During travels far from home, you start having symptoms that cause you concern. Whether it’s chest pain that’s mild but won’t go away, lightheadedness for no apparent reason or a sudden sore throat and sharp cough, you feel the need for medical attention. But with your primary care doctor’s office hundreds or even thousands of miles away, the only health care option seems to be the nearest hospital emergency room. However, you don’t think your symptoms warrant a trip to the ER, not to mention the likely long wait while other, sicker patients get treated first.
[See: 14 Tips for Traveling With Diabetes.]
Even if you’re close to home, it can be tough to get a doctor’s appointment when you need one. According to a 2017 survey, the average wait time for a first appointment with a family physician was more than three weeks. That represents an increase of 5.5 days of extra waiting since the previous survey from 2014. With the U.S. population growing older, and the Affordable Care Act giving more people access to health insurance, wait times are only getting longer as more patients compete for scarce spots in doctors’ schedules.
Primary care offices have historically handled patients with urgent problems by assigning one doctor “acute care” responsibilities for the day or squeezing extra patients into already crammed schedules. The downside: Patients can end up seeing doctors who are unfamiliar with their medical histories, harried due to time pressures, or both, which raises the risk of misdiagnosis or improper treatment.
That’s why some practices — including participating Veterans Heath Administration clinics — have switched to “advanced” or “open-access” scheduling. Rather than scheduling a visit weeks or months in advance, patients can call for an urgent or routine appointment the day before or the same day they want to be seen. This arrangement works because physicians’ schedules are kept empty until 24 hours ahead of the appointment time. With well-known health providers, such as Cleveland Clinic and Mount Sinai Health System in New York City now offering same-day appointments, more practices may follow suit.
A July 2011 review of 28 studies published in the Archives of Internal Medicine (now JAMA Internal Medicine) found that advanced-access scheduling increases the chance that patients will be able to see their doctors and also reduces no-show rates. A June 2017 article in the New England Journal of Medicine suggested that when providers organize care to reduce wait times — instead of playing the standard “waiting game” of overbooking patients — it can reduce patients’ anguish and prevent some from getting sicker. Many experts believe that advanced access decreases emergency room visits and improves patient satisfaction and medical decision-making, too.
[See: 9 Strategies for Reducing Emergency Room Medication Errors.]
Another alternative to improve access is the “concierge” or direct-pay medical practice, where patients pay a monthly or annual membership fee directly to the doctor — rather than to the insurance company. Freed from the administrative expenses associated with filing insurance claims, these practices offer shorter waits, longer visit times and unlimited telephone and email consultations.
Although the first direct-pay practices charged thousands of dollars per year and were therefore available only to the rich, direct-pay practices (or direct primary care practices) with affordable fees are increasingly cropping up.
The DPC Frontier website has an interactive map of direct primary care practice locations throughout the U.S. For example, a Bakersfield, California, practice charges patients $79 to $135 per month; a practice in Overland Park, Kansas, charges $50 to $135 for adults; and a Boston practice charges $75 to $100 monthly, according to information on the map as of February 2018.
For patients who don’t live near advanced-access or direct-pay practices, telehealth technology has made speaking with a primary care doctor by phone or online video conference easier than ever. For instance, Teladoc offers 24-hour access to board-certified primary care physicians in every state. Since virtual consultations are less expensive than in-person visits (and far cheaper than an emergency room visit), many insurers will pay for them.
It’s not just millennials choosing online scheduling options like Zocdoc to arrange doctors’ appointments at convenient locations, days and times. In addition to avoiding long waits for appointments, patients bypass phone-based scheduling and waiting on hold.
If you’re comfortable with receiving health care advice via smartphone, app-based services can provide quick turnaround no matter where you are, depending on the condition. For instance, teledermatology apps like First Derm let you snap skin-condition selfies for virtual dermatologists to review within a day or two — either while you’re waiting for an in-person appointment or in lieu of one.
If you would prefer to consult your own physician, groups like HelloHealth are connecting doctors with patients via online portals that also allow you to access portions of your electronic medical records, such as specialists’ notes and laboratory test results.
[See: On a Scale From 1 to 10: Most Painful Medical Conditions.]
Be proactive. Before a situation arises when you need to consult a doctor but can’t wait weeks for an appointment, look into your options. It could be that a medical practice with same-day appointments, advanced-access or online scheduling, direct pay or telehealth services would be a good health care fit for you.
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How to See a Doctor — Stat originally appeared on usnews.com
Update 03/07/18: This article was originally published on June 23, 2011.
