Richard Payerchin

Family physicians are getting patients in for appointments more quickly, which may indicate people are using other sources for their gateway to health care.

Meanwhile, family medicine was the only one among five specialties to show an overall decrease in patient wait times since 2017. Average wait times are growing for nonemergency consultations in cardiology, dermatology, obstetrics-gynecology, and orthopedic surgery.

 were part of the “2022 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates,” published this month by physician recruiting firm Merritt Hawkins. The study from spring 2022 examined wait times for nonemergent conditions among 1,034 physician offices with five specialties in 15 major cities across the United States.

Overall, the average wait time for a physician appointment in 2022 is 26 days, up from 24.1 days in 2017, the most recent year the survey was conducted, and up from 21 days in 2004, the survey’s first year.

There were 222 family physician practices included among the study. It found an average time to appointment of 20.6 days, down from 29.3 days in 2017, and up from 19.5 days in 2013 and 20.3 days in 2009. The average shortest time to appointment was 1.8 days, and 74.7 days was the average of longest time to appointment.

Patients in Washington, D.C., enjoyed the shortest average time to an appointment, eight days, while those in Portland, Oregon, had the longest average wait time at 44 days.

Portland also had the longest, shortest time to an appointment, at seven days, while Boston had the longest, longest time to an appointment, at 136 days. At least a dozen cities – Boston, Seattle, Denver, San Diego, Dallas, Atlanta, Detroit, Los Angeles, Houston, Miami, New York, and Washington, D.C. – had at least one family physician able to get patients an appointment with just a one-day wait time.

The findings about family medicine might sound like good news for patients seeking care. But it also indicates “a major shift in how patients access primary care that has taken place over the last several years,” Tom Florence, president of AMN Healthcare physician search division, said in a 

“The number of urgent care centers and retail clinics is exploding, creating a new front door to the healthcare system,” Tom Florence, president of AMN Healthcare physician search division, said in a news release. “As a result, accessing a family physician, while still challenging, can be less difficult.”

Those venues often are staffed by nurse practitioners (NPs) and physician assistants (PAs). The study cited a November 2018 report from the Health Care Cost Institute (HCCI), which found 

While demand for primary care physicians remains “robust,” 

 has surpassed it in the last two years, according to Merritt Hawkins recruiting data.

“As NPs and PAs take on a greater percentage of primary care appointments, appointment times for family physicians may continue to decline,” the Merritt Hawkins study said.

Fewer adult patients have no primary care physician, the study said. That included 45% of people aged 18 to 29 years, 29% of people aged 30 to 49 years, and 18% of people aged 50 to 64 years, according to the HCCI figures. 

 in drawing patients away from primary care physicians, Florence said.

The study said Merritt Hawkins aimed to replicate the experience of someone new to a community seeking to schedule a nonemergency physician appointment through a general accessible source, such as the Internet.

Overall, the figures support a possible shortage of physicians across the United States, Florence said, and the report examined factors such as a growing, aging population in ill health, an aging population of physicians, burnout and limited numbers of new physicians.

For the other specialties, the report said:

The average wait time to see an obstetrician-gynecologist is 31.4 days, up from 26.4 days in 2017, a 19% increase. Average wait times ranged from a high of 59 days in Philadelphia to a low of 19 days in New York.

The average wait time so see a dermatologist is 34.5 days, up from 32.3 days in 2017, a 7% increase. Average wait times ranged from a high of 72 days in Minneapolis to a low of nine days in Philadelphia.

The average wait time to see a cardiologist is 26.6 days, up from 21.1 days in 2017, a 26% increase. Average wait times ranged from a high of 49 days in Portland, Oregon to a low of 13 days in Dallas.

The average wait time to see an orthopedic surgeon is 16.9 days, up from 11.4 days in 2017, a 48% increase. Average wait times ranged from a high of 55 days in San Diego to a low of 5 days in Washington, D.C.

This article was published by our sister publication Medical Economics.

Articles

Study examines how long it takes to see a physician across United States.

Appointment wait times drop for family physicians, indicating shift in care

The U.S. Centers for Disease Control and Prevention (CDC) have recommended using 

 to stem a projected fall surge of the disease.

CDC’s Advisory Committee on Immunization Practices (ACIP) met Sept. 1 to consider using the bivalent vaccines from 

 to fight the virus’ omicron BA.4 and BA.5 variants. The vaccines aim “to restore protection that has waned since previous vaccination by targeting variants that are more transmissible and immune-evading,” the centers’ announcement said.

