Most of the discussion was about acute/subacute visits and ignores huge primary care responsibilities. It sets up a system where the backlog is almost always large. You have to schedule ahead -- for convenience and malpractice issues you can't just tell someone to do it themselves. WIth health maintenance and follow-up visits for hundreds or thousands of patients most of the day is full. After that it's MD preference. I have worked with doctors who refuse to schedule a patient after 2PM (to do follow-up, calls, paperwork, and finish up the visits from the morning) and doctors who stay as long as is needed until every "I need to see a doctor today" visit is done. I like (and follow the example of) the latter.

Yes, it's difficult with insurance limits and the wait for a "new patient" appointment slot, but trying to find a doctor who will always see you within a day is worth it. Many exist, but MD's (outside of the few trolling for cash-paying botox visits) still resist advertising shorter wait times, so it's frustrating to wait 2-4 months to see a new MD just to find more of the same lack of responsiveness. It's just the bias of training to not appear to look for business -- maybe that would put a competitive pressure on other MD's if they saw their patients moving away to better, more responsive MD's.

Also, amongst the biggest reasons for a wait is simple supply and demand -- subspecialists limit their numbers severely by only training a set number per year (and subspeciality licensing generally requires going through an official training program, as does getting hospital priviliges for most better quality hospitals).

If seems as if the medical educators cannot get this right. Part of the problem is the inertia in the system--I mean this in the physics sense of the word--where a change in direction occurs slowly. If we decide that we need another 10,000 cardiologists, the residency training programs cannot produce an additional 10,000 cardiologists by admitting them today and pushing them out the door in a year. There aren't the number of programs or the clinical volume to do that, not to say that the training programs can be lengthy.

The problem exists on the other end of the scale, too. Train a cardiologist and he will want to be one for the next 30 years--he's not likely to return to residency at age 50 to become a general surgeon.

There are other considerations as well. I think one of the factors that has yet to be formally investigated is a "learned helplessness" of the US patient population. As a primary care physician, I once received a call at 2AM from a patient who had stubbed a toe but called me without even stopping to turn on the lights so he could look at it himself. My waiting room is flooded with patients with common, mild, self-limiting problems that they haven't given a moment's thought on how they might be able to care for themselves. I don't recall when I was a kid (and that wasn't *that* long ago) myself or anyone I knew going to the doctor for a simple cold, yet the vast majority of my "urgent" same-day calls andn visits are for just that.

Along the same lines and as the PA in the article pointed out, one could certainly argue that instant gratification takes too long in our modern society. Most folks don't want to be seen on the same day, they want to be seen at precisely whatever time is conveient for them on that day. I've had patients offered same day appointments to only have them turn it down and complain later that I "didn't have anything available." Likewise, there is little understanding or respect for the amount of time to heal. It takes time to get over a cold, even if I see you and give you medications, and there is little I or any other physician can do to change that. I've had patients call me the day after surgery complaining about pain, but noted that they didn't think they needed to still take their pain medication because "it shouldn't be hurting still."

Can doctors improve the access issue? Yes, but they can't resolve it alone.