7 ms·

I've been experiencing this exact issue in the US. Lately a medical issue of mine has been getting worse, and the earliest I can see a new PCP is in May 2025. I

by plus 2y ago

I've been experiencing this exact issue in the US. Lately a medical issue of mine has been getting worse, and the earliest I can see a new PCP is in May 2025. I managed to get a referral to a specialist by visiting urgent care, but they referred me to a different specialist, and I won't be able to see the latter until late January 2025. Meanwhile my medical issue is continuing to get worse, and I have no one I can talk to about it. I'm looking into alternative options but things are looking bleak. I'm probably going to have to go out-of-network and drive 2 hours to find a doctor that has wait times on the order of weeks (as opposed to the in-network providers, that have wait times on the order of months).

Spooky23 2y ago
I had this issue due the consolidation of medical networks. Luckily I have a BlueCross PPO. So I’ll get fast access to a specialist in NYC in Boston then transfer the records back to the local dude if needed. My wife had an issue with a complication, and I found a doctor who was a contributor to a major study on it and we got treated by him. Epic makes managing this trivial. It’s the best of both worlds, but only if you have the privilege of legacy insurance and PTO.
JumpCrisscross 2y ago
> I won't be able to see the latter until late January 2025 Where are you? This is unusual. In America, the "average wait time for a [cardiologist, dermatologist, og/gyn, orthopedic surgery or family medicine] appointment for the 15 large metro markets surveyed in 2022 is 26.0 days" [1]. In Canada, the "median national wait time 1 was 78 days," with wait ime "defined as the period between a patient’s referral by a family physician to a specialist and the visit with said specialist" [2]. Broadly speaking, American medical wait times are quite good, particularly for specialists [3]. But PCPs/capita vary greatly from state to state [4]. [1] https://www.wsha.org/wp-content/uploads/mha2022waittimesurveyfinal.pdf https://www.wsha.org/wp-content/uploads/mha2022waittimesurve... [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC7292524/ https://pmc.ncbi.nlm.nih.gov/articles/PMC7292524/ [3] https://worldpopulationreview.com/country-rankings/health-care-wait-times-by-country https://worldpopulationreview.com/country-rankings/health-ca... [4] https://www.beckershospitalreview.com/rankings-and-ratings/states-ranked-by-total-primary-care-physicians-in-2024.html https://www.beckershospitalreview.com/rankings-and-ratings/s...
- lokar 2y ago
  IME (SoCal) the 1st visit can take 2-3 months. After that you can get back in with only a 2-3 week wait, shorter if it’s urgent. They seem to rate limit new patients so current patients can get in.
- strict9 2y ago
  OP is correct in my anecdotal experience. I live in a large urban area and wait time for PCP is several months out. Even longer for Women's health as I hear from my partner. I don't remember it being this bad in the past. Perhaps things have changed in the several years since those publications were published.
  - CharlieDigital 2y ago
    > I don't remember it being this bad in the past. Perhaps things have changed in the several years since those publications were published. There's an analogous pattern happening in clinical trials that I suspect is related: there has been a consolidation by private equity[0]. There are several reasons for this, but the gist of it is that pharmas have moved much of the actual work of running large clinical trials to contract research orgs (CROs) and the cost of recruiting patients for trials, training staff, records keeping, and administering the trial becomes out of reach for small independent sites where clinical trials are executed. It's also more efficient on the sponsor side to interface with one large entity rather than several small entities. I suspect that the increasing demands of technology and burden of records keeping in both clinical trials and health insurance makes it difficult for small independent sites to operate profitably. So what happens is that many small, independent offices end up joining a larger entity that can consolidate some of the "system level complexity" more efficiently. The tradeoff is that it's no longer about the doctor-patient relationship; it's about efficiency and profits. I also suspect that part of it is that PE realizes that consolidation lets them control prices. If they can control a network of trial sites, then they have more power to negotiate rates with sponsors and CROs for each patient they sign up to the trial. The bigger the network, the greater their leverage. I think this probably also holds true for healthcare and insurance providers in general. [0] https://www.fiercebiotech.com/cro/private-equity-invests-trial-sites-cro-consolidation-continues-pitchbook https://www.fiercebiotech.com/cro/private-equity-invests-tri...
nopinsight 2y ago
If you think it’s worth it, you can fly to a few places in East Asia or Southeast Asia where you can see a medical specialist in private hospitals on the same day, especially if arranged a couple of days in advance. These include Singapore, Thailand, Malaysia, Hong Kong, Taiwan, etc. The quality of care in these private hospitals is usually high as well. For some cases, the costs in more affordable locations among the above—even after including economy flights—could be cheaper than treatment in the US. https://chatgpt.com/share/e/671fb198-2a34-8011-a2e8-e0b4aa450535 https://chatgpt.com/share/e/671fb198-2a34-8011-a2e8-e0b4aa45...
- nateweiss 2y ago
  The city of Merida in Mexico might also be an option.
- nradov 2y ago
  Which metrics are you using to measure quality of care?
- 31carmichael 2y ago
  I visited an international hospital in Saigon to have a skin infection drained and cleaned and bandaged. I remember them charging me around $14. Strange, as surely the nurse used more than $14 in PPE and bandages. International hospitals in Singapore and Malaysia will be more normally priced, but still a small fraction of what you'd spend in USA.
31carmichael 2y ago
I live in Asia. I can see any specialist within the week, and if it is urgent, possibly that evening. I needed surgery once and they told me to come back at 6pm, the same day.