“The updated COVID-19 boosters are formulated to better protect against the most recently circulating COVID-19 variant,” CDC Director Rochelle P. Walensky, MD, MPH, said in a news release. “They can help restore protection that has waned since previous vaccination and were designed to provide broader protection against newer variants. This recommendation followed a comprehensive scientific evaluation and robust scientific discussion. If you are eligible, there is no bad time to get your COVID-19 booster and I strongly encourage you to receive it.”

The Pfizer-BioNTech bivalent boosters may be used for people aged 12 years and older. The Moderna bivalent boosters are recommended for people aged 18 years and older.

CDC announced in the coming weeks the health experts expect to recommend updated COVID-19 boosters for other pediatric groups, per the discussion and evaluation of the data by ACIP on Sept. 1, 2022.

“When data are available and FDA authorizes these other types of COVID-19 boosters, CDC will quickly move to help make them available in the United States,” the centers’ announcement said.

The move came a day after the U.S. Food and Drug Administration (FDA) announced 

 for the vaccines. FDA Commissioner Robert M. Califf, MD, encouraged anyone who qualifies to get a booster for the fall season, at least two months after finishing their initial vaccine cycle or after one or two previous boosters.

From December 2020 to December 2021, vaccinations are estimated to have prevented 13.7 million to 15.9 million deaths across 185 countries, an estimated 63% reduction in total COVID-19 deaths globally, according to 

The American Medical Association (AMA) also has published 

AMA Board Chair Sandra Adamson Fryhofer, MD, issued a statement noting the omicron variant is “highly transmissible,” but that the updated bivalent booster dose could prevent more than 100,000 hospitalizations, compared to a later rollout of the shots.

“We continue to strongly urge everyone to stay up to date on their COVID-19 vaccines, including recommended booster doses, to protect themselves and their loved ones from severe complications, hospitalization, and death,” Fryhofer said in the statement. “Anyone with questions about the vaccines should speak with their physician and review trusted resources, including 

The website is maintained by the COVID Collaborative, a group of businesses and organizations including CDC, AMA, and the Ad Council.

Move comes after FDA give emergency use authorization for bivalent vaccines.

CDC recommends updated COVID-19 boosters ahead of possible fall surge

Federal health leaders hope physicians will join the chorus advocating for people to get COVID-19 booster shots to protect against a possible fall surge of the virus.

U.S. Food and Drug Administration (FDA) on Aug. 31 amended its emergency use authorizations for bivalent COVID-19 vaccines by 

 for use as booster doses for people at least two months after their primary or booster vaccinations. The bivalent vaccines contain two messenger RNA (mRNA) components, one to fight the omicron variants BA.4 and BA.5 joined with the original strain of SARS-CoV-2.

 is waning, but models predict another peaking around Dec. 1, when people are spending more time indoors, FDA Commissioner Robert M. Califf, MD, told reporters in an online press conference held Aug. 31. He was joined by Peter Marks, MD, PhD, FDA’s director biologics evaluation and research.

“I want to make clear that these updated boosters present us with an opportunity to get ahead of the next predicated wave of COVID-19,” Califf said. “These updated boosters are critical in helping protect teens and adults from the most serious outcomes of COVID-19 caused by the currently circulating variant.”

 from birth dropped again in 2021, to an average of 76.1 years, with COVID-19 and the opioid epidemic major factors. Citing the U.S. Centers for Disease Control and Prevention, Califf said data show people up to date on their COVID-19 vaccines have lower risk of death.

“As a clinician then I urge all individuals to consider receiving a booster and encourage other practitioners to speak to their patients about the importance of these boosters,” he said.

Reporters’ questions dealt largely with recommendations on timing and the available evidence, or paucity of it, for what FDA is calling the “updated boosters.”

 of the booster authorizations included data supporting the EUAs. In the online discussion, Califf bristled at the suggestion the regulators relied only on animal studies to revise the EUAs.

Several factors make the public health experts “highly confident” in the EUAs, Marks said.

FDA and other researchers have a lot of clinical experience with mRNA vaccines since the original vaccines have been given to more than 200 million people in the United States.

The new bivalent vaccines with the EUA, are “quite similar” to the vaccine combining the original virus strain’s mRNA with mRNA from the BA.1 omicron variant, and studied by the manufacturers.

Data exists from nonclinical studies of the vaccines with the new EUAs.

FDA researchers have extensive past experience with strain changes made without clinical studies, in making annual strain changes for influenza vaccines.

It’s fair for people to raise questions, Califf said, but the EUAs represent “the best consensus that we have among the experts.”

“It’s just painful to see people dying unnecessarily when there’s a free treatment that would prevent their death and you know, as a cardiologist in my career, I spent my career trying to save lives,” Califf said. “This is much more clear than anything I’ve ever seen.”

Apart from details about the new vaccines, Califf and Marks emphasized the importance of getting vaccinated or boosted.

