Why does it take so long to see a doctor in Utah?

4 months for an OB-GYN appointment. 6 months for a sleep study. Why does it take so long to see a doctor in Utah?

The state’s major health care systems cite staffing shortages and COVID-19 (still) as reasons for the delays.

This article was originally published in the Salt Lake Tribune on August 25, 2023.

Erin Jemison, 45, does a calculation every time she needs medical care.

She asks herself, “what’s the cheapest way for me to get this taken care of quickly?”

Take her hurt wrist. The injury didn’t seem worth a trip to an emergency room or even an urgent care clinic. But getting in to see her primary care doctor could take a month.

“And it’s just a minor injury,” Jemison said. “It’s not something that’s going to be relevant in a month or two.”

Jemison is just one of several Utahns The Tribune spoke with about their experiences trying to book medical appointments. This summer, The Tribune asked readers to share how long they’d waited to book a medical appointment and more than a dozen wrote that it took two months or more to see a provider.

The state’s largest healthcare systems attribute the wait times, in part, to provider shortages. Data from the federal Health Resources and Services Administration indicates that Utah has 179 “health care provider shortage areas.”

A few Utahns said they were able to see providers quickly — like Marcia Reinhart, 76, who said ever since finding a general practitioner at Intermountain Health she’s “had absolutely no problem since then.”

But most patients The Tribune spoke with faced months-long wait times for a variety of health care needs. Jemison faced lengthy appointment wait times when trying to address a few different health problems — switching jobs, and in turn insurance providers, made getting care even harder.

During the pandemic, it took Jemison around four months to get an appointment with a mental health therapist. It took about seven months to make an appointment with a menopause hormone specialist, Jemison said. Last year, she needed to do a sleep study. The wait time was six months. One month before her appointment date, she switched health insurance plans.

It would take another six months to get a new appointment, so she decided to just go through with the study. “I ended up with a $5,000 bill at the end of it,” Jemison said.

“If you have anything beyond your regular-annual-go-see-your-doctor, it just feels like a slog.”

Labor shortages and population boom

The Tribune reached out to the state’s two largest healthcare systems, where many of the patients interviewed sought care — Intermountain Healthcare and the University of Utah — to ask why medical appointment wait times seemed to be longer since the COVID-19 pandemic.

“Unfortunately, Utah has not been immune to the national trends of increases in some medical appointment wait times and provider shortages in some medical specialties,” Jess Gomez, director of media relations for Intermountain Health, wrote via email.

Gomez noted that since the COVID-19 pandemic, there have been longer appointment wait times for “certain specialities and practices.”

He wrote that in Utah “rapid population growth, an aging population and lingering impacts of the COVID pandemic,” have all impacted the state’s health systems.

University of Utah Health “has seen increased patient volumes consistently for the past decade,” wrote Kathy Wilets, senior director for the office of public affairs at the University of Utah Health, via email.

The pandemic, Wilets wrote, created “its own set of pressures including staffing constraints, supply chain disruptions and increased patient needs.”

A prescription ‘held hostage’

Earlier this year, Madison Hayes, 30, realized she needed to refill her prescription for her inhaler and anxiety medications.

She logged onto the University of Utah Health Care Systems patient portal, MyChart, to do so. It wouldn’t allow her to refill the prescriptions, so she tried to send a message to her primary care physician, only to discover he was no longer listed.

“I didn’t get any sort of notification from the clinic that my PCP had left,” Hayes said. “I had to call the clinic and try to figure out how to get a refill.”

Hayes was able to see a provider to quickly get her refills at the end of February, but then she had to go through the process of finding a new primary care physician. It took four months to get an appointment with a new provider.

When Hayes had to later schedule an appointment with her OB-GYN to refill her birth control prescription, it took over three months to get in.

The process of trying to get into a provider after getting denied a refill was stressful. “I feel like they’re holding my birth control hostage,” Hayes said.

