient.
With so many patients left hanging, it’s stressing another part of the health care system.
Hatfield: If I can’t get an appointment with my doctor, and something’s going on that I need an antibiotic before, say, my only option may be to go to the emergency room.
Nearly three in four Americans find it easier to go to the emergency room than to get a doctor’s appointment, according to one survey. Not surprisingly, ER wait times are also growing. And those ER visits are adding to the nation’s health care debt, costing an extra $32 billion a year for care that could have been given at a doctor’s office or clinic.
All the delay is more than a frustrating inconvenience. It’s dangerous. During long waits, people may miss out on preventive care. Patients with treatable conditions can become sicker, harder to cure, and can even die.
One study shows adults who waited just 24 hours for surgery after a hip fracture were more likely to have complications or die within 30 days of surgery.
Dr. Mehrotra says one answer could come from specialists re-examining their treatment style where they tend to keep bringing established patients back every few months.
Sharyl: Who teaches doctors the style?
Mehrotra: I mean, I think this is a bit of a dirty secret. In medical school, there’s never a lecture on, “When you have a patient with high blood pressure, how often do you bring them back?” And some health systems are trying this and saying to their specialty physicians, “If you’ve been seeing this patient once a year for the last five years, everything’s pretty stable, send them back to the primary care doc.” And that’ll open up a new slot for a new patient. And I understand it, that when I see a patient, “I’ll see you back next year, Sharyl.” But maybe sometimes it’s better to say, “You’re doing really well. If there’s an issue, call me, but I don’t need to see you.” And trying to make that more, “I take care of the problem, and then they move back to the primary care doc.”
From the patient’s view, Hatfield says she hasn’t had much success navigating the system to meet her family’s needs — even though she’s a registered nurse.
Hatfield: I think I’m very well-educated as a patient, what to expect and how to get what I need out of the health care system. But it’s constantly changing. And it’s frustrating, even though I know how things should work, and they don’t work. It has limited getting my care in a timely manner, finally getting the right medications to get what works. It’s sad. It’s really sad that you have to work so hard to be able to manage your health.
Sharyl (on-camera): Dr. Mehrotra suggests compensation to a health system be adjusted based on specialty wait times, forcing the health systems to prioritize tackling this problem.