For the updated boosters, data on effects in children are expected in coming months, Marks said. Some critics say the latest vaccination campaign should focus on older adults most at risk, he said.

But long COVID is real and it affects millions of people, including those in their 20s and 30s, Marks said. Califf noted when he was young, he felt invincible like other young people may feel.

“And again, I’d emphasize we’re not talking about trivial things here,” Califf said. “We’re talking about prevention of death and hospitalization as an outcome. It’s just me but I’ll also tell you I’m turning 71 next month, I will be at the front of the line at the pharmacy getting my vaccination. I’m very confident about this.”

The Moderna COVID-19 vaccine, bivalent, is authorized for use as a single booster dose in individuals 18 years of age and older. The Pfizer-BioNTech COVID-19 vaccine, bivalent, is authorized for use as a single booster dose in individuals 12 years of age and older.

With the approval, the monovalent mRNA COVID-19 vaccines are no longer authorized as booster doses for those aged aged 18 years and older for the Moderna shots and for people aged 12 years and older for the Pfizer-BioNTech vaccine. But they will remain in use as the primary vaccines for anyone aged 6 months or older, and the Pfizer-BioNTech vaccine remains authorized for a single booster dose for patients 5 through 11 years of age, at least five months after completing a primary series with the Pfizer-BioNTech COVID-19 vaccine.

Latest emergency use authorizations for Moderna, Pfizer-BioNTech vaccines.

FDA approves ‘updated boosters’ to fight COVID-19 omicron variants

Medical and insurance organizations generally reacted favorably to the Senate’s Aug. 7 approval of the 

This week, the House of Representatives is expected to begin deliberating on the law, which has at least three national-level effects on health care:

Medicare will be allowed to negotiate drug prices.

Seniors’ out-of-pocket spending on prescription drugs will be capped at $2,000.

Subsidies will continue for patients purchasing health insurance through the Affordable Care Act Marketplace.

The American College of Physicians (ACP) praised the legislation to improve access to health care and improve health for all Americans, President Ryan, D Mire, MD, FACP, said in a 

“We are glad to see that the final version of the legislation still includes many of the important provisions that we 

 when the agreement was announced,” Mire said. “Subsidies for health insurance plans under the Affordable Care Act will be extended for three additional years, Medicare will now be allowed to negotiate lower drug prices with manufacturers, and the legislation will help to reduce carbon pollution and advance clean energy solutions. We are also encouraged that the legislation will cap insulin costs for Medicare beneficiaries, allowing our senior patients to more easily afford this life-saving medication. We look forward to the House taking up the bill and call on them to swiftly pass it.”

The Association of American Medical Colleges (AAMC) said the legislation will invest $64 billion for the ACA insurance subsidies.

“As the COVID-19 pandemic has highlighted many disparities in access to coverage and care, we commend senators for agreeing on a bill that will allow patients and families to maintain access to affordable coverage, empowering them to seek care before treatable conditions become more complicated and costly,” AAMC President David J. Skorton, MD, said in a 

. “Additionally, the high cost of prescription drugs often prevents patients from obtaining the medications they need. We support efforts to lower drugs costs and increase access to affordable medications.”

Louise Norris, health policy analyst for consultant 

“This is excellent news for the 13 million Americans who rely on premium subsidies to make marketplace health coverage affordable. Larger and more widely available subsidies have led to record-high marketplace enrollment,” Norris said. “Without action from Congress, millions of people will likely see their subsidies decrease or disappear in 2023, and 3 million current enrollees might lose their coverage altogether. The Senate’s vote to pass this legislation is a step toward ensuring these hard working Americans will still be able to afford their health coverage next year, and we hope to see it pass quickly in the House.”

The Endocrine Society issued a statement praising the IRA for addressing high insulin costs. More than 7 million people rely on insulin to manage diabetes and live, and the U.S. Centers for Disease Control and Prevention logged 37.3 million people with diabetes – 11 % of the nation’s population.

Insulin nearly tripled in price from 2002 to 2013, with the upward trend continuing.

The Endocrine Society noted the Senate missed an important opportunity to also help children and adults with type 1 diabetes when 43 Republicans voted against including a provision that would have capped out-of-pocket costs for individuals with private insurance, that the society supported.

, President Joe Biden led with the potential health care benefits, noting the IRA will lower the costs of prescription drugs and health insurance, along with other provisions of the bill. Biden said he ran for the post “promising to make government work for working families again, and that is what this bill does – period.”

 the new law will have a negative effect on innovation in the pharmaceutical industry, which in turn will have consequences for health of Americans.

