By George W. Chapman
Per a survey of more than 1,400 physician offices by AMN Healthcare recruiters, the average time until your appointment has increased 48% in the last 20 years. It has increased 20% in just the last three years. In 15 major metro areas, the average wait for an appointment is a full month. Average wait times vary by location and specialty. But the overall trend is national. For cardiology, the average wait time is 33 days. Family medicine is 24 days. Orthopedics is actually down to 12 days. Boston has the longest average wait of 65 days, while Atlanta has the shortest at 12 days. In Portland, Oregon, you will wait 291 days for a dermatology appointment. In Detroit you will wait 208 days for a gastroenterology appointment. (Critics of Canada’s universal healthcare system are quick to cite their waiting times.) Our physician and nurse shortages are having an obvious deleterious effect. Shorter wait times can be an indication of a surplus of docs in a specialty while longer wait times can indicate a dearth of physicians. The maldistribution of physicians is just another indication of our catch-as-catch-can healthcare.
Uncompensated Care Increasing
Hospitals and healthcare systems have seen charity care and bad debt jump 20% in just the last two years, placing them near their breaking point. Raising eligibility requirements for Medicaid and decreasing Medicare benefits will only add to the burden of uncompensated care and bad debt. Hospitals, healthcare systems and physicians are all facing increased costs for medical supplies, drugs and equipment due to tariffs. Profitability margins are at or below 1%. Healthcare providers do not have the option, like any other business, of raising prices as their reimbursement is either set by Medicare and Medicare or negotiated with their numerous commercial payers. Third party payers are increasingly less empathetic in order to protect their bottom lines. An insurance company going out of business is certainly less calamitous than a hospital closing. When people lose their insurance, they rarely seek care until it’s an emergency which puts undue pressure on emergency rooms and bad debt.
Physician Shortage and Flight
Our current administration in Washington is threatening to revoke the visas of foreign students which could also include medical students. If so, this will only exacerbate our physician supply problem. Foreign born U.S. medical school grads who have opted to remain here, have significantly contributed to our supply of physicians. To revoke their visas would only accelerate the projected shortage crisis. However, the very recent phenomenon of American-born and trained physicians migrating to nearby Canada further exacerbates our problem. Mixed messaging from Washington, the increased suspicion of scientists and researchers and the appointment of non clinical hacks to head the CDC, NIH and HHS are among the main reasons cited by physicians wanting to leave the U.S. American docs are creating accounts on “phyciansupply.ca” (ca as in Canada) highlighting their specialty and educational background. In just the first four months since our election, the number of accounts on physiciansupply.ca has surged from 70 to 750 and it’s still early. Working in an actual healthcare “system” is also cited by frustrated physicians seeking employment in Canada even for less compensation.
MAHA
MAHA, led by Secretary Kennedy, (neither a scientist, researcher nor physician), released a “study” that cited numerous fictitious resources and studies. The White House brushed off the errors in the study as mere “formatting issues.” What, wrong font? To make matters worse, anti-science Kennedy has proclaimed, without evidence, that the highly esteemed publications New England Journal of Medicine, Journal of American Medical Assn, and Lancet are “corrupt” because they only publish studies “funded and approved by” pharmaceutical companies. So, Kennedy is suspicious of research funded by pharmaceutical companies, but at the same time has drastically slashed government funded research from the NIH and CDC to universities. And what are physicians looking to Canada again?
Billing Nightmare
There are innumerable examples of our fragmented, confusing and frustrating healthcare “system” where it seems it’s literally every man for himself. “John,” 62, was visiting South Dakota from his home in Florida when he experienced a heart attack. That turned out to be the least of his problems. John was insured by Sunshine Health, one of Florida’s Medicaid programs. He received excellent treatment at Monument Health in Rapid City. After a two-day stay, John received a bill for more than $77,000. Although covered by Sunshine insurance, Monument claimed they didn’t participate in Medicaid plans that weren’t in contiguous states to South Dakota. So, pay up. (There is no federal law requiring Monument to do so.) John then submitted his bill to Sunshine. They said they could only accept bills directly submitted by the provider or Monument in this case. It’s surprising John did not suffer a second heart attack. Monument, looking to be paid, threatened to send the bill to a collection agency. John resorted to taking his dilemma to the press. Miraculously, once this went viral, Monument lowered the bill to $0. In fairness to both Monument and Sunshine, this lack of coordination and confusion among thousands of providers and hundreds of insurers occurs every day. All of this would be avoided by a universal plan.
Surprise! Customer Satisfaction Is Down
Well, if you’ve read this far, you’re not surprised. Per a survey conducted by national firm J.D. Powers, customer satisfaction with their insurance plan (not providers) is at an all-time low. The average satisfaction score of a commercial health insurance plan is 563 out of 1,000. Twenty percent of employers admit they switch plans based on poor employee satisfaction. (I have always felt bad for people in HR.) Service and communication are the top indicators of plan performance. The Kaiser Plan in California was rated highest by their customers. Not one plan in NYS made the top 10.
George W. Chapman is a retired healthcare business consultant who worked exclusively with physicians, hospitals and healthcare organizations. He used to operate GW Chapman Consulting based in Syracuse.