Where did all the medical appointments go?

Long before the stethoscope comes out, patients say their stamina is tested by whether they can steer themselves onto the doctor's schedule and into an exam room.

Patients who were new to a medical practice waited an average of 26 days nationwide to see a physician in 2022, up from about 24 days in 2017 and 21 days in 2004, according to the staffing firm AMN Healthcare and its physician recruiting division, Merritt Hawkins, which publishes surveys on access to medical care in metro areas. The researchers called to request appointments with physicians for non-emergency issues but didn’t extensively explore online scheduling tools, the survey noted. 

Appointments tended to be easier to secure in New York City than the 14 other metropolitan areas included in the survey. But researchers reported a huge range in waiting times. Patients in the city may have been able to see a cardiologist in two days or need to wait 206 days, according to the analysis. Meeting with a dermatologist could have happened in just five days — or 158 days. The city had the lowest rate of acceptance of Medicare, the government-run insurance program that primarily serves seniors, and a relatively small number of providers accepting Medicaid, the government-administered program for low-income households. 

The struggle to schedule appointments can feel just as acute on Long Island, medical providers and health economists said. They weren't aware of data focused on the Nassau-Suffolk region, and none of the major health systems on Long Island would share average wait times with Newsday.

Health systems don't want to advertise that it may take longer to get care with them than with a competitor, said Dr. David Podwall, president of the Nassau County Medical Society, a trade group for doctors. 

His Lake Success practice, Neurological Associates of Long Island PC, created a waitlist while reopening after being shut during the early days of the pandemic, Podwall said. He thought his team would work through the backlog within six months or so, but he no longer believes that's possible. 

“Our waiting lists are well into the summer at this point,” he said. “Anyone can tell you: You call one of these larger hospitals  … they're very good, but you get put on a waiting list. It's just very hard to get in.”

Newsday asked doctors, economists and patient advocates why securing a medical appointment has become so difficult, and what people can do about it. Here's what they had to say: 

How bad is it? 

It's hard to quantify how wait times have changed on the Island, but plunging Medicaid and Medicare acceptance rates nearby raise concerns, said Martine Hackett, chair of population health and director of public health programs at Hofstra University. About a dozen years ago, all the New York City cardiologists surveyed by Merritt Hawkins accepted Medicaid; as of 2022, 38% did. In 2009, 79% of family medicine practices took Medicaid; that fell to 50% in 2022, according to the survey.

Many clinicians in the city also turned away Medicare patients. Just 55% of dermatologists surveyed accepted the insurance, along with 50% of orthopedic surgeons and 27% of obstetric gynecologists, the survey noted.

Doctors tend to drop these insurance plans first because they pay lower rates and can present compensation challenges, Hackett said. The survey suggests that the pool of patients is vast enough that practices can fill their rosters with those who have preferred insurance plans, she said.

Many people hold fast to traditional advice about routinely seeing one — or a few — specific doctors. Physicians share this vision, but the setup is becoming illusive in an industry that has undergone immense change in recent years, Hackett said.

“This is not sustainable. You see this in the data, but you also see this in the sort of calling-out-into-the-wind from physicians who are like: We want it to be like it was,” Hackett said.

For years, surveys have captured high levels of stress and burnout among physicians. By one account, more than half of physicians have considered leaving the industry or no longer seeing patients, according to a survey published in 2024 by Athenahealth, which sells software to groups in the health industry.

Nearly one-fifth of physicians nationwide are 65 or older and likely to leave the clinical workforce within a decade, according to a 2024 report from the Association of American Medical Colleges, a consortium of medical educators. The strain of working during the pandemic has already pushed many to retire earlier than they may have, according to Podwall.

What's changed?

Demand for health care is growing, and the process for providing it has grown more demanding, experts say.

Over the past decade, more people have enrolled in insurance plans and sought a wider array of treatments because of the Affordable Care Act and policies that expanded the reach of Medicaid, Hackett said. A greater share of Americans are aging, and older people tend to need more care. But the volume of licensed doctors hasn't kept pace, experts said.

The mismatch was exacerbated when a crush of people rushed to get appointments after putting off elective care during the pandemic.

Medical record-keeping rules and insurance paperwork has cut into time for clinical care. Research shows doctors in multiple specialties are strained by bureaucratic obligations, and a 2022 analysis found that primary care doctors would need to work 26.7 hours a day to meet national standards for an average caseload.

Consolidation could be another contributing factor, according to John Rizzo, a family population and preventive medicine professor at Stony Brook University. Self-employed doctors see an average of 12% more patients than those who work for other organizations, according to Merritt Hawkins.

Scheduling can become harder if 12 doctors suddenly rely on one receptionist, when they used to work for three offices that each had an administrative assistant, Rizzo noted.

