For health care provider network executives, ensuring robust network adequacy is paramount. It’s the bedrock upon which member satisfaction, regulatory compliance, and overall organizational success are built. However, a persistent and growing challenge threatens this foundation: escalating physician appointment wait times. These delays are not merely an inconvenience for patients; they are a critical indicator of network strain and can have profound implications for the perceived and actual adequacy of your provider network.
The Data Paints a Stark Picture
Recent industry data reveals a concerning trend. The 2022 Survey of Physician Appointment Wait Times by AMN Healthcare/Merritt Hawkins reported an average wait of 26 days for new patients across 15 large metropolitan markets—an 8% increase from 2017 and a 24% jump from 2004, as cited by the Washington State Hospital Association and VHHA Solutions.
More alarmingly, preliminary findings from the AMN Healthcare 2025 survey, published in May 2025, show this average has surged to 31 days. This represents a significant 19% increase in just three years and a staggering 48% rise since 2004, according to reports from GlobeNewswire and Medical Economics citing the AMN Healthcare survey. This trend underscores a growing physician shortage and access challenge, even in urban centers with higher physician-to-population ratios. If patients in these areas face such delays, the situation is likely more acute in less-served regions.
Key insights from the 2025 AMN Healthcare survey highlight specific pressure points:
- Obstetrics/Gynecology: Average wait time of 42 days (a 33% increase since 2022).
- Gastroenterology: 40 days (a new benchmark in the 2025 survey).
- Dermatology: 36.5 days (a 6% increase since 2022).
- Cardiology: 33 days (a 23% increase since 2022).
- Family Medicine: While 2022 data showed a decrease in wait times for family physicians (20.6 days, attributed partly to the rise of alternative care venues like urgent care and telehealth staffed by nurse practitioners and physician assistants), the 2025 survey indicates a reversal, with average wait times climbing to 23.5 days (a 14% increase since 2022).
- Orthopedic Surgery: Bucked the trend with a decrease to 12 days (down 29% from 2022).
These wait times can vary dramatically between metropolitan areas. The 2025 AMN Healthcare survey noted Boston had the longest average wait at 65 days, while Atlanta had the shortest at 12 days.
The Direct Hit on Network Adequacy
Extended physician wait times directly challenge the core principle of network adequacy, which the American Medical Association (AMA) defines as a health plan’s capacity to offer timely access to a sufficient number of in-network providers to meet member needs. The impact is multifaceted and significant. Critically, long waits mean reduced access to care, potentially leading to delayed diagnoses, postponed treatments, and the worsening of health conditions. This is especially dangerous for patients managing chronic illnesses or those with urgent, non-emergency needs.
Furthermore, regulatory bodies, including the Centers for Medicare & Medicaid Services (CMS), are intensifying their focus on network adequacy, with appointment wait times becoming a key metric. As an example, new CMS rules effective Jan. 1, 2025, for Federally Facilitated Exchange (FFE) plans mandate adherence to specific wait time standards. According to information from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and a benefits administration software provider called PeopleKeep, compliance will be monitored via “secret shopper” surveys. Failure to meet these standards can result in penalties and corrective action plans.
Beyond regulatory pressures, member dissatisfaction and attrition are major concerns. In an increasingly consumer-driven health care landscape, lengthy waits lead to frustrated members who may seek care out-of-network, thereby incurring higher costs for both themselves and the plan, or they might switch plans entirely during open enrollment. This strain also affects providers; when existing in-network physicians are overwhelmed, it not only increases wait times but also contributes to provider burnout.
Ultimately, consistently long wait times can damage a health plan’s reputation among members, employers, and brokers, making it harder to attract and retain business and potentially exacerbating health disparities by making timely care less accessible for vulnerable populations.
Actionable Steps for Health Care Provider Network Executives
Protecting your network adequacy in the face of these challenges requires proactive and strategic interventions. Consider these actionable steps:
Embrace Technology for Efficiency: Implement or expand patient self-scheduling portals to offer convenience and reduce administrative burdens. Utilize automated appointment reminders via text, email, or voice to minimize no-shows, and consider digital intake forms that patients can complete before their visit to streamline the check-in process. It’s also crucial to leverage telehealth services for appropriate consultations, follow-ups, and the management of chronic conditions to effectively expand capacity and improve patient access.
Optimize Scheduling Processes: Develop strategic waitlist management systems designed to quickly fill cancelled appointment slots. Analyze current practices and implement optimized scheduling templates, such as block scheduling for specific appointment types or open-access models, tailored to individual practice needs and patient demand patterns. Regularly conduct patient flow analyses within clinics to identify and address any bottlenecks that contribute to delays.
Enhance Provider Network Management: Actively recruit and retain a diverse panel of physicians, which may involve exploring innovative contracting models to attract and keep talent. Support the integration and effective utilization of advanced practice providers, like nurse practitioners and physician assistants, within care teams. They can expand capacity for routine and follow-up care while working within state scope-of-practice laws. Crucially, ensure meticulous provider directory accuracy so members can easily find and access in-network care, a point emphasized by the AMA.
Foster Transparent Communication: Communicate clearly and proactively with members regarding average wait times for various services. When waits are long, provide resources or suggest alternative care options if appropriate. Implementing secure messaging platforms for non-urgent patient-provider communication can also be beneficial, potentially reducing the need for some in-person visits and improving overall patient engagement.Invest in Data Analytics: Continuously monitor wait time data across all specialties and geographies within your network to swiftly identify emerging hotspots and areas of concern. Employ predictive analytics to forecast demand for services more accurately, allowing your organization to proactively adjust network capacity and resources where they are needed most.
Advocate and Collaborate: Work closely with provider groups to gain a deeper understanding of the challenges they face in managing appointment access. Collaboratively develop solutions that aim to improve both efficiency and access from the provider’s perspective. Stay thoroughly informed about evolving state and federal network adequacy requirements and advocate for reasonable standards that also support provider sustainability and quality of care.
The challenge of physician appointment wait times is complex and multifaceted, driven by factors including physician shortages, an aging population, and increased demand for services. However, by understanding the data, recognizing the impact on network adequacy, and taking decisive, data-driven action, health care provider network executives can better navigate these turbulent waters. As noted by organizations like MGMA, patient access strategies are critical for future success.