Provider Supply and Access to Specialty Care

To estimate the effect of two provider supply components-(1) clinic time from providers and (2) the number of new patient appointments provided per day-on the wait times for new patient appointments in specialty care.

In this observational analysis, we examine wait times in the largest public health care delivery system in the US-the Veterans Health Administration (VHA). We introduce new data on wait times for specialty appointments at the VHA. We estimate the impact of the two supply components on new patient wait times for specialty care appointments, while controlling for patient characteristics, local area characteristics, medical center fixed effects, and national changes over time and across seasons. We use an instrumental variables approach to handle endogeneity concerns.

Secondary administrative data from the VHA were analyzed, focusing on four specialties: cardiology, orthopedics, urology, and gastroenterology. The sample includes 126 medical centers with the specialty departments observed at 2-week intervals spanning July 2014 to December 2019.

Our estimates indicate that a 10% increase in the sample average clinician time from specialists (equivalent to 2.5 full-time clinicians per 100 enrollees) would reduce the average wait time for a new patient appointment by 1.1 days [95% CI: 1.08-1.13] or 3.9% of the sample average wait time. A 10% increase in the average number of new patients seen per clinic day by providers (0.37 visits) would reduce the average wait time by 4.0 days [95% CI: 3.97-4.03] or 12.9% of the sample average.

Increasing clinic time and the new patient visit rate among providers can improve access to care for new patients. Scheduling policies that prioritize new patients can affect this visit rate without substantially reducing access for other patients.