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Comment by JumpCrisscross | Hacker News Reader

> I won't be able to see the latter until late January 2025

Where are you? This is unusual.

In America, the "average wait time for a [cardiologist, dermatologist, og/gyn, orthopedic surgery or family medicine] appointment for the 15 large metro markets surveyed in 2022 is 26.0 days" [1]. In Canada, the "median national wait time 1 was 78 days," with wait ime "defined as the period between a patient’s referral by a family physician to a specialist and the visit with said specialist" [2].

Broadly speaking, American medical wait times are quite good, particularly for specialists [3]. But PCPs/capita vary greatly from state to state [4].

[1] https://www.wsha.org/wp-content/uploads/mha2022waittimesurve...

[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC7292524/

[3] https://worldpopulationreview.com/country-rankings/health-ca...

[4] https://www.beckershospitalreview.com/rankings-and-ratings/s...

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I've seen this too, in the northeast US. I didn't go to our family doctor of 10+ years for 18 months during COVID-19. When I called for a new appointment, they said I had was no longer a patient and had to wait at least 90 days for an appointment to address a painful condition. I still haven't gone back, and now I just use urgent care if needed.

I had similar problems with a specialist. Their appointments are typically six months out, and if you need something more urgent, the answer is "sorry that's all we can do." My last actual appointment, after the ~six-month wait, was a simple 15-minute telehealth visit. It's insane.

I have great insurance and I've never had any problem paying. It's amazing to me that doctors seem to really push back against having patients, or their patients having appointments. Isn't this how they make money? What kind of weird market effect incentivizes this behavior?

It's interesting that dentists and oral surgeons seem to be the opposite. I've never had a problem finding one and they usually seem welcoming, happy to help, and glad to have the business.

Every doctor I personally know is double booked at least a substantial portion of every single day. They count on last minute cancellations and no shows just like airlines do in order to maintain their schedules.

Making friends with folks in the medical field is eye opening to say the least. The system is operating redlined and has been since before Covid. Covid just caused the fractures to finally start showing to the average person.

The real thing coming for us is that every doctor I know other than some specialists are simply counting down the days until they can leave the field of direct patient care entirely. Whether this be early retirement, paying off student debt and bouncing, or making a lateral move to research or a tech firm. The field has gotten to be untenable for many, typically the ones who actually care. The profession as a whole has lost its personal agency to the administrative class. It’s not idle talk either - plenty have actually already executed on these plans.

>The profession as a whole has lost its personal agency to the administrative class.

This has happened all across the American economy, in every business, every industry, every company.

My father was a grocery store manager for decades. He retired and went to be a contractor for a decade. The grocery chain recently tempted him back, by offering him top position (over other candidates, who kinda deserved the position, but that's just how much this company loved my dad, he was literally legendary in the company) in their "show off store" which they had purchased to scoop up the location from a competitor that they want to keep out of the market (yay capitalism) and spent millions to completely re-roof, rebuild, redesign as their premier location, to be used exclusively to lose money in a busy market, to show off for the C-Suite, and to shoot commercials in. My father was clearly super excited to get back to the company, to get back to management which he is very good at, and to get stable health insurance.

He gave up after a few months. Everything is that kind of awful "automated" that any software developer could immediately recognize, with KPIs and useless metrics created by someone inexplicably above you who has zero familiarity with what those KPIs even measure.

No more agency for lower management. Just shut up and follow the whims of the useless nepo-baby who runs your division as it continuously fails to do anything.

Definitely not the case in my area, my wife enjoys being a provider.

It is really frustrating but I've found that most doctors and hospitals have two systems. One for new or very infrequent patients. One for established or regular patients. The latter gets appointments fairly quickly in most cases.

It is rather messed up but One Medical (now owned by Amazon) and a few other services can be worth the money because they have access to the fast track appointment line.

I only know this because after many many months of searching for a primarily care doctor and waiting for an appointment I was told about this. New patient scheduling for my doc is months out. If I email and ask if I can come in next week they always say how about tomorrow/the next day?

Maybe there are simply not enough doctors, so their waiting list is exactly that, months long?

Right, we have a shortage of physicians and the problem will only get worse as the population grows older and sicker. The first thing we need to do is get Congress to increase funding for residency programs in order to eliminate that bottleneck.

https://savegme.org/

I think it's likely simply gotten worse since those studies.

A friend of mine needed a specialist. She called multiple offices across two different states, and the soonest appointment available was about 4 months out.

Four or five years ago, we didn't typically see wait times like that.

Could this be a result of HDHP plans that allow "direct to specialist" appointments, as opposed to triage through a PCP?

I believe most of the offices she called actually required referrals for all initial appointments (regardless of insurance), so I don't think that's a factor here.

I see similar lead times simply trying to get a PCP.

OP is correct in my anecdotal experience. I live in a large urban area and wait time for PCP is several months out. Even longer for Women's health as I hear from my partner.

I don't remember it being this bad in the past. Perhaps things have changed in the several years since those publications were published.

    > I don't remember it being this bad in the past. Perhaps things have changed in the several years since those publications were published.

