Alexis Blount is a doctoral student at Saybrook’s School of Mind-Body Medicine. She is also a family nurse practitioner providing care coordination and integrated health services at the University of Maryland Medical Center, Baltimore, Maryland.
Much of my day is spent on the phone. I have become really good at using the speaker function while I write notes, read lab results, or answer emails. I listen to recorded voices that apologize for keeping me waiting and promise me excellent customer service, or that tell me about Hospital A’s new robotic surgery or women’s cancer center. I don’t need robotic surgery; I just need someone to answer the phone.
This is the third pulmonologist’s office I am calling to make an appointment for my patient Amanda whom I introduced you to in my last post. I have gone through a doctor’s office that never called me back, one that no longer sees new patients, and one whose listed phone number on the referral is incorrect. After several tries I am able to make her an appointment in two months time. I have a similar experience when I help her with a gastrointestinal referral; none of the attending physicians are seeing new patients, I am able to get her an appointment with a nurse practitioner in four weeks time.
A recent survey by the consulting firm Merritt Hawkins showed that wait time for a physician appointment is increasing throughout the United States. Fourteen hundred medical practices throughout the country were surveyed. Patients wait an average of 18 days to get an appointment with a physician. Boston, Massachusetts, an area with many physicians per capita, has the longest wait time in the country. Patients there wait 45.5 days to schedule an appointment with a family physician, obstetrician/gynecologist, or some specialists such as a dermatologist. Massachusetts has had a form of health care coverage that was the model for the Affordable Care Act.
Lest we blame “socialized medicine” for this situation, a New York Times analysis piece by Elizabeth Rosenthal on July 5, 2014, pointed out that some countries with national health systems have shorter wait times than the U.S. In the United States it can take longer for your asthma to be evaluated than for you to get a new knee replacement. The opposite is true in other countries whose systems emphasize preventative, primary care.
A projected physician shortage combined with increased access to care under the Affordable Care Act is going to make the situation worse before it gets better. The Association of American Medical Colleges commissioned IHS Inc. to study this issue. IHS projects that by 2025 there will be a shortage of 46,000-90,000 physicians, even after accounting for increased use of nurse practitioners and physician assistants, greater expansion of alternative settings such as retail health care, and delayed physician retirement.
It is clear that a re-imagining of our health care system is in order. For the chronic conditions that our patients face we need to ask the question, do we need more medical care or do we need care that is focused on health and wellness? Is the physician the best person to provide that care or do we need providers with other, integrative skills, such as health coaches, massage therapists, nutritionists, and advanced practice nurses?
In the meantime, it looks like I am going to be on hold for a long time. (Alexis Blount)