Despite Bostons reputation as a medical powerhouse awash in specialists, patients cant get in to see them at least not quickly.
The Texas-based consulting ﬁrm Merritt, Hawkins & Associates surveyed 1,062 physician specialists ofﬁces in 15 major cities and found Boston patients wait longest for appointments. The study, released this week, found that new patients in Boston wait an average 37 days to see a cardiologist, 45 days to see an obstetrician-gynecologist, and 50 days to see a dermatologist the longest waits of the 15 cities. Patients schedule appointments with an orthopedic surgeon in Boston 24 days in advance on average, the second longest delay after Los Angeles, where patients wait 43 days.
Overall, the survey said, Boston has the longest waits while patients in Washington, D.C., can see doctors the fastest, within 8 to 15 days. Since the numbers are averages, some cardiologists in Boston, for example, had four-month waits, while others could see patients in as soon as seven days.
The survey did not address whether the delays harm patients, or why certain cities are worse than others. But executives at Merritt, Hawkins, which recruits staff for hospitals and doctors ofﬁces, and health-care specialists pointed to several possible reasons for delays in Boston and other cities, including shortages of specialists as older doctors cut back on hours or retire. Patients also may be demanding more appointments, now that managed care insurers have loosened restrictions on access to specialists.
Frankly, Im at a loss to explain it, said Paul Ginsburg, president of The Center for Studying Health System Change, a nonproﬁt research organization based in Washington, D.C. Boston is a great place to practice. But this is a longstanding pattern. Obviously there seems to be some kind of shortage.
The surveyors randomly called doctors who practice privately or are afﬁliated with hospitals in the city and surrounding suburbs, posing as new patients and requesting appointments for nonurgent problems. They called cardiologists to request heart checkups and dermatologists to ask for routine screening for skin cancer. They complained of knee pain or knee injury when calling the orthopedic surgeons, and requested routine gynecological exams.
They not only uncovered long waits, but also discovered that patients may ﬁnd it hard to reach a live person. Many physicians ofﬁces had answering machines directing callers seeking appointments to leave messages. In many cases ofﬁce staff did not call back even after the researcher left two or more messages.
They also asked ofﬁce staff whether the doctors treat patients with Medicaid, the federal-state program that helps pay for health care for the needy. There was a wide range of responses, with 100 percent of Portland, Ore., doctors in all four specialties accepting Medicaid patients to a low in New York City, where fewer than 10 percent of doctors took Medicaid. In Boston, 11 percent of cardiologists, 17 percent of dermatologists, 56 percent of obstetriciansgynecologists, and 88 percent of orthopedic surgeons said they accept Medicaid patients.
Ginsburgs group also found delays for patients trying to see all types of doctors in three surveys it conducted in 1997, 1999, and 2001. In Boston, 54 percent of patients with Medicare, the federal insurance program for the elderly, said they waited more than three weeks for a checkup and 70 percent waited more than a week for an illness some of the longest waits in the 12 communities his group studied.
Even so, Massachusetts is second only to Washington, D.C., in terms of the number of doctors per 100,000 residents. The state has 356 doctors both specialists and primary care who treat patients 20 hours or more a week for every 100,000 residents. That compares to 234 doctors per 100,000 people nationally in 2002, according to the most recent data from the American Medical Association.
So why the long waits?
The Massachusetts Medical Society argues that in recent years physicians have begun ﬂeeing the state or refusing to come because of relatively low fees and high malpractice premiums and cost of living.
But Dr. Barbara Gilchrest, chief of dermatology at Boston Medical Center, said there may be another reason: Many of Bostons doctors work in academic medical centers, where they also conduct research and teach medical students, leaving less time for patient care. While the AMA measures the number of doctors who treat patients at least 20 hours a week, it lumps together doctors who see patients 20 hours a week and those who see patients for 40 or 50 hours.
The 14 dermatologists in her department, for example, see patients anywhere from a half-day to 3½ days a week. Someone may be listed as a dermatologist, but actually see patients a small fraction of the time, she said.
Because of the horrendous waits in the city, she said, Boston Medicals ambulatory care center now requires dermatology patients to conﬁrm appointments within 48 hours or the center will give away the slot to someone else. As a result, the centers wait is very short, because many patients are getting unconﬁrmed, freed-up slots. At other hospital practices, though, the wait can be up to four weeks for a new patient.
This problem is under study nationally, Gilchrest said. Dermatologists may be spending more time doing cosmetic procedures, which pay better and are interesting, taking themselves out of treatment of the usual acne, warts, and psoriasis.
Dr. Richard Marshall, chief medical ofﬁcer at Harvard Vanguard Medical Associates, the large physicians group, said patients can wait two months for a routine dermatology appointment. But, he said, Harvard Vanguard has installed a computer alert that notiﬁes primary care doctors when
their patients have not been scheduled with a dermatologist in the time frame requested. The doctor then calls the dermatologist directly and asks them to squeeze in the patient.
We ﬁnd that wait times are tricky to measure, said Daniel Ginsburg, president of the Massachusetts General Physicians Organization. If you call with something urgent, doctors ﬁgure out how to ﬁt you in tomorrow or today. Gyn visits or annual physicals usually get scheduled quite a ways out. But if I had a pain in my knee, 24 days would seem like a long time.
Liz Kowalczyk can be reached at firstname.lastname@example.org.