These are just a few barriers the local health care industry is currently facing, according to Austin-based Harbor Health Drs. Clay Johnston, a neurologist and family physician, and Luci Leykum, an internal medicine physician.
The big picture
Austin’s rapid growth has made the local health care system unable to keep up with demand, Johnston said.
Fewer primary care physicians—but also specialists such as neurologists, rheumatologists and endocrinologists—have led to longer wait times across the city, he said.
“The bottom line is that the finances that support those specialties just aren't as strong,” Johnston said. “Fewer people go into them, and the health systems are less likely to hire extra of them, and so you just end up with a chronic shortage of those specialists.”
A 2022 study by health care staffing company AMN Healthcare, which surveyed over 1,000 medical offices across 15 major metropolitan areas including Dallas and Houston, found that average wait times were:
- 16.9 days for an orthopedic surgeon appointment
- 20.6 days for a family medicine physician appointment
- 26 days for a physician appointment
- 26.6 days for a cardiologist appointment
- 31.4 days for an OB-GYN appointment
- 34.5 days for a dermatology appointment
“They tend to not be able to address all the issues,” Leykum said. “They’re very focused on, ‘How do we address this to stabilize it?’ not, ‘How do we really get at the root of the problem?’”
Diving in deeper
Part of physician burnout is driven economically, Johnston said. Some systems attempt to keep revenue high by increasing the number of patients physicians see in a day.
“So much of medicine has to do with connection, and that’s hard to do when [physicians] ... just don’t have the energy,” Johnston said. “Ultimately, folks get pushed and pushed and pushed, and then they underperform and can’t meet the demands of the system.”
More physicians in the U.S. are also being employed by larger health care organizations instead of independent practices, Leykum said, which could give them less autonomy over their schedule.
“You put that on top of a situation where people were maybe less likely to make a choice to pursue primary care to begin with, and it sort of has a synergistic effect,” Leykum said.
According to Leykum and Johnston, patients can help combat longer wait times by:
- Finding a clinic that has a team-based care model
- Utilizing telehealth when able
- Asking clinics what its average wait times are for routine or urgent needs
Ultimately, the rate of medical school graduates is greater than the state’s ability to train them, Johnston said. This can lead to longer wait times as fewer physicians end up staying to practice in Texas.
Graduates must complete a residency program upon graduating, but there are limited slots in Texas available each year. The Legislature has increased the number of spots through the years, but it hasn’t been adequate, Johnston said.
A 2022 Texas Department of State Health Services report projected that by 2032, the supply of graduate medical education residents, or GMEs, will not be keeping up with demand.
Of the five specialties projected, pediatric physicians would have the largest gap with only 71% of demand met. General internal medicine physicians would need the most residency slots added each year to address the projected deficit, with 70 slots needed.
