Patient access to physicians keeps slipping as appointment waits grow and coverage losses mount

New patients in 15 large U.S. metropolitan areas waited an average of 31 days for a physician appointment in 2025, 19% longer than in 2022, according to a survey by health care staffing firm AMN Healthcare.

The Health Resources and Services Administration (HRSA) counted 92.3 million people living in designated primary care health professional shortage areas as of Dec. 31, 2025, according to KFF.

The number of people paying for Patient Protection and Affordable Care Act (ACA) marketplace coverage fell 12% in February, from 21.8 million to 19.2 million, after enhanced premium tax credits for marketplace plans expired at the end of 2025, according to KFF. By June, individual market enrollment was down 18% from a year earlier. Medicaid work requirements under H.R. 1, the 2025 budget reconciliation law, are set to begin Jan. 1, 2027, for most adults covered through Medicaid expansion.

Sixty percent of registered voters said they were worried about affording health care for themselves and their families in a KFF poll taken weeks before the Nov. 3 midterm elections. At an October roundtable, a former congressman and two health policy advocates said they expected government shutdown or debt ceiling standoffs to set the terms of any health care deal next year, with a Democratic House holding more leverage to press for restoring the ACA subsidies and rolling back the Medicaid cuts.

A report released Nov. 2, "The Access Gap," draws on the AMN survey and other published research to argue that money spent inside the health care system loses much of its value when people can't get in the door. Its author, OnMed, places its CareStation telehealth booths in workplaces, health systems, college campuses and community sites, and the report pairs the published research with the company's own patient data.

"No one should have to lie awake wondering whether a symptom is serious, then spend the next morning calling for an appointment they cannot get," Karthik Ganesh, OnMed's CEO, said in the announcement.

The report says it does not argue for any single policy fix and takes no partisan position on insurance or government spending.

What does the report cite?

Family medicine averaged 23.5 days in AMN's survey, up 14% from 2022 and shorter than every specialty in the survey except orthopedic surgery. Obstetrics-gynecology averaged 41.8 days. Boston had the longest average wait of the 15 metro areas at 65 days, and Atlanta had the shortest at 12. AMN notes that its figures reflect the most available physician in a group, so patients of busier physicians may wait longer.

OnMed also cites an Association of American Medical Colleges analysis of how many more physicians the country would have needed in 2021 if underserved communities faced fewer barriers to care. The report uses the high end of that estimate, 202,800. The association put the range at 117,100 to 202,800, or three to six times current shortfall estimates.

On costs, the report points to a nonprofit Integrated Benefits Institute estimate that illness-related lost productivity cost U.S. employers $575 billion in 2019. It also cites a Peterson-KFF Health System Tracker analysis of Census Bureau survey data finding that people in the United States owed at least $220 billion in medical debt at the end of 2021.

The report's estimate that 120 million Americans lack adequate access to care is attributed to federal shortage-area data and runs higher than HRSA's count. The report does not show how the number was calculated.

What does OnMed say its stations show?

Inside each 8-by-10-foot CareStation, a patient sees a licensed clinician over live video while a digital stethoscope, an exam camera and vital sign monitors support the evaluation, according to the company. Patients can leave with a treatment plan and, when appropriate, a prescription or referral. The report says CareStation clinicians document findings centrally and provide care navigation, referrals and follow-up.

According to company data in the report, 80% of CareStation users have no primary care clinician, 86% are diagnosed and treated without escalation and 37% come back on their own. Patients rate the stations 4.96 out of 5. The report attributes those figures to 2026 clinical performance data and does not say how many visits or sites they cover or how escalation is defined.

Ganesh said in the announcement that the future of health care "isn't replacing primary care," but "making primary care available again where people already are."

OnMed signed a nonbinding letter of intent in October 2025 to combine with Berto Acquisition Corp., a publicly traded special purpose acquisition company, in a deal that would make the combined company publicly listed.

"We have to be careful that more support does not equal more care fragmentation," Jennifer Brull, M.D., FAAFP, board chair of the American Academy of Family Physicians, said at a Sept. 15 kickoff event for Medicare's ACCESS model, which pays participating organizations to help manage chronic conditions with technology-supported care. When care involves technology and outside organizations, she said, fragmentation is "a very real risk that we have to consider."

What are practices seeing?

New primary care patients now wait 13.5 days for the third-next-available appointment, up from 9.5 days, according to Medical Group Management Association (MGMA) data. The measure counts the days until the third open slot on a schedule and is a standard benchmark for access. Existing primary care patients wait eight days, up from five.

Andrew Swanson, M.P.A., FACMPE, chief customer success officer at MGMA, shared those figures with Physicians Practice, a sister publication of Medical Economics, at MGMA's annual conference in San Antonio in September.

"So access is getting worse somehow," Swanson said in the interview, which aired on "Off the Chart," the Medical Economics business of medicine podcast.

A decade ago, he said, practices debated opening for half a day on Saturdays. Now the question is whether to stay open until 7 p.m. instead of 6 p.m., or open at 7 a.m. instead of 8:30 a.m. "But in the end, it's sheer visit volume tied to number of providers in a practice," Swanson said.

"There's only so many physicians coming out of training every year," he said, "and we're back to square one again."

In a July 14 MGMA Stat poll, 28% of medical groups said new-patient waits were longer than a year earlier, 22% said they were shorter and 46% said they had not changed.

Could Medicare pay cuts make access worse?

In July, the Centers for Medicare & Medicaid Services (CMS) proposed cutting the 2027 conversion factor, the dollar amount that turns each service's relative value into a payment, 1.68% to $32.84 for most clinicians as a one-year 2.5% increase Congress approved for 2026 expires. CMS typically releases the final rule around Nov. 1, and new rates take effect Jan. 1.

The Medicare Payment Advisory Commission (MedPAC) found in its March 2026 report that Medicare beneficiaries' access to physician services was adequate, said Michael Chernew, Ph.D., Leonard D. Schaeffer Professor of Health Care Policy at Harvard Medical School and a former MedPAC chair. The commission still recommended raising 2027 rates 0.5 percentage points above current law.

In an interview for "Off the Chart," Chernew called the question of when payment reductions begin to threaten access "unbelievably important," then added, "by the way, I don't know the answer." He named the growth of concierge practices and physicians declining to see public patients as worries, "but I don't think we're sort of at a burning platform right now," he said.

"Right now, 98% of non-pediatric physicians accept traditional Medicare, and we'd certainly like to keep that number that high," Miranda Yaver, Ph.D., an assistant professor at the University of Pittsburgh and author of "Coverage Denied," a book on how health insurers drive inequality, said in a separate interview for the episode. In Medicaid, she said, when reimbursement rates are too low, "people simply don't participate in the program."

"I'd be curious to know if we are having a harder time getting medical appointments because of these increased financial pressures," Yaver said.

Lawmakers return after the election facing a Dec. 11 deadline to fund the government under the continuing resolution signed in September. Medicare's 2027 payment rates and the Medicaid work requirements are both set to take effect Jan. 1.