The Doc's In, but It'll Be a While

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There is no systemized, nationwide collection of data on wait times in the U.S., making it difficult to compare delays to those in countries with national health systems, who typically track and publish data on wait times. But a 2005 survey conducted by the Commonwealth Fund of sicker adults in six highly industrialized countries found that only Canada was worse than the U.S. when it came to waiting six days or longer to schedule a doctor's appointment for a medical problem.

Of the countries surveyed, 81% of patients in New Zealand got a same or next-day appointment for a nonroutine visit, 71% in Britain, 69% in Germany, 66% in Australia, 47% in the U.S., and 36% in Canada. Those lengthy wait times in the U.S. explain why 26% of Americans reported going to an emergency room for a condition that could have been treated by a regular doctor if available, higher than every other country surveyed.

No. 1 in Foregone Care

The Commonwealth survey did find that patients in the U.S. had shorter wait times than every country except Germany when it came to getting an appointment with a specialist for nonemergency elective surgery, such as hip replacements, cataract surgery, or knee repair. But Gerard Anderson, a health-policy expert at Johns Hopkins University, says most doctors know how to "game the system" in those countries where there are queues for elective surgery, by putting at-risk patients on the list long before their need is critical. "Their wait might be uncomfortable, but it makes very little clinical difference."

The Commonwealth survey found one area in which the U.S. assumed first place—by a wide margin: 51% of U.S. adults surveyed did not visit a doctor, get a needed test, or fill a prescription within the past two years because of cost. No other country came close to that percentage.

The Commonwealth study was one of very few to compare wait times in the U.S. to other nations, but several other surveys have compared the difficulty in getting to see a specialist in different regions in the U.S., and found that some cities perform very poorly on that score. For example, a 2004 survey by medical recruitment firm Merritt Hawkins & Assoc. looked at wait times for appointments with four different specialists in 15 metropolitan areas. The researchers found that average waits for a heart checkup with a cardiologist can range from 37 days in Boston to nine days in Seattle, while patients with a knee injury who want to see an orthopedic surgeon can wait an average of 43 days in Los Angeles, or eight days in Atlanta.

Minute Clinics

In the UCSF study published last year, the researchers set out to determine how long it would take to get an appointment in 12 cities to examine a face mole that had changed color, a common warning sign of skin cancer. They found a range of mean wait times according to geography, from 20 days in Little Rock to 73 days in Boston. The researchers pointed out that the wait in rural areas, where dermatologists are scarcer, are likely much longer.

Few solutions have been posited for wait times, in part, say policy experts, because the problem is rarely acknowledged in the U.S. But the health-care market itself is beginning to address the issue, with the rise of walk-in medical clinics situated in retail stores. Hundreds of these clinics have sprung up in stores like CVS/Caremark (CVS), Wal-Mart Stores (WMT), and Pathmark Stores (PTMK), and they are rapidly growing. Usually staffed by nurse practitioners, they promise rapid care for minor medical problems, usually getting patients in and out in 30 minutes. The slogan for CVS's Minute Clinics says it all: "You're sick, we're quick." Those are comforting words for patients who'd rather not wait 10 weeks for a routine medical screening.

Arnst is a senior writer for BusinessWeek in New York.