Long waits to see a doctor are a public health crisis

In 2004, the physician search firm Merritt Hawkins first issued their Survey of Physician Appointment Wait Times. That year, the national average wait to get in to see a new physician was 21 days, an unacceptable amount of time to wait to access care.

But that number has only gotten worse. In their 2022 survey, the wait for a new patient appointment increased to an average of 26 days.

The story is even worse when you look under the hood at certain specialties and markets. The average wait time for an OB-GYN appointment is 31.4 days, a 19% increase from 2017. Wait times grew across dermatology (+7%), cardiology (+26%), and orthopedic surgery (+42%) between 2017 and 2022. And while residents of New York can consider themselves “fortunate” to have an average wait time of just over two weeks to access care (17.4 days), people in Portland, Boston and Minneapolis are facing the longest average wait times at 45.6 days, 33.8 days, and 30.8 days respectively.

As the CEO of Zocdoc, a company whose entire existence is predicated on empowering patients to quickly and easily get in to see a health care provider, I recognize that it may seem self-serving to focus on reducing long wait times. But solving this is not just good for Zocdoc. It’s vital for patients, providers, and the system on the whole — and Zocdoc is far from the only solution here.

Long wait times are not just an inconvenience, they’re a public health disaster. According to a study published in Preventive Medicine Reports, delays in medical care may increase morbidity and mortality risk among those with underlying, preventable, and treatable medical conditions. In a survey my company conducted, nearly 3 in 4 Americans said it was easier to go to the ER than to get a doctor’s appointment. We also found that although 84% of Americans have an established relationship with a primary care physician, 65% would still visit the ER if they couldn’t get in to see a doctor at the office quickly enough.

Given the ever-rising wait times to access ambulatory care, it’s no surprise that ER wait times are also on the rise. But receiving treatment at the ER can be up to 12 times more expensive than at a doctor’s office, contributing $32 billion in wasted spending on hospital care that could have been delivered in a lower-cost setting.

And for those who don’t turn to the ER, delayed care leads to worsening conditions, late or missed diagnoses, more severe prognoses, and more. When we look at the behaviors of Zocdoc users, there is a strong correlation between the timeliness of an appointment and the realization of that appointment. In other words, a patient is more likely to attend a same- or next-day visit than one they’ve booked many weeks in the future.

A confluence of factors have led to these worsening wait times. The first is that Americans put off care during the acute phase of the pandemic. In 2021, roughly one in five Americans said they delayed or forewent care due to Covid-19, and 57% of those who delayed care said they experienced negative health consequences. This has led to pent-up health care demand that began to rebound in 2022 and has continued on an upward trajectory.

While demand for care is rising, the supply is contracting. On the heels of the pandemic, staffing shortages abound, with one report estimating that since 2020, one in five health care workers have quit their jobs; in 2021 alone, 117,000 physicians left the workforce while fewer than 40,000 joined it.

We can’t wait decades to expand the supply of care; we need to be smarter and more efficient with the resources available to us now. When I speak with leaders at care organizations of all shapes and sizes about their supply-demand challenges, those conversations typically focus on two main opportunities.

The first opportunity is getting smarter about inventory management. Many other consumer industries — from airlines to hotels — vigorously manage and market their inventory (e.g. unbooked seats, unfilled beds) to ensure their valuable assets are fully utilized. This often does not hold true when it comes to health care. While physicians like to say they’re fully booked, that does not hold true when you retrospectively audit their appointment fill rates.

A McKinsey report found that roughly 20% of a providers’ time goes to waste due to last-minute cancellations and reschedules. This is a lose-lose: The care organization is wasting their most valuable asset — a provider’s time — while patients are waiting weeks for a visit as precious appointments go to waste. Making this hidden supply of care available to patients who are eager to be treated is one of the biggest opportunities to bend the wait time curve.

Care organizations should dig into the erroneous assumption that their providers are fully booked out and begin by auditing providers’ actual appointment fill rates when they look back over the last three months of appointments. Sizing this problem will help them understand how much of their perishable inventory is going to waste. From there, they should examine modern, digital marketing channels — such as Zocdoc — that make providers’ openings transparent and bookable, to more efficiently leverage providers’ time and accelerate patients’ access to care.

The second opportunity is allowing physicians to practice at the top of their license by leveraging advanced practice providers (APPs) — which include nurse practitioners and physician assistants — for appropriate visits. When we look at utilization of APPs across our marketplace, 45% of large medical groups, 34% of health systems and 25% of small practices use APPs.

Across all specialties, we found that the practices that leverage APPs have more time to see more patients. On average, in 2022, they had more than double the patient availability over 90 days, compared to practices that don’t use them. Furthermore, data shows that patients are open to seeing these health care providers; practices with APPs received 72 percent more bookings than their counterparts over 90 days.

There is also a third opportunity, which is to more fully embrace urgent care as an important part of the overall health care ecosystem. The supply is there. Between 2013 and 2019, there was a nearly 60% increase in urgent care facilities across the U.S. And the demand is on the rise, too. Nearly 70% of patients said they would visit an alternative care site if their PCP wasn’t available that day. And for younger patients, urgent care is often their first stop. Nearly 50% of people 18-29 says their primary care is an urgent care type facility.

According to the American College of Emergency Physicians, an urgent care facility is likely a good choice for minor injuries or illnesses — cough, sore throat, earache, rash, minor cuts, etc. — or if the doctor’s office is closed. These facilities take pressure off of overburdened primary care providers, and can also serve as a pressure release valve for unnecessary, higher-cost emergency room visits.

Our health care system has excess capacity in the form of perishable inventory, underutilized APPs, and a rapidly growing volume of urgent care facilities. Surfacing this supply isn’t just good for people who expect and deserve timely access to care. It’s also good for provider organizations’ bottom lines, helping them generate additional revenue, recoup otherwise lost revenue, and attract and retain motivated patients who are eager to be seen. If these changes can be implemented, perhaps the 2027 Merritt Hawkins physician wait time survey will, at long last, start to trend in a better direction.

Oliver Kharraz, M.D., is the founder and CEO of Zocdoc.