Why your patients feel like they can’t get an appointment

For the modern physician, the daily grind is often a whirlwind of clinical complexity, electronic health record management and the constant effort to optimize practice operations. From the inside looking out, many providers feel they are finally making headway. According to the 2026 State of Patient Access Survey by Experian Health, nearly half of providers — 46% — believe that patient access has improved over the past year. This is a jump from 36% in 2025, suggesting that investments in digital tools and operational efficiencies are bearing fruit.

However, from the outside looking in, the view is much bleaker. Only 18% of patients believe access to care has improved, a 28-point disconnect that suggests a fundamental misunderstanding between those giving care and those seeking it.

Mindy Fortson, chief operations officer at Experian Health, says the disconnect isn't just about different opinions; it’s about different definitions of success.

“I think the disconnect is really caused by the way that patients and providers are measuring outcomes," Fortson says. "I think the provider is looking at their ability to staff, how they're adopting digital tools, how quickly they're able to train staff, and they're looking at some of those outcomes of adoption across their facilities. Patients are looking for, how am I going to be able to afford this bill? What is my cost estimate up front? How quickly can I access my provider? And so while both are very valuable and important metrics to be looking at, I just think that they're looking at two different sides of the ball when they're measuring success.”

The unsettling truth about financial toxicity

While physicians often view the "business" side of the practice as secondary to the clinical mission, research indicates that financial barriers have become a primary clinical concern. The PAN Foundation’s 2025 report assigned the state of health care access a C grade (75.2), specifically noting that "Financial Toxicity" — the debilitating emotional and physical side effects of treatment costs — has dropped to a D+.

This financial strain manifests in a statistic that Fortson finds particularly alarming from the Experian report: 73% of providers report that their patients at least occasionally delay or forfeit necessary medical care if they cannot obtain a cost estimate up front.

“That was actually the most unsettling stat for me, personally, that I saw in the survey, because both over 70% on the provider side and almost half on the patient side said they will forego or delay care," Fortson says. "That's not a revenue problem; that's a public health problem. And so I think it's very important for providers to find ways and find tools to deliver accurate, or as close to accurate, estimates as possible, so that the patient understands what that cost is going to look like, especially if they are delayed care.”

Data from the Peterson-KFF Health System Tracker corroborates this public health problem. In 2024, approximately 1 in 6 adults (17%) reported delaying or forgoing medical care, mental health care, or prescription drugs specifically due to cost. The burden is even heavier for those in poor health, who are nearly twice as likely to forgo care due to cost compared with healthier individuals. For these patients, the financial barrier leads directly to medical debt, which 40% of chronic patients now carry, with an average balance of $729. This debt is not just a line item; 86% of patients report that it negatively impacts their levels of stress and anxiety.

The invisible wall: Insurance and administrative hurdles

Even when a patient is willing to pay, administrative hurdles often stand in the way of the exam room. The PAN Foundation found that access to treatment through health care plans earned the lowest scorecard rating of any category: a D- (63.1). And the Experian report found that for the fourth consecutive year, access to practitioners remains the top patient-reported challenge, at 27%.

The Experian report also highlighted three specific roadblocks that stop patients before they see a doctor:

• Authorizations: 36% of patients report difficulty with authorizations for procedures.
• Insurance verification: 28% of patients have experienced care delays due to verification issues.
• Complexity: 50% of patients find it nearly impossible to understand their health plan details.

When asked how much of this burden falls on the practice versus the payer, Fortson notes that it requires a "meet in the middle" approach.

“I think a lot of this still falls within the payer and policy reform,” she says. “We're seeing advancements in the digital tools that providers are able to use to help kind of automate some of that, but it's just a difficult problem to solve. It's very payer-specific, plan-specific, and it's just not an easy thing to solve from a digital perspective, because there's so much clinical work that has to get authorization as well.”

Pharma executives are feeling this friction as well. A survey of 35 executives by Guidehouse revealed that reimbursement support — specifically, benefits investigation, prior authorization and denials support — is considered the single most significant bottleneck in the patient journey. This has led many pharmaceutical firms to invest heavily in patient support programs (PSPs), prioritizing copay assistance and "bridge" programs to circumvent these access obstacles.

The internal struggle: Staffing and training deficits

For physicians trying to fix these problems from within, the greatest enemy is often a lack of manpower. The Experian report shows that 64% of providers say staffing shortages are actively reducing patient access, an increase from 57% just one year ago.

It isn't just about having enough bodies; it’s about having the right skills. Thirty-nine percent of providers report that insufficient staff training negatively impacts patient access. Fortson suggests that the sheer complexity of the modern insurance landscape makes manual training a losing battle.

“When you're hiring and staffing some of these upfront registration areas, for example, there's just a lot of things the staff needs to know," Fortson says. "AI [artificial intelligence], I think, is going to have an impact in this space. It helps deliver the information directly to those registrars here at hand, so that you can start to reduce the amount of training, because it is complex. Every payer is different. Every patient experience is going to be different for what they're being seen for.”

The AI inflection point: From pilot to infrastructure

Despite the gloom of the patient sentiment numbers, there is reason for optimism. To future-proof patient access, 35% of providers now view automation as "nonnegotiable," and 28% say the same for AI, according to the Experian report.

While physicians are looking at AI to solve administrative burdens, patients are beginning to trust the technology more. Trust in health care AI jumped from 30% to 41% in a single year. However, a significant portion of patients (43%) remain worried that AI could exacerbate socioeconomic disparities.

“I think over the next year to two years, you're going to see AI moving out of a pilot phase into kind of the general infrastructure of health and people adopting it being able to get information more readily," Fortson says. "So, I think as these tools start gaining traction, you're going to see that process start to improve health care. Of course, as we all know, it is much more regulated than a number of areas, so our providers have to be cautious and careful on how and where they're adopting it, but the ones that are adopting it and adopting it safely I think [will] be the ones that are going to be able to advance in that experience and be able to continue to gain that trust with their patients.”

The path forward: Trust and transparency

While the data shows that 96% of patients still find their primary care physician trustworthy, that trust is being tested by a system that feels increasingly opaque and expensive, according to the PAN report. To bridge the perception gap, experts suggest that physicians must shift their focus toward price transparency and administrative ease.

Among the 14% of patients Experian identified who said paying for health care improved this year, the top reason was greater transparency, specifically the ability to understand costs before receiving services.

Fortson’s says physicians need to continue investing in the patient experience — and not just the clinical one.

For the modern physician, clinical excellence is no longer enough. To ensure patients actually receive the care you provide, the practice must become as efficient, transparent and digitally accessible as the rest of their lives. As Fortson notes, the technology is now here to help close those gaps; the question is which practices will be bold enough to adopt it.

“I think that providers are going to need to continue to invest, they're going to need to continue to look for automated ways, especially when you look at the staff shortage and training numbers, and figure out ways to help automate that experience,” says Fortson.