Industry changes cause long waits to see doctors
A huge push for more dental professionals in the 1970s led to dental schools filled to the brim with eager dentists-in-training. A decade later, dental schools became concerned they were flooding the market with new dentists. They closed some training facilities to reduce the number of new dentists — which proved an effective strategy.
“First, they were worried we had too many dentists,” said Dr. Paul Keelan, of Keelan Dental in Butler Township. “Now, they’re freaking out because there aren’t enough dental schools or new dental students.”
Pennsylvania ranks seventh in the United States, with 7,036 active dentists, according to data from the Pennsylvania Coalition for Oral Health. Yet, it can take between eight and nine months — up from the usual six months — to receive hygienic dental care such as cleanings and annual exams.
Keelan said the COVID-19 pandemic played a role in the longer wait times, noting that some of the older dentists in Pennsylvania chose not to return to treating patients. Some hygienists also chose not to return. While Western Pennsylvania has dental school programs at the University of Pittsburgh, West Virginia University and Youngstown State University, those classes often are filled with nonlocal students who leave the area after graduating, he said.
To avoid long wait times, Keelan said he has three to four dentists available every day to treat patients. They’re also strategic about their schedules.
“Each doctor has two, 30-minute blocks for emergency visits each day,” he said. “In the past we didn’t always do that. But now, we do it so our regular patients don’t have to wait to be called back for their scheduled appointments if there’s an emergency patient here.”
To help speed up the process, Keelan said he recommends patients schedule their next hygiene appointment during their current visit. He also reminds patients that if they fail to show up for an appointment or cancel one and need to reschedule, it can take another eight to nine months to get in.
Dentists aren’t the only medical professionals with longer wait times. Seeing any specialist requires ample patience and sometimes a flexible schedule. One dermatology practice working hard to reverse the trend is Pittsburgh Skin in Cranberry Township.
The average wait time for most appointments is one month, according to practice manager Amanda Troiano. However, they can fit someone in sooner if they have an emergency or discover a new spot or lesion that potentially could be cancerous.
“For those situations, we can get you in same day in our Shadyside office or no later than within two weeks in our other offices,” she said.
Some procedures have longer wait times — including Mohs surgery for skin cancer — because the practice only has one Mohs surgeon, Troiano said.
Troiano said the practice maintains a waitlist as part of its efforts to reduce wait times for appointments. The list is updated in real time online, so patients who need an urgent appointment can go on the website and check for any cancellations.
“Going online and checking that same-day schedule will help them find openings quicker than waiting for us to call people on the list,” Troiano said. “If they see an opening, they can book themselves in.”
To reduce the number of cancellations and no-shows, Troiano said the practice also sends out several appointment reminders, including day-before and day-of notifications to help people remember.
“If people schedule three months out, we certainly understand that they may forget,” she said. “So, we send multiple reminders, even after they confirm the appointment.”
Like most health care providers, Pittsburgh Skin struggled with staffing after the COVID-19 pandemic. While finding new staff still poses some challenges, Troiano said the practice currently has all the staff it needs to meet patient demand.
“Right now, we’re fully staffed, so that allows us to provide a high quality of care. If someone calls off, we have others we can call in to fill the gap, so patients won’t experience any disruptions.”
Health care practitioner offices aren’t the only ones experiencing backups for timely care in Butler County and statewide. Emergency departments across Pennsylvania face a crisis that extends beyond their waiting rooms.
Dr. Kristen Sandel, past president of the Pennsylvania Medical Society and current chair of its emergency department overcrowding task force, said the issue is systemic.
“It’s not just an emergency department phenomenon,” she said. “It’s a hospital and health system phenomenon in the U.S.”
Sandel likened the situation to a clogged sink. Patients flow in from the outside, filling the emergency department basin, but can only drain through discharge to home, transfer to another facility, or admission to the hospital.
“When hospitals are overcrowded, that sink gets clogged,” she said. “And then it overflows.”
Part of the reason some emergency rooms are experiencing higher volumes of patients is the longer wait times to be seen by their regular health care providers.
“Access to primary care plays a role, but it’s not the sole driver,” Sandel said. “Sometimes patients need an urgent resolution, but the approval process can take weeks depending on their insurance. At the ER, they get the care they need in a shorter period of time.”
To address these challenges, Sandel’s task force assembled multidisciplinary teams of emergency physicians, primary care providers, inpatient colleagues, behavioral health specialists, substance abuse disorder experts and geriatricians. They reached out to the governor’s office and the state health department for assistance, recognizing that solutions require a comprehensive approach.
Telemedicine offers one potential avenue for relief. Sandel said telemedicine in ambulatory settings, urgent care and even within emergency departments for stroke care and behavioral health consultations is on the rise.
“Some emergency departments are exploring telemedicine as part of the triage process, though implementation must carefully adhere to the Emergency Medical Treatment and Labor Act, which ensures patients can seek medical care regardless of insurance status or ability to pay,” she said.
Despite the challenges, Sandel said she remains committed to the emergency department’s role as a health care safety net.
“We’ve come a long way in the last few years with our task force in Pennsylvania, but it’s only a small step in the journey,” she said. “ERs are the safety net in the health care system. We’re the only options open 24/7 in most communities, and we are here to treat patients. Not every patient needs an ER, but we’re not going to turn people away. We just need to think smarter as a health care system.”
This article first appeared in the April edition of Butler County Business Matters.
