WSJ: Why is it Such a Pain to see a Doctor?

I haven’t been to the doctor in several years because it’s such a hassle. All that time I’ve had health insurance that I have not used. The reason is because my old doctor retired (as did the previous one) and it’s too big a hassle to find a new one.

The Wall Street Journal wrote about what a pain seeing a doctor has become.

You struggle to make an appointment. You sit and sit in the waiting room. You get barely any face time with the doctor. Why is it so difficult?

Why is it so frustrating to see a doctor these days—and can anything be done to make it easier?

I have an answer to WSJ’s questions, but I will wait until the end to provide them.

WSJ reports that one survey found new patients like me have a month-long wait for a first  appointment in more than a dozen major cities. (let’s not even talk about the “new patient” appointment fees.) Commonwealth Fund found in another survey that more than one-in-three Medicare patients are waiting a month or more to see a primary care doctor. It’s not just the long waits to see your doctor, it’s everything in between.

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.

Well into the article WSJ reveals half of the problem: there is a physician shortage. The United States is not producing nurse practitioners, physicians’ assistants and new physicians fast enough to meet growing demand. Let’s ignore for the moment that Match Day 2024 passed a couple weeks ago and about 10,000 medical school graduates were disappointed to discover they did not match to a residency and may never be allowed to practice medicine in the U.S.

Of course, the American Medical Association blames low payment rates from Medicare for why it’s difficult to see a primary care physician. Medicare’s fees are lower than what private insurers pay but only a small percentage of physicians decline to treat Medicare patients. Some Medicare fees are too low, while some are undoubtedly too high. On balance Medicare fees did not affect the supply of primary care physicians. As an aside, the AMA lobbied nearly 30 years ago to cap the number of residencies that Medicare funds, thus limiting the supply of new physicians. Therefore, blame the AMA, not Medicare fees.

The Wall Street Journal came up with some solutions:

• Make it simpler to schedule
• Cut wait time in the office
• Schedule more face time with the physician

While these are not bad ideas, they’re little more than band-aids. Furthermore, physicians’ offices have little incentive to pursue them. My wife and I have often discussed why doctors’ offices are (generally) poorly managed. It’s mostly because your doctor is not competing with other physicians for your business. If their office portal is poorly designed, drops calls, makes you wait on hold and the phone is rarely answered, you’re unlikely to take your business elsewhere. If you do, there is someone else to take your place. My wife told me a story about a physician she sees whose previous office manager was a close relative of the physician. He would not answer his phone much of the time and did not configure his phone to accept voicemail. He joked it was easier that way. Getting a refill called in was like pulling teeth. It generally took multiple phone calls to the doctor, to the pharmacy, again to the doctor’s office, then to the pharmacy.

The problem of getting in to see primary care physicians does not have an easy fix. Hospitals employing physicians certainly does not help and it often restricts former physician employees from quitting and working in the same community. However, creating a path to practice for thousands of medical school graduates, who are currently inhibited from advancing in their careers, is a huge step in the right direction. Expanding scope of practice regulations to allow more advanced practice nurses and physicians’ assistants to practice will also help. Programs like 3-year medical degrees for students going into primary care may boost those working in primary care. Finally, state and local communities may have to partner with teaching hospitals to create more primary care residencies in return for doctors agreeing to work in a given area for a few years.

Read more at WSJ: Seeing a Doctor Doesn’t Have to Be So Frustrating