“Now you're a big bureaucracy,” he said. “It could lead to bottlenecks and less efficiency.”

What's distinct about Long Island?

Physician shortages are a concern in many parts of the country, but recruiting in a high-cost environment like Long Island is particularly challenging, doctors said. Many people leave medical school with student loan debt and want to live in areas where their salary will go further.

The cost of medical malpractice insurance is particularly high in New York, which diminishes how much medical organizations can pay new hires and deters those looking to open their own practice, regional health leaders said.

“While we provide excellent training sites for residents, many do not stay here,” Suffolk County Medical Society president Dr. Leslie Marino wrote in an email. “This is only projected to worsen in the future as the population continues to grow and physicians continue to leave the workforce and the state.”

Which doctors are hardest to see?

National wait times were most pronounced for dermatologists, obstetrics and gynecologists, according to the Merritt Hawkins survey. However, that research only examined five medical disciplines.

Primary care is expected to become less accessible, experts say. More medical students are choosing to train in other specialties or work in hospitals — roles that tend to pay more than working as a family doctor, pediatrician or internist. Within a decade, the nation is expected to have a shortage of 17,800 to 48,000 primary care physicians, according to research from Northwell's Institute of Health System Science at the Feinstein Institutes.

Are insurance companies contributing to the problem?

The physician shortage is beyond the control of insurers, experts said.

But researchers also lack insight into how narrow insurers' medical networks have become, and whether small networks are making it more difficult for patients to find a provider, said Elisabeth Benjamin, vice president of health initiatives at Community Service Society of New York, a social service provider and public policy group based in New York City.

Depending on their structure, health plans may fall under network standards put forward by federal or state agencies. In many cases, the rules are fairly lax, Benjamin said. For instance, plans regulated by the state only need to have agreements with one hospital and three primary care doctors per county.

“Anybody can pass. A grade schooler can put together an insurance carrier,” she said.

Health Care for All New York, a coalition pushing for affordable, quality health coverage, wants the state to release broad descriptions of health plans' network size — something that would put plans in categories like small, medium and large, Benjamin said.  

“How many times do people say: Well, which one has the most doctors? Which one has the most hospitals?” she said. “We don't know. They won't tell us. It's a state secret.”

The New York Health Plan Association, which represents insurers, said its members work hard to develop robust networks that "far exceed" the state's minimum requirements, senior vice president Leslie Moran said. 

State regulators regularly review health plans' list of providers and require them to have a process for requesting that services be provided by out-of-network clinicians if the treatment isn't available within the network, the state departments of Health and Financial Services said. 

The U.S. Centers for Medicare & Medicaid Services said it has taken several steps to ensure the insurance programs promptly serve patients. 

The federal Department of Labor, which oversees many union-sponsored plans and some plans offered by employers, didn't respond to Newsday's questions.

What can speed things up?

People seeking primary care can get a list of doctors from their insurance company or research who takes their plan using the state’s provider lookup tool at pndslookup.health.ny.gov.

New Yorkers with Medicaid may want to find federally-qualified health centers, which are designed for Medicaid patients, Hackett said. People can look up center locations at findahealthcenter.hrsa.gov.

Urgent care centers may be able to handle more routine primary care concerns such as back pain, sprained ankles, colds or sore throats, Rizzo said. Telehealth appointments can quickly address issues that don’t require physical inspections, such as getting assessed for medications or conducting follow-ups, experts said. 

Traditionally, primary care offices have directed patients to specialist, who often require a referral, said Rizzo.

People may also be able to get appointments more quickly if they see non-physician providers like nurse practitioners or midwives instead of OB-GYNs, Hackett said. 

For all types of treatment, patients can advocate for themselves by calling around and seeing which practices have openings. Many offices have waitlists, which can come in handy. Many doctors will expedite care if a primary care or specialist physician calls and underscores how critical the situation is, Podwall said.

“That makes a huge difference,” he said. “Physicians want to help out our fellow physicians if we feel that they have someone who needs emergent care.”

Can my insurer help?

Health plans should be able to help patients get appointments, Benjamin said.

Insurance companies must work out arrangements for patients to see someone outside their commercial network if none of their contracted clinicians can help, Benjamin said. For many health plans, there aren't rules about how long insurers can ask patients to wait before covering care outside their network. Regulators are starting to draft and implement such standards, which are detailed in the sidebar.

If health plans aren't able to help, people can file a complaint with their insurer or reach out to the Community Service Society. The group's Community Health Advocates program helps people sort through insurance, billing and other concerns, and can be reached at 888-614-5400 or cha@cssny.org.

By Sarina Trangle

sarina.trangle@newsday.com@SarinaTrangle

Sarina Trangle covers affordability and cost of living issues and other business topics. She previously worked as an editor and reporter at amNewYork.