Long waits continue for new patient appointments with primary care doctors
WALTHAM – The Massachusetts Medical Society released its ninth annual Patient Access to Care Study, showing that wait times for new patient appointments with primary care physicians remain long, that half or more of primary care practices remain closed to new patients, and that acceptance of the government insurance programs of Medicare and MassHealth (Medicaid) by physicians remains high in the Commonwealth.
The 2013 survey of 1,137 physician offices is the ninth annual such study conducted by the statewide physicians’ organization and examines three areas of access to care: (1) wait times for new patients getting non-emergency appointments with a physician; (2) percentages of physicians accepting new patients; and (3) physician acceptance of the government insurance programs of Medicare and MassHealth.
Seven physician specialties were surveyed for the study: family medicine, internal medicine (the two major primary care specialties), cardiology, gastroenterology, obstetrics/gynecology (OB/GYN), orthopedic surgery, and pediatrics.
Massachusetts Medical Society President Ronald Dunlap, M.D. said, “Our latest survey once again points out a critical characteristic of health care in the Commonwealth. While we’ve achieved success in securing insurance coverage for nearly all of our residents, coverage doesn’t guarantee access to care. The concern is that limited and delayed access can lead to undesirable results, as people will seek more costly care at emergency rooms, delay care too long, or not seek care at all.”
Dunlap also noted that, contrary to reports from other states, the overwhelming majority of physicians in the state continue to accept Medicare, and that the percentage of primary care physicians participating in MassHealth has increased from last year.
Waiting times/open practices
Primary Care – The 2013 study shows wait times for new patient appointments with primary care physicians remain long in the Commonwealth, with the average time to see a family medicine physician at 39 days (down from 45 days in 2012) and the average wait time to see an internal medicine physician at 50 days (up from 44 days in 2012). New patient wait times reflect the total number of calendar days, including holidays and weekends, between the interview and next available appointment.
The study also showed that only about half or less of primary care practices – 51 percent of family physicians and 45 percent of internists – are accepting new patients in 2013.
For pediatrics – primary care for youngsters up to age 18 – the average wait time was 25 days, two days longer than last year, with 70 percent of pediatric practices accepting new patients, a decrease of 2 percent from 2012.
Primary care trend data
Medical Society officials say the trend data for access to primary care shows cause for concern in all three primary care specialties. While the numbers have fluctuated from year to year, the percentage of family physicians accepting new patients has dropped 19 percent over the last seven years; the percentage of internists accepting new patients has plunged 21 percent over the last nine years; and the percentage of pediatricians accepting new patients has fallen 10 percent over the last four years.
County information: Wide variations
Wide variations exist in average wait times from county to county. For family medicine, Suffolk County has the shortest average time at 16 days, and Franklin County has the longest average wait time at 106 days.
For internal medicine, average wait times run from 26 days in Worcester County and 28 days in Barnstable County, to 128 days in Bristol County, 63 days in Essex County, and 55 days in Norfolk County. Wait times for new pediatric patients ranged from 13 days in Bristol County and 16 days in Plymouth County to 38 Days in Suffolk County and 44 days in Berkshire County.
Specialty Care New patient wait times for cardiology, gastroenterology, OB/GYN, and orthopedic surgery were stable or shorter for all specialties except orthopedic surgery. The biggest changes occurred with gastroenterology, whose wait time decreased 11 days, and with orthopedic surgery, whose wait time increased six days.
The average wait time in 2013 for cardiology is 28 days, versus 29 days in 2012; for gastroenterology, 33 days, versus 44 days in 2012; for OB/GYN, 37 days, versus 38 days in 2012; and orthopedic surgery, 22 days, versus 16 days in 2012.
Access to specialists continues to be much easier than it is for primary care, with 85 percent of cardiologists, 92 percent of gastroenterologists, 84 percent of OB/GYNs, and 98 percent of orthopedic surgeons accepting new patients.
Acceptance of government insurance
Despite some national reports that physicians are abandoning Medicare in other areas of the U.S., the overwhelming majority of physicians in the Commonwealth continue to participate in the federal insurance program for seniors age 65 and older.
While primary care has the lowest acceptance rates of Medicare, the specialties nonetheless maintain high rates of participation: 90 percent of family physicians and 85 percent of internists continue to accept Medicare. Acceptance rates for the specialties are as follows: orthopedic surgery, 98 percent; gastroenterology, 97 percent; cardiology, 96 percent; and OB/GYN, 94 percent.
Consistent with last year’s findings and in line with Medicare, primary care specialties are the least likely to accept MassHealth (Medicaid), with family medicine at 70 percent and internal medicine at 66 percent. However, physician participation in this program increased by 6 percent among family physicians and by 12 percent among internists in 2013. Pediatrics saw a decrease in acceptance, at 83 percent for 2013, down from 86 percent last year.
Acceptance of MassHealth by specialists saw increases in orthopedic surgery, to 85 percent, up from 78 percent; cardiology, to 85 percent, up from 83 percent; and OB/GYN, to 90 percent, up from 87 percent. Gastroenterology dropped to 90 percent, from 92 percent.
The 1,137 telephone interviews with physician offices were conducted between Feb. 28 and April 15 of this year. The survey contains statewide data, as well as data for each of the 14 counties in the state. Also included are nine-year trend data for five of the specialties, seven-year trend data for family medicine, and four-year trend data for pediatricians.
The 2013 Patient Access to Care Study is available online at www.massmed.org/patientaccess and is a component of the Society’s Physician Workforce Study, the organization’s annual comprehensive look at the state’s physician labor force. The 2013 Workforce Study, which includes additional information from surveys of practicing physicians, teaching hospitals, and community hospitals, will be released later this year.
Comments From Our Readers: