If you are a new patient needing to see a doctor for the first time, you may have to wait, according to a survey by Merritt Hawkins, a physician search and consulting firm that questioned some 1,399 medical offices in 2014 to determine wait times for new patient appointments in various specialties.
In 15 metropolitan areas across the United States before Obamacare expanded coverage, the average wait time for a new patient to see a physician in five medical specialties was only 18.5 days.
After implementation of Obamacare, wait times increased. The longest increase by far was in Boston, where patients waited an average of 72 days to see a dermatologist and 66 days to see a family doctor. The shortest wait times were in Dallas, where the average wait time was 10.2 days for all specialties, and just five days to see a family doctor.
Striking Differences Exist
Sean Parnell, a policy advisor to The Heartland Institute, which publishes Health Care News, and president of Impact Policy Management, says the differences between Massachusetts and Texas are striking since both states have pursued different paths and achieved far different results.
“Massachusetts has gone towards more central planning by expanding its Medicaid program with reimbursements so low many doctors limit the number of patients on the program they will see,” said Parnell. “Meanwhile, over in Texas, the Lone Star State has remained more market-oriented with self-pay patients, many of them uninsured, who are still able to access care simply by paying directly for their treatment.”
Why Wait Times Increased in Massachusetts But Not Texas
When Massachusetts passed Romneycare in 2006, wait times started growing until something as routine as a normal physical would have to be scheduled 18 months out, says Merrill Mathews, a resident scholar with the Institute for Policy Innovation.
“There was suddenly a big influx of people into the [Massachusetts] system, creating a backlog, and emergency room use went up because people with insurance got tired of waiting,” Matthews said.
There are several other reasons why wait times increased in Boston, says Matthews.
“More people who were previously uninsured were now getting care,” said Matthews. “This is not necessarily a bad thing, but it did cause their utilization of health care services to spike. Also, expansion of Medicaid also put some scheduling pressure on health care providers.”
Dallas avoided many of these problems because Texas has always had a lot of physicians due to the high number of medical schools in the state, says Matthews.
“Also, [Texas] passed malpractice reforms about nine years ago and the joke was that when Texas did this, all the Texas trial lawyers moved to Oklahoma and all the Oklahoma doctors moved to Texas,” said Matthews.
Restrictive Regulations Blamed in Boston
In contrast to business friendly Texas, a right-to-work state with no state income tax, Boston, Massachusetts has a restrictive set of regulations about who doctors can see for medical treatment, says Joshua Archambault, a senior fellow at The Foundation for Government Accountability and formerly a senior fellow in health care policy at The Pioneer Institute in Boston.
“If you live in Boston and you want medical care, you pretty much have to go to a hospital there because there are no Minute Clinics or doc-in-a-boxes, etc.,” says Archambault. “You have to go to a hospital for everything, and even if you see a physician’s assistant or a nurse practitioner, they bill everything at [medical doctor] rates, so this makes things necessarily more expensive.”
Massachusetts is very insurance rich—high rates of private insurance, employer-provided insurance, and state-provided insurance—and about 95 percent of the state is insured, says Archambault.
“The tradeoff is there is rationing through time, thus the long waits,” Archambault said. “If you are a new patient on Medicaid, there are certain pockets in the state where it is hard to even find a doctor who will see you.”
Matthew Glans ([email protected]) is a senior policy analyst at The Heartland Institute.
“Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates: 2014 Survey,” Merritt Hawkins: https://kaiserhealthnews.files.wordpress.com/2014/01/mha2014waitsurvpdf.pdf