Barriers accessing specialty care in the United States: a patient perspective

Specialty care is a critical component of the healthcare system in the United States (US). Despite the frequency and importance of specialty referrals, disparities accessing specialty care have been reported across geographic regions and sociodemographic groups in the US.

The purpose of this study is to help inform health policy and practical solutions for improving access to specialty care in the US. We examined patients' perspectives and experiences regarding access to specialty care for themselves and family members across 5 specialty areas (oncology, neurology, ophthalmology, endocrinology, and other specialty). Data for access to care were collected from the RAND American Life Panel, a nationally representative probability-based panel of 6,000 participants who are regularly interviewed over the internet.

The survey population consisted of 2,137 adults, with a specialist referral recommended for 1,391 respondents (65%). The mean age of the population was 59.4 years, 23.0% were rural dwellers, 57.6% were female, 80.8% were White, 59.4% were married or living with a partner, and 85.4% were in good health. Approximately one-third (28%) of the US population experienced a barrier accessing a care specialist (oncologist, neurologist, ophthalmologist, endocrinologist, or other specialist) for themselves or for their families in 2021. Differences in access to specialty care were observed between US census regions. Difficulty accessing specialty care differed according to sociodemographic groups; a greater percentage of respondents who were < 65 years, women, or BIPOC (Black, Indigenous, and people of color) experienced a problem accessing a specialist. Numerous barriers were identified that limited access to specialty care in the overall US population, with difficulty getting an appointment and long wait times being identified as primary barriers.

Patient access to specialty care may be further complicated by patient-specific compounding factors including the number of specialty referrals, insurance providers, and barriers.