by plus 2y ago

Spooky23 2y ago

I had this issue due the consolidation of medical networks. Luckily I have a BlueCross PPO. So I’ll get fast access to a specialist in NYC in Boston then transfer the records back to the local dude if needed. My wife had an issue with a complication, and I found a doctor who was a contributor to a major study on it and we got treated by him. Epic makes managing this trivial. It’s the best of both worlds, but only if you have the privilege of legacy insurance and PTO.

JumpCrisscross 2y ago

> I won't be able to see the latter until late January 2025 Where are you? This is unusual. In America, the "average wait time for a [cardiologist, dermatologist, og/gyn, orthopedic surgery or family medicine] appointment for the 15 large metro markets surveyed in 2022 is 26.0 days" [1]. In Canada, the "median national wait time 1 was 78 days," with wait ime "defined as the period between a patient’s referral by a family physician to a specialist and the visit with said specialist" [2]. Broadly speaking, American medical wait times are quite good, particularly for specialists [3]. But PCPs/capita vary greatly from state to state [4]. [1] https://www.wsha.org/wp-content/uploads/mha2022waittimesurveyfinal.pdf https://www.wsha.org/wp-content/uploads/mha2022waittimesurve... [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC7292524/ https://pmc.ncbi.nlm.nih.gov/articles/PMC7292524/ [3] https://worldpopulationreview.com/country-rankings/health-care-wait-times-by-country https://worldpopulationreview.com/country-rankings/health-ca... [4] https://www.beckershospitalreview.com/rankings-and-ratings/states-ranked-by-total-primary-care-physicians-in-2024.html https://www.beckershospitalreview.com/rankings-and-ratings/s...

lokar 2y ago
IME (SoCal) the 1st visit can take 2-3 months. After that you can get back in with only a 2-3 week wait, shorter if it’s urgent. They seem to rate limit new patients so current patients can get in.
strict9 2y ago
OP is correct in my anecdotal experience. I live in a large urban area and wait time for PCP is several months out. Even longer for Women's health as I hear from my partner. I don't remember it being this bad in the past. Perhaps things have changed in the several years since those publications were published.
- CharlieDigital 2y ago
  > I don't remember it being this bad in the past. Perhaps things have changed in the several years since those publications were published. There's an analogous pattern happening in clinical trials that I suspect is related: there has been a consolidation by private equity[0]. There are several reasons for this, but the gist of it is that pharmas have moved much of the actual work of running large clinical trials to contract research orgs (CROs) and the cost of recruiting patients for trials, training staff, records keeping, and administering the trial becomes out of reach for small independent sites where clinical trials are executed. It's also more efficient on the sponsor side to interface with one large entity rather than several small entities. I suspect that the increasing demands of technology and burden of records keeping in both clinical trials and health insurance makes it difficult for small independent sites to operate profitably. So what happens is that many small, independent offices end up joining a larger entity that can consolidate some of the "system level complexity" more efficiently. The tradeoff is that it's no longer about the doctor-patient relationship; it's about efficiency and profits. I also suspect that part of it is that PE realizes that consolidation lets them control prices. If they can control a network of trial sites, then they have more power to negotiate rates with sponsors and CROs for each patient they sign up to the trial. The bigger the network, the greater their leverage. I think this probably also holds true for healthcare and insurance providers in general. [0] https://www.fiercebiotech.com/cro/private-equity-invests-trial-sites-cro-consolidation-continues-pitchbook https://www.fiercebiotech.com/cro/private-equity-invests-tri...

nopinsight 2y ago

If you think it’s worth it, you can fly to a few places in East Asia or Southeast Asia where you can see a medical specialist in private hospitals on the same day, especially if arranged a couple of days in advance. These include Singapore, Thailand, Malaysia, Hong Kong, Taiwan, etc. The quality of care in these private hospitals is usually high as well. For some cases, the costs in more affordable locations among the above—even after including economy flights—could be cheaper than treatment in the US. https://chatgpt.com/share/e/671fb198-2a34-8011-a2e8-e0b4aa450535 https://chatgpt.com/share/e/671fb198-2a34-8011-a2e8-e0b4aa45...

nateweiss 2y ago
The city of Merida in Mexico might also be an option.
nradov 2y ago
Which metrics are you using to measure quality of care?
31carmichael 2y ago
I visited an international hospital in Saigon to have a skin infection drained and cleaned and bandaged. I remember them charging me around $14. Strange, as surely the nurse used more than $14 in PPE and bandages. International hospitals in Singapore and Malaysia will be more normally priced, but still a small fraction of what you'd spend in USA.

31carmichael 2y ago

I live in Asia. I can see any specialist within the week, and if it is urgent, possibly that evening. I needed surgery once and they told me to come back at 6pm, the same day.