You haven’t been feeling well lately. You’re more tired than usual, a bit sluggish. You wonder if there’s something wrong with your diet. Or maybe you’re anemic? You call your primary-care doctor’s office to schedule an appointment. They inform you the next available appointment is in three weeks.
So, you wait.
And then you wait some more.
And then, when you arrive on the day of your appointment, you wait even more.
You fill out the mountain of required paperwork, but the doctor still isn’t ready to see you. You flip through a magazine for a while, then scroll through your phone until you’re finally called. You wait a little longer in a scratchy paper gown, then talk to your physician—if you can call it talking, since she’s mostly staring at a computer screen—for all of 10 minutes before you’re back out in the lobby with a lab order to have your blood tested.
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Then you call to set up your blood test, and the waiting process starts over.
A few weeks after you get your results, a bill arrives in the mail. You’re charged hundreds of dollars for the blood work. The appointment was over in minutes, but your bank account will feel the effects for a long time.
Going to the doctor may never be a fun experience, but surely it can be better than it is right now. In 2019, even before the COVID-19 pandemic rocked the foundations of health care, an Ipsos survey found that 43% of Americans were unsatisfied with their medical system, far more than the 22% of people in the U.K. and 26% of people in Canada who were unsatisfied with theirs. By 2022, three years into the pandemic, just 12% of U.S. adults said health care was handled “extremely” or “very” well in the U.S., according to a poll from the Associated Press–NORC Center for Public Affairs Research.
Americans pay a premium for the care they rate so poorly. The U.S. spends more per capita on health care than any other developed country in the world but has subpar health outcomes. Average life expectancy is lower in the U.S. than in other wealthy nations, and about 60% of U.S. adults have a chronic disease. About 10% of the population doesn’t have health insurance.
And the customer service sucks. U.S. patients are tired of waiting weeks or months for appointments that are over in minutes. They’re tired of high prices and surprise bills. They’re tired of providers who treat them like electronic health record entries, rather than people.
That could dissuade them from getting medical care at all—and if that happens, America may get a whole lot sicker than it already is. Patients are, in a phrase, burned out.
Primary care is supposed to be the bedrock of the U.S. medical system. In theory, patients get annual physicals so doctors can assess their overall health and detect any red flags (or refer them to specialists who can) before those warning signs become full-blown chronic disease. While experts debate whether everyone needs a checkup each year, studies show that on balance, patients who regularly see a physician tend to be healthier and live longer than those who don’t.
Yet about a quarter of American adults don’t have a primary-care provider, and, as of 2021, almost 20% hadn’t seen any doctor during the past year. There are many barriers: it can take weeks to get an appointment, particularly in more rural areas where fewer doctors practice, and visits can be costly even for people with insurance. Research shows that during the past year, financial strain caused about 40% of U.S. adults to delay or go without medical care.
Plus, people just don’t like going. A third of participants in one 2015 study said they had avoided going to the doctor because they found it unpleasant, citing factors like rude or inattentive providers, long wait times, and difficulty finding a convenient appointment. Many people also skipped appointments during the COVID-19 pandemic, largely because of office closures and fears of the virus—but one study found that people were more likely to forgo doctor’s visits during the pandemic if they’d had previous poor experiences with health care. People of color, women, and people who are overweight frequently report feeling mistreated by their doctors.
Jen Russon, a 48-year-old English teacher and mother of two from Florida, says she can’t remember a single positive experience she’s had with a doctor. She struggles to square the $400 her family pays in monthly insurance costs with what she characterizes as a rushed and underwhelming care experience that pales in comparison with the attention her pets get at the veterinarian. “I wish we could see our vet instead, because they really spend a lot of time” with their patients, she says.
Part of the problem may go back to the way doctors are trained, says Jennifer Taber, an associate professor of psychological sciences at Kent State University and a co-author of the 2015 study on doctor avoidance. U.S. medical schools do an excellent job of teaching students how to practice medicine. But, she argues, they aren’t always as good at preparing students to be doctors, with all the interpersonal complexity that entails. “Patients won’t necessarily want to go back to doctors they don’t like,” she says. Even small gestures, like making eye contact with or leaning toward a patient as they speak, can help build a strong rapport, Taber says.
The pandemic certainly hasn’t improved bedside manner. It’s pushed nearly every element of medical care to the brink and prompted some providers to leave the profession entirely, worsening existing personnel shortages and contributing to an epidemic of physician burnout. According to one recent survey, 30% of U.S. physicians said they felt burned out in late 2022, and about as many said they’d considered leaving the profession in the previous six months.