There's an analogous pattern happening in clinical trials that I suspect is related: there has been a consolidation by private equity[0].

There are several reasons for this, but the gist of it is that pharmas have moved much of the actual work of running large clinical trials to contract research orgs (CROs) and the cost of recruiting patients for trials, training staff, records keeping, and administering the trial becomes out of reach for small independent sites where clinical trials are executed. It's also more efficient on the sponsor side to interface with one large entity rather than several small entities.

I suspect that the increasing demands of technology and burden of records keeping in both clinical trials and health insurance makes it difficult for small independent sites to operate profitably. So what happens is that many small, independent offices end up joining a larger entity that can consolidate some of the "system level complexity" more efficiently. The tradeoff is that it's no longer about the doctor-patient relationship; it's about efficiency and profits.

I also suspect that part of it is that PE realizes that consolidation lets them control prices. If they can control a network of trial sites, then they have more power to negotiate rates with sponsors and CROs for each patient they sign up to the trial. The bigger the network, the greater their leverage. I think this probably also holds true for healthcare and insurance providers in general.

[0] https://www.fiercebiotech.com/cro/private-equity-invests-tri...

I live just outside a large urban area, and my wait time for a PCP is weeks if I agree to see their PA (the PCP will review all findings anyway), or days if I put myself on their cancellation list. Maybe try calling around just outside of your urban area.

> This is unusual.

Is it? That's pretty normal in my part of the US, and that's assuming you already have a PCP. If you don't, then finding one that's accepting patients can take much, much longer.

> Is it? That's pretty normal in my part of the US

Are you in a state with a shortage of PCPs [1]? If so, yes. But most Americans aren't in those states, and in at least a few of them the harm is closer to a political choice than an oversight.

[1] https://www.beckershospitalreview.com/rankings-and-ratings/s...

I have heard the same comments from people in states all across the nation. It may very well be that it's a minority of states (I don't know), but it's certainly a very substantial portion of the population that's affected.

I'm not asserting that what I've experienced, seen, and heard represents the majority experience. As I mentioned, I don't know. But it's not exactly a rare experience.

In FL. Been to 2 different PCP over the past decade. Was 90+ days before I could get my first appointment at both locations.

I’m in Southern California and it also is a bit of a wait

IME (SoCal) the 1st visit can take 2-3 months. After that you can get back in with only a 2-3 week wait, shorter if it’s urgent.

They seem to rate limit new patients so current patients can get in.

> This is unusual.

> In America, the "average wait time for a [cardiologist, dermatologist, og/gyn, orthopedic surgery or family medicine] appointment for the 15 large metro markets surveyed in 2022 is 26.0 days" [1].

I want to point out the important missing fact there that the "America average" time tells you nothing about variance across geography, specialty, or patient population, and you really need to at the very least look further down at the charts where they talk about shortest and longest times in the different cities and specialties.

For instance I see Boston's longest 2022 time for family medicine is 136 days, average 40 days. And Massachusetts is one of the top states on your list for PCPs per capita. At least that's better than 2017 where the longest time was "fuck you, get rekt, lmao".

Connecticut. Everything is like this here. I have genuinely considered moving because of this. My current employer has another location in California, and as much as I hate the idea of moving back there, it might be necessary for my own physical well-being.

Wait times for certain types of appointments are just as long in much of California. But the variance is huge, so it could be better (or worse) depending on exactly where you go and which providers are in your health plan network.

USA/Bay Area here.

My surgery took months of specialist appointments and months to get an OR slot. There was a conflict and it was delayed again.

I changed networks and when searching for a new PCP I had to wait over a month for the first appointment.

Sometimes a doctor is available but crappy scheduling software hides that.

I got a small scratch from a squirrel and since it did cause a little blood to appear I figured better safe than sorry and went to Kaiser's site to make an appointment with my PCP.

They had nothing for a few weeks.

So I changed to requesting an appointment with any doctor at the same facility. It then gave me an appointment with my PCP for the next day at 9 am.

I've seen similar problems with vaccine scheduling using their web site. It will sometimes only show appointments at a bigger Kaiser facility in the next town, or an even bigger one 30 minutes away.

But if I actually go in and talk to the people at the front desk at the Kaiser office in my town they can often make me an appointment at that facility.

It's also much faster to get in front of a NP than a doctor.

As it should be. One of the few levers we have to control costs across the healthcare system is shifting much of routine primary and urgent care to PA/NP practitioners. I understand that might mean a loss of quality in some cases (have been on the receiving end of that myself) but we'll have to lower our expectations and be content with good enough.

I'm in Oregon - in the Portland metro area - and a cardiologist appointment for me was about 3 months, neurologist about 4 months, and sleep lab 3 months. My PCP is usually a 1-3 weeks wait, but sometimes I get lucky and he's available in like 2 days.

In my experience it depends on the speciality you need.

If you need to see an Otolaryngologist (ENT), you might be able to get an appointment within a few weeks. If you need to see an Endocrinologist, it might be 4-6 months.

There is a specialist shortage. Refs I've sent to Endros take months. I've even had to refer patients to places nearly 150 miles away.

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