Patient Access to Primary Care: What Has Changed?

The historic “charge” to a primary care physician was straightforward, and honestly a little limited.  They were asked to build a practice of somewhere around 1,500 people and do their best to take care of their “panel.”  As a physician’s practice became busier, workflows were designed to protect the physician from being overwhelmed by their patients.

Medical necessity became the primary yardstick for determining whether a patient needed to be seen within the office.  By design, established patients would call the front desk and do their best to convince the receptionist that they not only needed to be seen, but they needed an appointment sooner rather than later.  If all else failed, fortunate patients could have another physician call and lobby for access on their behalf (i.e., physician-to- physician referrals).  Under this model, new patients fell outside the practice’s primary charge and were often scheduled months out.

Eventually, a primary care practice would be considered full and stop taking new patients altogether.  Closing a primary care practice became the ultimate tool in protecting the physician from being overwhelmed.  Plus, physicians often enjoyed knowing that they had a back log of patients in case they ever needed them. 

Over the last several decades two factors have made this historic access model to primary care virtually obsolete.  First, hospitals and health systems have employed primary care physicians in a big way, resulting in over 70% being employed across the U.S.  As primary care employment surged, these new employers began to change the purpose of the primary care practice.  Yes, physicians were still expected to take care of their 1,500 or so people, but they were also viewed as a key entry point into the health system. 

This subtle shift in practice purpose changed everything as it relates to access.  As a key entry point, primary care practices must get new patients into the system quickly and seamlessly rather than make them line up behind 1,500 established patients.  Under this new reality, primary care practices simply should never close to new patients.  No healthy business on the planet says no to customers.

Customers are the second dynamic that has disrupted the historic primary care access model.  Patients went from quiet appreciation for being on the inside of the practice to informed consumers with internet access.  The evolution of patient to consumer comes with a whole new set of expectations and demands.  Imagine if other businesses operated like the historic primary care model – you call your barbershop and do your best to convince the receptionist that you really, really need a haircut.  Or, you call your mechanic for maintenance on your car, but are told that you have to wait months due to all of the urgent car needs of their other customers!

Based on our consumer research across the country, primary care consumers want at least four behaviors from their physician’s practice as it relates to access:

1. Not to wait on the telephone,
2. Not to rely on medical necessity,
3. To be told yes
4. Reasonable access

Telephone Wait Time

As part of 3Dhealth’s consumer research, we asked 1,497 potential patients “How long are you willing to hold on the telephone to make a doctor's appointment?”  46% of consumers noted that they are willing to wait 1 to 4 minutes to book an appointment, 31% are willing to wait 5 to 9 minutes, 10% are open to waiting 10 to 14 minutes, and only 13% of consumers are willing to wait more than 15 minutes.

When analyzing the consumer data by age, gender, and region of the U.S., we found almost no variation with only two exceptions.  Consumers age 18 to 24 seem more patient in waiting to speak with an operator with 23% willing to wait 15 or more minutes.  On the other end of the spectrum, only 8% of consumers age 65 or older are willing to wait 15 or more minutes.

Medical Necessity

When surveyed, 43% of consumers stated that they are not willing to wait longer to see a physician based on medical necessity.  Overall, women are less likely to accept medical necessity as a criteria for gaining entry into a primary care practice.  The 55 to 64 and 65+ age cohorts are also less likely to accept medical necessity as a hurdle to seeing a primary care physician.  Geographically, consumers in the South and West are more likely to push back on primary care access based on medical necessity.

Say Yes

Consumers expect to be told yes, and well running businesses develop their culture and workflow around this reality.  Most of 3Dhealth’s partners are focused on scripting and training the front desk personnel to say “yes” to the market and consumers, rather than “no, sorry”.

While our partners are undertaking this important work, we are encouraging them to develop “work arounds” until they achieve targeted access.  For example, create a New Patient Concierge Program that ensures the first impression for new patients is a great one.  Rather than practices telling new customers no, have them direct patients to the Concierge.  From there, the Concierge can customize their new patient experience and make them feel special rather than locked out of the system.

Reasonable Access

Over the past year, 3Dhealth has surveyed over 63,000 consumers around how long they are willing to wait for a new patient appointment for 42 different specialties.  While consumer expectations certainly run high – 55% expect access in four days or less – they do not appear to be unreasonable.  Consumers appear to adjust their expectations based on physician specialty.

Only 30% of consumers attempting to book a new patient appointment with a Pediatric physician are willing to wait five or more days.  Family Medicine is a similar story, with only 33% of consumers willing to wait five or more days.  Yet, 64% of consumers are willing to wait five or more days to access an OB/Gyn.

Conclusion

Today, primary care practices serve as critical entry points into hospitals and health systems and employed primary care practices are expected to embrace this new purpose.  At the same time, consumers have become much more sophisticated, and their access expectations have dramatically increased.

In the short term, we believe that access to primary care is a perfect way to differentiate yourself within your market and capture incremental market share.  In the mid to long term, we believe that meeting consumer demands around access will be a requirement of doing business.

For questions or comments, please email Shane Foreman at SForeman@3Dhealthinc.com or Ron Flower at RFlower@3Dhealthinc.com .

We are excited to announce the addition of Andrew Gargiulo and Annalisa Reese to the 3Dhealth team!  Andrew is being added as a Manager and among other duties, will run a project team for us.  Annalisa is our new Executive Assistant and will support our project teams with scheduling and pushing our projects forward.

Andrew comes to 3Dhealth having recently finished the Bucher-Jackson Postdoctoral Fellowship in the Sciences at Bryn Mawr College.  Andrew is a Doctor of Philosophy in Neuroscience from Drexel University College of Medicine and has been published several times within our industry.  Annalisa brings over a decade of healthcare experience to 3Dhealth and holds a Bachelor’s degree in Business Administration from Wichita state University.

Please join us in welcoming Andrew and Annalisa!

Our Mission

Striving to be the partner of choice for Provider Development Planning, Medical Staff Development Planning and Community Needs Assessments.