This Article examines the growing crisis of long primary care wait times and the health care fragmentation that is associated with them. Patients who feel ill or are worried about new symptoms must often wait weeks or longer for appointments. In the wake of excessive wait times for primary care physician (“PCP”) appointments, patients increasingly turn to convenience care models such as urgent care centers, retail clinics, direct-to-consumer telemedicine, and at-home testing. While these alternatives offer prompt attention, they sacrifice other core functions of primary care and may exacerbate poor health outcomes and inequities. The Article argues that long wait times and resulting care fragmentation have significant spending, quality, access, and equity implications. Furthermore, they expose health care providers to potential medical malpractice and discrimination claims. The PCP shortage, rooted in factors such as physician burnout, inadequate compensation, and insufficient residency positions, underlies the problem.
This is the first law journal article to comprehensively analyze the legal and policy implications of long PCP wait times. It recommends that policymakers and payers support strategies to improve primary care capacity and lower wait times, for example, by using artificial intelligence to facilitate administrative tasks and adopting creative scheduling policies. The Article also critiques laws and regulations that directly address appointment wait times and suggests modifications to improve their efficacy. It concludes with a brief examination of legal interventions that aim to increase the supply of PCPs and ease the financial and workload burdens that PCPs face. As the population ages and demands for care grow, addressing primary care access barriers is crucial for maintaining the health of the American population.
* Edgar A. Hahn Professor of Law, Professor of Bioethics, and Co-Director of Law-Medicine Center, Case Western Reserve University School of Law (CWRU). BA, Wellesley College; JD, Harvard Law School; LLM in Health Law, University of Houston; SJD in Health Law, Case Western Reserve University. For more information see https://sharonahoffman.com/. We thank Jessie Hill, Andy Podgurski, Cassandra Robertson and attendees at the CWRU 2024 summer works-in-progress workshop for their invaluable insights and comments. We also thank Shelby Conklin and Lucas Katz for their dedicated research assistance.
** Associate Professor of Medicine, Harvard Medical School and Brigham and Women’s Hospital. MD Harvard Medical School; MPH, Harvard T.H. Chan School of Public Health. Dr. Ganguli also serves on the National Academies of Sciences, Engineering, and Medicine (NASEM) Standing Committee on Primary Care. The views expressed in this article do not represent official positions of the NASEM Standing Committee.
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