- The Washington Times - Friday, June 4, 2004

Patients in the Washington area wait an average of eight to 15 days to see medical specialists, the shortest such waits nationally, according to a new survey of 15 metropolitan areas across the United States.

The 2004 Survey of Physician Appointment Wait Times found that, on average, new patients in the Washington area wait 12 days to see a cardiologist, 15 days for an appointment with a dermatologist, 11 days to see an obstetrician/gynecologist and eight days to see an orthopedic surgeon.

In contrast, the survey by the consulting firm of Merritt, Hawkins & Associates of Irving, Texas, found that Boston-area patients have the longest wait for nonemergency appointments with specialists. Their waits range from 24 to 50 days, and in most cases, patients wait more than a month.

The firm, which recruits employees for hospitals and doctors’ offices, determined that Boston patients wait an average of 37 days for an appointment with a cardiologist, 45 days to see an obstetrician/gynecolo- gist, 50 days to visit a dermatologist, and 24 days to see an orthopedic surgeon.

“Average wait times reported for Washington, D.C., were consistently low,” the report said. Its authors hypothesized that a “high physician-to-population ratio may explain the relative ease of scheduling a physician appointment in the D.C. area.”

The survey cited data from the American Medical Association indicating that the Washington area has the “highest per capita ratio of physicians per population in the country, with 718 doctors per 100,000 people.” Idaho has the lowest ratio with 178 physicians per 100,000 population.

No one would expect a shortage of medical specialists in Boston, because of the presence of the Harvard Medical School and some of the nation’s top teaching hospitals. But Merritt said in its report: “Our experience in recruiting to the area indicates that Boston is having challenges in physician retention.”

Rising malpractice-insurance rates and a high managed care presence “are causing many physicians to leave the area,” the report said.

Merritt said it conducted the survey because it has observed a “sharp increase” in the demand for medical specialists in recent years.

Factors in this increase, it said, include an aging population, population growth, patient treatment preferences and the use of payment plans that allow more direct patient access to specialists.

But although demand for specialists is growing, there has been a reduction in the supply of some specialists, which include factors such as physicians’ aging and retiring and the skyrocketing malpractice premiums, according to the report.

“The result is that patient access to specialists has become increasingly problematic … the length of time patients must wait for a physician appointment appears to be lengthening … and a growing number of physicians appear to be unwilling to schedule Medicaid patients,” said an overview of the survey.

In the Washington area, Medicaid acceptance rates are high among heart doctors, obstetrician/gynecologists and dermatologists. But only 46 percent of local orthopedic surgeons accept Medicaid patients, the survey found.

Survey data was collected by researchers for the consulting firm, which called between 12 and 20 cardiologists, orthopedic surgeons, dermatologists, and obstetrician/gynecologists in each of 15 metropolitan regions. The staffers posed as patients, seeking initial appointments for one of these purposes: a heart checkup, a routine skin exam to detect possible cancer, injury or pain in the knee, or a routine “well-woman” gynecological exam.

In the Washington area, some “patients” who called cardiologists were able to get same-day appointments, and the longest wait was 23 days. In Philadelphia, the longest wait was 136 days; in Denver and Portland, Ore., waits were as long as 128 days; and in Boston, 120 days.

In orthopedic surgery, the faux patient wait times exceeded two weeks in nine of the 15 metropolitan areas surveyed, even though research callers reported pain. Waits exceeded three weeks in three areas: Boston, Los Angeles and Denver.

The Texas researchers concluded that many specialists were busy, but they criticized the answering machines many offices employ that direct callers seeking appointments to leave a message. In many instances, they said, no one called back after two or more tries.

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