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Referral Conundrum: Wait Times for Subspecialists Versus Comprehensive Otolaryngologists in the United States
Arman Saeedi1, Tyler Muffly2, Michaele Francesco Corbisiero3
1Department of Otolaryngology - Head and Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, USA.
Introduction:
Timely access to care is a critical indicator of system efficiency and equity. This study aimed to investigate potential differences in new patient wait times for otolaryngology care between neurotology and pediatric subspecialists compared with generalists for matched-case vignettes. Methods: A national cross-sectional audit study using a "mystery caller" approach was analyzed with linear mixed-effects regression Poisson models. A total of 682 physicians across 48 states, Puerto Rico, and the District of Columbia were included, representing three otolaryngology subspecialties. Mystery callers contacted otolaryngology physicians via telephone as patients with scripted clinical vignettes. Subspecialists were matched by city with generalists for the same corresponding clinical vignette. Callers requested the next available appointment. Wait times for new patient appointments were recorded and analyzed in R (R Development Core Team, Vienna, Austria) using generalized linear mixed-effects regression Poisson models.
Results:
A total of 682 of 706 calls reached a representative (96.6%). The median physician age was 53 years. The median wait was 11.0 and 31.5 business days longer to see neurotologists or pediatric otolaryngologists (both p < 0.01) compared to generalists, respectively. Longer waiting times were also associated with physicians affiliated with universities (p < 0.001). Regional differences were also observed, with specific American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) regions showing longer wait times. The pediatric and neurotology models both achieved conditional R-squared values of 0.97.
Conclusions:
These findings indicate that subspecialty may significantly influence new appointment wait times, with pediatric otolaryngology patients experiencing the longest wait times. These differences in waiting times can have clinical and ethical implications for patient care, and future research should focus on optimizing care models to improve access to care.