In July, Hayes told The Tribune, “I’m switching to a [contraceptive] implant next week because I’m tired of worrying about the refills and whatever insurance drama comes with it.”

For that procedure, she was able to get an appointment within the week. “It’s three months for the annual checkup and a week for [the implant],” Hayes said, “I can’t figure it out.”

Playing post-pandemic catch-up

Both Intermountain Health and the University of Utah are trying to bring medical appointment wait times down, according to their spokespeople.

Wilets, with University of Utah Health Care, wrote they have “ramped up virtual care, increased capacity in areas where possible, improved utilization of our health care teams.”

Wilets also noted there is a “renewed focus on retention and recruitment of qualified health care workers for long-term stability.”

Intermountain Health has hired 320 physicians and advanced practice providers in Utah since the beginning of the year, Gomez, with Intermountain Health, wrote.

Gomez wrote they also “encourage people to establish care with a primary care provider, have regular checkups and health screenings to identify medical conditions or disease in its early stages.”

A primary care doctor tries to provide solutions

Dr. Kevin Mangum started his own primary care practice in January of this year.

A growing population coupled with a limited supply of primary care doctors has stressed the medical care system, he said. “We just need way more primary care doctors.”

He started his practice, Primary Health Care, “to try to be more available for my patients,” Mangum said. “I work very long hours, like 90 hours a week.”

He tries to always have same-day-appointments available and sometimes sees patients during lunch. “It’s essential for a healthy community to have good access to care and have good doctors to take care of the community,” Mangum said.

But ultimately, he sees a problem with the medical school and reimbursement system.

“Primary care is reimbursed at a lower rate than some other specialties in medicine,” Mangum said. That reality may ultimately factor into what specialty medical students decide to pursue.

Mangum also noted that the current residency system poses a problem: without completing a residency, doctors cannot get licensed and become a practicing physician. In 2021, Congress approved the creation of 1,000 new Medicare-supported residency positions over the next five years, The New York Times reported.

However, the American Hospital Association noted in a statement released this past June that the country is still expected to be short 124,000 physicians by 2033. The association is calling for the passage of the Resident Physician Shortage Reduction Act of 2023, which would add 14,000 Medicare-funded slots in the next seven years.

“It always seems like it’s a catch-up game, or a perpetual need for more health care workers in the state of Utah,” said Mark Knold, chief economist at the Department of Workforce Services, “because the population just keeps getting bigger and bigger.”

Even if the state stopped growing for a year or two, Knold said, it would still take a while to fill all the current job openings.

“But there is this perpetual pressure on that industry to find more workers, bring more people in,” he said.

While the state struggles to fill those positions, Utahns have had to contend with months-long wait times and untreated conditions.

Cara Bailey, 44, injured her back in December of 2021 on the way home from a trip to Hawaii. Bailey fell asleep in a chair at the Dallas-Fort Worth airport and she slumped into an unusual position. When she woke up, her body didn’t feel the same.

She initially went to physical therapy, which helped keep the back pain at bay but wasn’t really improving her situation. Bailey’s physical therapist recommended she see a doctor around May of 2022. The earliest available appointment was in February of 2023.

Her job as a middle school art teacher requires her to be active. “I was living with this back pain and these muscle spasms,” Bailey said. “It was just making life in general kind of hard.”

She was eventually able to book an appointment for December of 2022 – seven months after physical therapy.

When she finally saw the doctor, an MRI revealed herniated discs in her thoracic spine, Bailey said. She had several rounds of cortisone injections but when she spoke with The Tribune in July she was still in pain.

“I get nervous about doing things that are too physical,” Bailey said. “We do a lot of kayaking, and I haven’t kayaked since this back condition happened and I’d really love to, but I’m nervous that it’s going to exacerbate it.”

Now, she’s waiting for an appointment in October to see a pain management specialist. The pain is less acute these days, “just discomfort,” Bailey said.

Like constantly needing to crack her back.