The researchers, all from the VA, compared wait times there for new patients to those for new patients in the private sector as determined by an outside company that used "secret shoppers" to investigate how long it would take to get a first appointment with various types of doctors.
"The VA is seeing more patients than ever and, at the same time, more quickly than ever," said study coauthor Dr. Steven Lieberman, acting Principle Under Secretary for Health at the Veterans Health Administration. "And, veterans are becoming more satisfied with the wait times than previously."
Since the publication of a critical report by the VA's inspector general and a public uproar about veterans' deaths potentially due to long wait times at the Phoenix facility - news reports listed the average wait time there at 115 days - the agency has made an extra effort to get veterans in to see a doctor more quickly, Lieberman said.
The new study, published in JAMA Network Open, was a chance to see if there had been improvements overall in wait times and also to see how the VA stacked up against private sector health care providers.
Lieberman and colleagues reviewed new appointment wait times for primary care, dermatology, cardiology and orthopedics at VA medical centers in 15 major metropolitan areas in 2014 and 2017. For comparison, the researchers turned to a published survey by Merritt Hawkins that used a secret shopper approach to gauge wait times in the private sector in those same 15 metro areas. Veterans' records were included in the study if they lived within 50 miles of one of those metro areas.
Overall, average wait times at the VA were comparable to those at private sector facilities in 2014: 18.7 days to get that first appointment with a private sector doctor versus 22.5 days to see a VA physician.
That changed in 2017. Veterans' average wait was 17.7 days as compared to 29.8 days in the private sector. Similar results were seen for three of the four subspecialties scrutinized by the researchers: primary care, 20 days at the VA versus 40.7 days private sector; dermatology, 15.6 versus 22.6; and cardiology, 15.3 versus 22.8.
Wait times for orthopedics, which had been longer for the VA than the private sector in 2014, continued that trend in 2017, with veterans waiting an average of 20.9 days to see an orthopedic specialist compared to 12.4 days for those seeking appointments in the private sector.
But by looking only at veterans living within 50 miles of metro areas, the study was unable to report wait times for rural vets. Lieberman and his colleagues say the study was designed this way so that it would be comparable to the private sector data from the Merritt Hawkins survey.
The VA has been trying to improve rural access with telemedicine, Lieberman said. "For veterans who live in parts of the country where it's harder to hire clinicians, particularly those in rural areas, we're providing virtual appointments," he explained. "Those are done on a home computer or increasingly on a smart phone."
While the new study is interesting, "there are two important omissions that are among the things people complain about the most: mental health and rural America," said Dr. Albert Wu, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. "Since one fourth of veterans live in rural areas, that's something I am concerned about not being able to get information on from this paper."
SOURCE: http://bit.ly/2CvG5SJ JAMA Network Open, online January 18, 2019.