Reading: It Shouldn’t Be So Hard to See a Specialist

I’m sitting on an examining table in my gynecologist’s office, focused on the stirrups at the end of the table and dreading what comes next. Those metal supports are the butt of jokes, and for some women — often those of a certain age, like me, a symbol of pain. I am here because I started spotting two days ago and yesterday I awoke with pelvic and lower back pain. With menopause long in the past, I knew this couldn’t be good.

I consider the roundabout way I got in to see this gynecologist and am angry all over again about how difficult it is to get an appointment with a specialist in a reasonable amount of time in our country. For new patients, the appointments can be three, four, or more months out. Even if you have a specialist, it can be difficult to see him or her. Mine was fully booked and his staff couldn’t squeeze me in yesterday when I called. I asked to see anyone else in his practice, and got an appointment with Dr. L, in an office half an hour away. I took it. Then he canceled because “he had to leave,” a staff member said.

I pondered my choices. My GP is one of the kindest, best doctors ever, and I knew he would probably fit me in. He always does. He sees a portion of patients on a concierge basis, and if I could afford it, I would gladly pay his fee. Ironically, however, I pretty much get this care from him because of his selflessness and commitment to his patients. I thought that perhaps a pelvic sonogram might uncover something if I had to wait for a transvaginal one from my gyno, and that I could probably get a script for the former from my GP.

First, however, I called two female doctor friends, an optometrist biking friend, and a friend from high school to ask their opinions. The former gave me the name of another gyno to try and the latter offered to try and get me an appointment with a GP friend of hers. The gyno recommended by the first friend was totally booked (no surprise there), and by the time the second friend responded, I had already gotten an appointment with my own GP.

Yes, I could have gone to the emergency room, but I didn’t want to risk being admitted, going through testing over a couple of days, and hoping that my gyno would visit if and when he did rounds there. Other scenarios involving the ER went through my head, but none seemed very good.

So I saw my GP. He took blood and said he’d forward the results to the radiology group I like so that the next day (today) I could get the CAT scan he decided to order instead of a sonogram. The radiology group would need to see the blood test results because my doctor was ordering contrast dye and my kidney function had to be checked for that. He told me, however, that I really needed to see a gynecologist. He also mentioned it could be serious — a lot of the time, post-menopausal bleeding means uterine cancer. I wasn’t shocked; I was already worried about that.

Before settling on the CAT scan, I called my gyno’s office back and begged. I told them my GP said I had to see a gynecologist. This time they squeezed me in with the doctor who had canceled the day before, who was in an office closer to me today.

When Dr. L walked in the room, I sighed with relief. One biopsy and transvaginal sonogram later, I was calmer. I had been “seen,” and I would find out if I was OK. Dr. L said I don’t have any of the risk factors for uterine cancer — I’m not obese, I exercise, and I’m not Black. He offered that it’s likely just atrophy of the vagina or uterus, or something like that, due to aging, and nothing to worry about. But women who start spotting often have uterine cancer, so it was hard not to be anxious.

Now I’m just waiting for the test results. It shouldn’t be this hard to see a specialist when you have a worrisome experience that’s too involved for a walk-in facility but not serious enough for hospital admission through an ER and perhaps several days’ stay as an inpatient. 

I’ve heard it said that it takes a long time to see doctors in countries that have socialized medicine, but it can be a problem in this country as well. A writeup on the Athena Health website reports that in 2016, the company’s researchers studied information from 4.2 million appointments and found that out of 13,000 providers in various specialties, ob/gyn patients waited the longest to see a doctor — 24 days, on average. (These were “new” patients, which Athena defined as those who hadn’t seen the provider in at least three years.) And I wasn’t even a new patient — I had seen my doctor two years previously!

It gets worse. A 2017 survey by healthcare staffing company Merritt Hawkins of wait times to see a physician in 15 major metropolitan areas and 15 mid-sized metropolitan areas found that in the 15 metro areas researchers studied, wait times for new patient appointments in the large metro markets were just over 24 days, an increase of 30% since 2014. In the mid-sized markets, the average wait time was worse ― 32 days, which the researchers surmised may be because there are fewer physicians per capita in those areas than in larger metro areas. 

Slingshot Health, a health tech start-up, offers several tips for possibly getting in to see your doctor sooner. The article also postulates why appointment wait times for specialists have increased ― not that it will make you (or me) feel any better. One reason may be that more people have gotten health insurance in the last few years, and another, if you can believe it, is a plethora of inept phone systems in doctors’ offices. But if you have what you think is an emergency and can’t get in, keep trying.