You hear it all the time, from doctors, patients, and critics of Medicare: “It is impossible to find a doctor who will take Medicare. If you find one, you will have to wait forever for an appointment.” There is just one problem: The story that patients cannot access care from Medicare physicians is an urban myth. It is not true. It is unsupported by evidence.
In reality, it is easier for Medicare patients to find a new physician—either a primary care doc or a specialist— than for those who have private insurance. And Medicare patients are more likely to report that they “never” have to wait for an appointment than younger patients with private insurance. The responses are from patient surveys conducted by the Medicare Payment Advisory Commission (MedPAC), an independent agency that advises Congress on Medicare. You can find the results on pages 96-98 here.
Percentage Of Patients Who Have “No Problem” Finding A Primary Care Doctor/Specialist, 2017
So despite complaints by critics of Medicare and even some doctors, there is no nationwide shortage of physicians willing to take Medicare patients. While in some markets the program may reimburse physicians at lower rates than private insurance, it also guarantees a steady stream of patients—many of whom make multiple visits.
Anecdotes are not data
This does not mean that some patients in some markets may have trouble finding a doctor who takes Medicare. Or that some patients may have to wait an unacceptably long time for an appointment. We all have heard the anecdotes. But it does suggest that there is no national shortage of Medicare physicians. There is similarly no evidence that Medicare patients overall are being harmed because they are unable to see a doc when they feel they need to.
MedPAC asked two basic questions: Among those who needed to see a doctor, it asked, “How often did you have to wait longer than you wanted for a doctor’s appointment?” And for those who were looking for a new physician, it asked, “How much of a problem was it finding a primary care doctor/specialist who would treat you?” MedPAC has been asking the questions since 2014 so we can see the pattern of answers over time.
Never waiting, always waiting
When it came to waiting for an appointment, in 2017 roughly 73 percent of Medicare beneficiaries said they “never” had to wait longer than they wanted for routine care, compared to 69 percent of younger patients with private insurance. Twenty percent of those on Medicare said they had to wait “sometimes” and 6 percent said they had to wait “usually” or “always.”
Among those who had suffered an illness or injury, 80 percent of Medicare patients said they never had to wait longer than they wanted to get an appointment compared to 76 percent of those with private insurance. Fifteen percent of those on Medicare said they had to wait sometimes and about 3 percent reported having to wait usually or always. For those with private insurance, 18 percent said they had to wait sometimes, and four percent said they had to wait usually or always.
Payment changes, access doesn’t
What about finding a new physician? It was pretty much the same story. Sixty-nine percent of Medicare patients said they had no problem finding a primary care doc in 2017, and 83 percent said the same for finding a specialist. By contrast, 59 percent of those with private insurance said they had no problem finding a primary care doctor and 81 percent said they had no problem getting a new specialist
Fourteen percent of those on Medicare said finding a primary care doctor was a “big problem” and only 5 percent said the same for specialists. Among those with private insurance, 22 percent said finding a primary care doctor was a “big problem” and 8 percent said the same for a specialist.
Has the pattern changed over time? Not really. Despite constant changes in Medicare physician payment rates, patient experiences were little different in 2017 than in 2014.
Fewer primary care docs
The MedPAC survey does confirm two challenging pieces of the patient access story, however. It shows that it is significantly more difficult to find a Medicare primary care doctor than a specialist. And it finds that non-white Medicare patients have a much tougher time finding a new specialist than whites but an easier time finding a new primary care doctor. It is not clear why.
But overall, there appears to be no nationwide shortage of Medicare doctors, either specialists or primary care physicians. When Medicare patients need a doctor, they usually can find one, whether for specialty or a primary care, or for an urgent medical problem or routine care. And when they make an appointment, they almost always can get it in god time.
Whatever may be wrong with Medicare, a physician shortage is not among its problems.