Using “savings” from drug price controls to cover ACA insurance “would lead to a massive loss of life, due to foregone medical innovation, and a reduction in the quality of care, due to the government gaining more control over people’s insurance coverage,” former White House economic adviser 

Medicare drug prices, insulin costs affected by Inflation Reduction Act.

Medical, insurance groups praise Senate action on health insurance

Monkeypox has been declared a public health emergency (PHE) in the United States.

U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced 

 Aug. 4 to “strengthen and accelerate the Biden-Harris administration’s response in recognition of the continued rapid transmission of monkeypox in the U.S. and globally, and to signal the seriousness and urgency with which the administration is responding.”

“Ending the monkeypox outbreak is a critical priority for the Biden-Harris Administration,” Becerra said in a news release. “We are taking our response to the next level by declaring a public health emergency.”

The same day, the U.S. case count reach 7,102 confirmed cases, according to the U.S. Centers for Disease Control and Prevention (CDC). More than 500 cases have been reported in New York, Georgia, Florida, Illinois, Texas and California, and just two states, Montana and Wyoming, have had no reported cases. Cities and states were quicker in their declarations than the federal government.

There were 26,864 confirmed cases in 88 countries around the world, with most of those in 81 countries that historically have not reported the disease. The World Health Organization on July 23 declared monkeypox to be a public health emergency of international concern.

 found some American believe it is a sexually transmitted disease. It is not, according to CDC, but can be spread through close, personal, often skin-to-skin contact, including sexual contact.

Along with the PHE declaration, the U.S. Food and Drug Administration (FDA) is working on new strategies to get vaccines to affected communities across the country, including a new dose-sparing approach that could increase up to five-fold the number of doses available, according to HHS.

As of Aug. 4, HHS announced it has shipped more than 602,000 doses of the Jynneos vaccine to states and jurisdictions, an increase of 266,000 in the past week. HHS has allocated 1.1 million doses to states and jurisdictions in total and is making more doses available as jurisdictions use their current supply. HHS has accelerated delivery of 150,000 additional doses to arrive in the U.S. next month instead of November.

So far, 51 jurisdictions have signed data use agreements to provide CDC with information related to vaccine administration. Declaring an emergency may provide the justification the remaining jurisdictions need to sign their agreements. The PHE provides authorities to the Centers for Medicare & Medicaid Services to collect testing and hospitalization data.

The developments came two days after the White House announced appointments of Robert Fenton, a regional administrator of the Federal Emergency Management Agency, as White House National Monkeypox Response Coordinator and Demetre Daskalakis, MD, MPH, director of HIV prevention for the Centers for Disease Control and Prevention (CDC), as White House National Monkeypox Response Deputy Coordinator.

“President Biden has called on us to explore every option on the table to combat the monkeypox outbreak and protect communities at risk,” Fenton said in the HHS announcement. “We are applying lessons learned from the battles we’ve fought – from COVID response to wildfires to measles, and will tackle this outbreak with the urgency this moment demands.”

White House ramps up efforts to fight outbreak.

HHS declares monkeypox a public health emergency in U.S.

Communication gaps remain open between primary care physicians and specialists who share patients, despite potential connections through improved electronic health records (EHR).

Lack of communication could affect a large number of patients across the country, according to a new study that examined connections between primary care physicians (PCPs) and specialists. “Communication Gaps Persist Between Primary Care and Specialist Physicians” was published in the 

A 2008 study “found sizeable gaps in communication among physicians caring for mutual patients,” with potential effects on patients, such as delayed diagnoses, unnecessary testing, and patient and physician dissatisfaction. With widespread use of EHR, it appeared physician communication might have improved since then, but things weren’t much better in 2019. Researchers examined responses from 4,754 PCPs who used the Comprehensive Primary Care Plus (CPC+) payment model through the federal Centers for Medicare & Medicaid Services, along with other data such as Medicare claims and enrollment.

“When you refer a patient to a specialist, how often do you send the specialist notification of the patient’s history and reason for the consultation?”

“How often to you receive useful information about your referred patients from specialist?”

Reply options were, “Always or most of the time,” “Sometimes,” and “Seldom or never.”

A total of 22% of PCPs reported they “sometimes” or “seldom or never” sent clinical information to specialists at the time of referral, and up to 35% reported they “sometimes” or “seldom or never” received information back from specialists after consultations, the study said. Physicians participating in the CPC+ survey were highly motivated with sophisticated EHR use, so “actual communication behaviors nationwide are likely worse than what we found,” the study said.

“Because these are physician-level proportions, the number of patients who are potentially affected is large,” the study said. “Further, the presence of any communication between providers does not guarantee that practitioners are sending or receiving the optimal information needed for clinical decision making.”

More communication measurement is needed because it is not enough to assume EHR systems will improve connections between physicians, the study said.