Research letter
Waiting Times for Appointments Depending on Medical Specialty
Findings of a Patient Survey in Connection with Routine Data of a Statutory Health Insurance Carrier
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Long waiting times for physician appointments are particularly common at specialty practices, but less so at primary care practices (1, 2). Differences in appointment availability between individuals with statutory versus private health insurance are likewise a topic of discussion (3). The data from the insured persons survey of the German National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) (1) do not permit small-scale analyses or linkages with routine data from the statutory health insurance system (Gesetzliche Krankenversicherung, GKV). To assess the experiences of its insured members, the German general local health insurance fund AOK (Allgemeine Ortskrankenkasse) for Rheinland/Hamburg conducted a survey.
Methods
Between August 1 and October 16, 2023, insured individuals were surveyed regarding their most recent visit to a specialist physician. Inclusion criteria comprised the following—age: 40–66 years, specialist medical billing for medical aids, therapeutic products, medications, or periods of incapacity for work within the last 3 months, relevant organizational criteria (for example, declaration of consent for telephone contact). The 10 most frequently mentioned specialties were linked to routine data, provided that an informed consent form was available.
The questionnaire was based on the KBV insured persons survey (1). The target variable, “time to appointment,” was summarized as follows: 1) Immediate/no waiting time/up to 1 week, 2) up to 3 weeks, 3) more than 3 weeks. Since the assumption of proportional odds was violated in the ordinal logistic regression, a generalized logit model with forward selection (significance level: 0.1%) was estimated. The objective here was to compare the effects of the specialties while controlling for other inclusion factors.
Results
Of the 8055 insured individuals contacted, 5685 responded. Lack of interest (n = 1134) and comprehension difficulties (n = 959) were the main reasons given for non-participation. Waiting times of more than 3 weeks were most commonly observed in gastroenterology, radiology, rheumatology, dermatology, and pulmonology (4). As the analysis was limited to the 10 most frequently mentioned specialties (n = 4721), gastroenterology, radiology, and rheumatology, among others, were excluded. Furthermore, insured persons who did not consent to data linkage (n = 504), whose reported specialty did not match the routine data (n = 866), who did not reside in the Rheinland area or Hamburg, or who did not provide complete information on waiting times (n = 146) were excluded. This left data for 3205 insured persons.
Of these, 38.4% (n/N = 1230/3205) waited > 3 weeks for a specialist appointment, 21.3% (n/N = 682/3205) ≤3 weeks, and 40.3% (n/N = 1293/3205) ≤1 week. Waiting times of over 3 weeks were most frequently reported in dermatology, cardiology, and pulmonology, and least frequently reported in otorhinolaryngology, urology, and gynecology (Figure). A total of 31.6% (n/N = 1013/3205) of respondents considered waiting times to be too long; for waiting times of over 3 weeks, the figure was 58.0% (n/N = 713/1230).
Reasons for making an appointment included: current problems (49.3%, n/N = 1580/3205; waiting times: ≤1 week: 42.3%; ≤3 weeks: 22.9%; > 3 weeks: 34.8%); a chronic disease (38.1%, n/N = 1 221/3205; waiting times: ≤1 week: 39.1%; ≤3 weeks: 20.1%; > 3 weeks: 40.8%); or another reason, for example, screening (12.6%, n/N = 404/3205; waiting times: ≤1 week: 36.6%; ≤3 weeks: 18.3%; > 3 weeks: 45.0%).
In response to the question, “When making an appointment, did you have the impression that a distinction was made between patients with private and those with statutory health insurance?”, 32.8% (n/N = 1051/3205) of respondents answered “yes,” 41.3% (n/N = 1326/3205) answered “no,” and 25.8% (n/N = 828/3205) were unable to say. Differences in appointment allocation were most frequently perceived in dermatology (42.7%, n/N = 70/164), cardiology (35.8%, n/N = 69/193), orthopedics (35.4%, n/N = 500/1412), and otorhinolaryngology (35.3%, n/N = 53/150). This was less frequently the case in urology (21.7%, n/N = 30/138), psychiatry (23.6%, n/N = 41/174), and gynecology (25.1%, n/N = 64/255).
The Table shows the odds of waiting up to 3 weeks or more than 3 weeks compared to a waiting time of under 1 week. After controlling for other variables in the model, insured individuals visiting dermatology, pulmonology, cardiology, psychiatry, or neurology practices were between four and five times more likely to experience waiting times of more than 3 weeks (reference: ≤1 week) compared to those visiting otolaryngology practices. Depending on place of residence, the odds may be up to twice as high. The odds of longer waiting times are slightly higher in the case of self-scheduled appointments, women, and persons of foreign nationality. These odds decrease somewhat in the case of current problems or previous use of the practice. The variance explained by the regression model is low.
Discussion
Waiting times differ significantly depending on the specialty. Across all specialties, at least 50% of respondents obtained an appointment within 3 weeks. Depending on the specialty, between 19% and 50% waited longer than 3 weeks. Even after controlling for the characteristics of insured individuals and their reported data regarding physician appointments, clear differences in waiting times remain. The low explained variance of the regression model points to influencing factors that could not be taken into consideration here. Future studies would benefit from more detailed data collection, especially with regard to longer waiting times.
Only cases in which specialties were concordant between the survey and the routine data were included. In 20% of cases, there was no concordance. It is also possible that patients’ reports regarding waiting times were subject to inaccuracy. Both factors could lead to bias in the results.
Lack of interest in the survey may be due to unproblematic appointment scheduling, potentially resulting in an overestimation of longer waiting times. Non-native German-speaking insured individuals may be underrepresented due to comprehension difficulties. At 71%, the participation rate was high.
In view of the shortage of healthcare professionals, demographic change, and cost pressures in the healthcare sector, the situation in specialist medical care is likely to worsen. Solutions must be sought to counteract the shortage of healthcare professionals and to make the most targeted use of existing resources—for example, through effective patient management using artificial intelligence, integrated primary care models, the delegation of medical tasks, and regional initiatives.
Acknowledgments
Particular thanks go to the team at the “Kunden” Service Center (customer service center) for conducting the insured persons survey, as well as to individuals insured with the AOK Rheinland/Hamburg who took part in the survey.
Kerstin Hermes-Moll, Moritz Kayser, Arnold Böcker, Maria Peters, Heike Rubbert, Christian Wehner
Conflict of interest statement
The authors declare that no conflict of interest exists.
Manuscript submitted on 21 February 2025, revised version accepted on 18 June 2025.
Cite this as
Hermes-Moll K, Kayser M, Böcker A, Peters M, Rubbert H, Wehner C: Waiting times for appointments depending on medical specialty: Findings of a patient survey in connection with routine data of a statutory health insurance carrier. Dtsch Arztebl Int 2025; 122: 529–30. DOI: 10.3238/arztebl.m2025.0116
kerstin.hermes-moll@rh.aok.de
AOK Rheinland/Hamburg – Die Gesundheitskasse, Department of controlling and finances (Böcker)
