Office Wait Times to Worsen in California

January 22, 2010 in Health Policy by RangelMD

Everyone has had this problem. You try to get an appointment to see your doctor but the first opening is weeks or even months away. This is acceptable if all you need is a blood pressure check and medication refills, but what if you are acutely ill? The California legislature was so concerned about this that they did what most legislatures are good at doing. They decided to disregard the complex causes of this problem and instead chose the brute force legislative approach of mandating minimum wait times for HMO enrolled patients to get a doctor’s appointment.

A new California regulation that takes effect [in January 2011] could prevent [long wait times] by requiring health maintenance organizations’ primary care doctors to see patients within two days for urgent needs and within 10 days for less pressing woes.

Not too surprising is the fact that very little time appears to have been spent on the root causes for this problem.

“The lack of timely access is a symptom of larger problems in the health system. It could be the shortage of providers. It could be that we’re not paying enough for certain types of doctors. Maybe there’s over-utilization,” said Anthony Wright, executive director of Health Access California.


In 2008, only 2% of medical school students had plans to enter primary care in internal medicine. This figure was 9% in 1990. The number of US medical students going into primary care (internal medicine, family practice, and pediatrics) fell by 51% since 1997.  Why? Anesthesiologists attend 4 years of post doctoral training and earn an average of $275,000 per year. Primary care internists attend 3 years of post doctoral training and earn an average of $135,000. Reimbursement rates for primary care office visits have been gradually eroded for years while Medicare and most private insurances have spent money on specialists, advanced imaging, and advanced procedures like a drunken sailor in a Tijuana whorehouse.

Many of these problems are way too big for one state to tackle but the legislature could have been much more pragmatic and rational and passed a law that mandated minimum staffing ratios and pay-scales for physicians employed by HMOs. However, this type of legislating would have required large gonads. It would also have put the financial burden on the HMOs. The fact that the current legislation has been given approval by both the the HMO industry group The California Association of Health Plans AND various patient and consumer advocacy groups is an indication of what a watered down piece of crap it is. Both sides got something. The HMOs avoided the expense of an unfunded mandate and the advocacy groups got mandatory minimum wait times. Too bad everybody else got screwed. Typical politics.

From the HMO’s perspective, appointment wait times can easily be reduced by double and triple booking patients into their already overworked physician’s schedules. After all, the legislation didn’t say anything about wait times while already at the doctor’s office. If you leave to go to the ER after waiting 4-5 hours to have your broken foot treated, the HMO is still in compliance since you were able to get that appointment within the minimum time. And massively overworked and underpaid physicians are going to start to leave for more humane conditions which will worsen the situation for those left behind and so on and so forth.

This is a good example of what happens when government-can-fix-anything liberal consumer advocacy groups get masterfully duped by much better paid industry lawyers and lobbyists.  It’s not that mandatory minimum wait times are a bad thing. It’s just that you might want to wait the extra time and put forth the extra effort to draft real reform legislation instead of settling for the quick and dirty version that will do nothing more than teach everyone about the law of unintended consequences. I hope that someone in Washington is listening.

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