Physician burnout only adds to patient burnout, says Dr. Bengt Arnetz, a professor at the Michigan State University College of Human Medicine who researches how to improve primary care. “Providers feel stressed, burned out, less empathetic. A lot of times they don’t engage the patient, and the patient wants to be engaged,” Arnetz says.
But these problems didn’t start with the pandemic, says Lori Knutson, executive director of the Whole Health Institute, a nonprofit focused on improving health care delivery. “We should all be honest,” she says, “about the fact that health care has been slowly imploding for a period of time.”
It’s impossible to explain problems with U.S. health care without talking about insurance. U.S. patients pay more out of pocket for health care than people in other wealthy, developed countries, most of which offer some form of universal health coverage.
The insurance system is also endlessly confusing, says Dr. Ateev Mehrotra, a professor of health care policy at Harvard Medical School. Doctors may not know how much the tests they’re recommending cost, particularly when every patient has a different type and level of coverage, so surprise bills are common—and so hard to understand that patients often have to spend hours on the phone seeking clarity from their insurance providers. One 2020 study estimated that dealing with insurance companies costs the U.S. more than $20 billion annually in lost productivity.
How doctors get paid affects the patient experience too. Many health systems pay physicians based on how many appointments and procedures they squeeze in, which rewards lightning-fast visits over those that are “about the whole person and not just what’s wrong with them,” Knutson says. This system can also incentivize doctors to recommend tests and procedures that aren’t strictly necessary, which leads to extra costs and hassle for patients and added strain on the health care system.
Here, too, insurance is part of the problem. Doctors in primary care or family medicine often make significantly less than specialists, in part because their services are reimbursed at lower rates. That dissuades some medical-school graduates—particularly those saddled with debts—from entering general medicine, which contributes to shortages in the medical fields patients are most likely to need on a regular basis. When there aren’t enough doctors to go around, appointments get scarcer and physicians become overworked, rushing from appointment to appointment and drowning in paperwork.
Some simple solutions exist. In a study published in 2020, Arnetz and his colleagues analyzed what happened when one small medical clinic made minor tweaks to its operations, such as reassigning some of the main provider’s administrative duties to nurses or medical assistants and adding short team meetings to delegate tasks for the day. After two weeks, the clinic scored higher than a comparison clinic on measures of efficiency, contributing to better patient and provider satisfaction.
Traditional medical offices could also take cues from the services patients are increasingly gravitating toward, says Pearl McElfish, who researches health services at the University of Arkansas for Medical Sciences. Patients who can afford it are flocking to startups offering perks like same-day appointments and flat-rate monthly memberships. And one 2018 study co-authored by Mehrotra found that visits to urgent-care clinics, where patients can walk in instead of waiting for weeks, increased by more than 100% from 2008 to 2015 among privately insured U.S. adults. (During roughly the same period, primary-care visits dropped 24%.) During the pandemic, urgent-care centers only became more popular—as did telehealth.
“Currently [the traditional system] isn’t meeting the needs of many patients,” Mehrotra says. “Patients are voting with their feet and going to these other care sites.”
The trouble with convenience-first medical care, however, is that it’s often issue-specific. If you go in to get a flu shot, you’ll get that vaccine and then be on your way. The clinician is unlikely to make sure you’re up to date on your other shots or perform recommended screenings—the kind of preventive care that can fend off bigger issues down the line. On the other hand, these newer options can “put pressure on existing providers to be a bit more patient-centric,” Mehrotra says.
Traditional medical offices could make some changes right away, without waiting for big structural overhauls, he says. They could offer “walk-in only” hours to treat people without appointments, text patients when the doctor is ready to see them, and include clear explanations on bills so patients understand what they’re paying for. Even small shifts like these could make significant differences to patients.
The stakes are high. Ashley, who is 35 and asked to use only her first name to protect her privacy, has a gene mutation that heightens her risk of breast cancer and is supposed to get an annual mammogram and two ultrasounds per year. But she has to move frequently for her job in academia and hasn’t had her tests done in four years because she got so fed up with the arduous process of finding new doctors, transferring medical records, and dealing with insurance every time she moves. “The barriers were enough that I just kept putting it off,” she says.
Burned-out patients may retreat from the institutions that made them feel that way. Ashley says she’s considering a preventive double mastectomy—a surgery she may have needed anyway because of her genetic predisposition, but one made more appealing by her desire to stop dealing with “pain in the butt” medical appointments. Russon, from Florida, says she’s felt tempted to cancel her family’s insurance and go to the doctor only when absolutely necessary, though she’s never acted on the urge. Other patients, however, may walk away from the health care system entirely. It may not be the wisest or healthiest response, but it’s a human one.
Patients are burned out by the U.S. health care system. It’s a simmering public health crisis.
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Health – TIME
