New AMN Healthcare report tracks the average new patient wait times in 15 cities for six specialties.

The struggles of rural Americans to access physicians in designated healthcare deserts is well-documented.

Now, a new survey from clinician recruiters AMN Healthcare shows that urbanites face similar hurdles. On average, AMN's 2025 Survey of Physician Appointment Wait Times found that it takes 31 days to schedule doctors' appointments in 15 of the nation's largest cities. That's an increase of 19% (26 days) since 2022, and 48% (21 days) since 2004 in cities with the nation's highest per capita concentrations of doctors.

"Average physician appointment wait times are the longest they have been since we began conducting the survey (in 2004)," says Leah Grant, president of AMN's Physician Solutions division. "Longer physician appointment wait times are a significant indicator that the nation is experiencing a growing shortage of physicians."

Average physician appointment wait times in the six specialties surveyed include:

• OB/GYN - 42 days, up 33% since 2022 and up 79% since 2004. 
• Gastroenterology - 40 days (gastroenterology was added to the survey in 2025).
• Dermatology - 36.5 days, up 6% since 2022 and up 50% since 2004.
• Cardiology - 33 days, up 23% from 2022 and up 74% since 2004.
• Family Medicine - 23.5 days, up 14% since 2022 and up 16% since 2009, the first year family medicine was included in the survey.
• Orthopedic Surgery - 12 days, down 29% since 2022 and down 29% since 2004.

Of the cities surveyed, Boston, with one of the nation's highest per capita concentrations of physicians, also has the longest average physician appointment wait time at 65 days, while Atlanta has the shortest at 12 days.

By some accounts, there were 313 physicians per 100,000 people in 2024, with 1,109,460 physicians covering 353 million people nationwide. The District of Columbia has 1,639 physicians per 100,000 residents, the highest in the nation, whereas predominantly rural Idaho has 19 physicians per 10,000 residents. In general, rural areas have about 13 physicians per 10,000 people, compared to 31 per 10,000 in cities.

Grant says it's telling that urban patients are having trouble booking appointments in areas rife with physicians.  

"It's a sobering sign for the rest of the country when even patients in large cities must wait weeks to see a physician," she says.

Physician appointment wait times can vary widely depending on the specialty and metropolitan area. For example, wait times can range from as short as one day to as long as 291 days for a dermatology appointment in Portland, Oregon, as long as 231 days for an obstetrics/gynecology appointment in Boston, as long as 208 days for a gastroenterology appointment in Detroit, and as long as 175 days for a cardiology appointment in Washington, D.C.   

What's Driving This?

There is no indication that wait times are going to improve in the near future. A 2024 Association of American Medical Colleges report projects a shortage up of to 86,000 physicians by 2036. The Health Resources and Services Administration projects a shortage of 57,259 full-time-equivalent physicians this year and a shortage of 81,180 physicians by 2035.

AMN says factors driving the physician shortage include population growth, an aging population and corresponding aging physician population, pervasive ill-health, limited physician training capacity, physician burnout, and physician maldistribution.

"Lengthening physician appointment wait times are the inevitable outcome of the growing gap between demand for physicians and the available supply," Grant says.

"An aging population is driving demand for doctors higher at the same time that physicians themselves are aging out of the system. Meanwhile, the pipeline of new physicians is limited due to underfunding of physician graduate medical education.  As a result, people are waiting weeks or months to see a physician."

Medicare / Medicaid Acceptance Rates

The survey reports that 82% of physicians in the 15 major urban markets accept Medicare. Boston has the highest number of physicians accepting Medicare at 94%, while Atlanta has the lowest at 68%.

However, only 53% of physicians in the 15 metropolitan areas accept Medicaid. Detroit leads the way at 85%, while New York has the lowest at 28%.

"The type of health insurance patients have may impact their access to physicians," Grant says. "While Medicare is widely accepted by physicians, Medicaid is less so."

The survey includes data from 1,391 physician offices in Atlanta, Boston, Dallas, Denver, Detroit, Houston, Los Angeles, Miami, Minnesota, New York City, Philadelphia, Portland, San Diego, Seattle, and Washington, D.C.   

Front-line nurses often cite inadequate support from leadership as their top reason for leaving.

Pizza parties, birthday sing-alongs, and other appreciation ceremonies can be welcomed as temporary distractions for stressed-out nurses. But that probably won't do much to prevent them from leaving.

Instead, nurse executives who want to bolster retention should focus on the profession's middle managers, the workhorse administrators who are the face of leadership to frontline nurses. That's according to a new report from McKinsey & Company, which estimates that hospitals could save up to $700 million annually—and improve care—by reducing frontline-nurse turnover through strengthened manager support.  

"Organizations that invest in nurse managers see benefits beyond improving workforce stability, team culture, and quality of care," writes Gretchen Berlin, RN, a senior partner at McKinsey. "Their investments can also deliver a clear financial benefit by reducing turnover for both frontline nurses and nurse managers."

The McKinsey Nursing Pulse Survey, 2025 finds that fewer nurses are considering leaving their jobs, when compared with previous surveys. However, of the 20% of frontline nurses who say in the survey that they are considering leaving their jobs, 41% blame inadequate support from leadership as their top reason for doing so, second only to the 53% of unhappy respondents who say they're simply looking for a better job.   

Savvy middle-managers observe first-hand the stressors direct-care nurses face every day and can offer effective strategies to reduce drudgery and increase job satisfaction.

Along with improved retention, strong middle-management has other benefits, such as influencing team culture, managing productivity, and maintaining care quality.

A 2024 report published by the American Organization for Nursing Leadership linked strong managers with fewer falls among patients, a reduced rate of hospital-acquired infections, along with a 68% increase in frontline-nursing retention.  

M'eh! No Thanks!

Perhaps the biggest obstacle for improving nurse managers is finding people who want the job. Even though 60% of front-line nurses in the survey say effective managers improve their job satisfaction, more than half (54%) of those front-line nurses say they are not interested in leadership jobs because of red tape hassles, high stress, and daunting responsibility.

This disinterest in leadership seems to develop as nurses age (which speaks volumes about the difficulty of the job). Nearly three-fourths (72%) of nurses with less than five years of experience want to pursue a leadership position, but only 53% of mid-tenure nurses with six to 20 years of experience feel the same.

"This drop in interest provides an opportunity for healthcare organizations to evaluate leadership roles in an effort to make leadership an attractive specialty across nursing tenures," Berlin says.

New Roles, More Help

Nurse executives can reduce the burden on mid-level nurse managers by first recognizing their pain points. For example, 48% of nurse managers who told McKinsey they were considering leaving cited "unmanageable workloads."

"To address this, organizations can focus on strategic role design, invest in upskilling, and implement best-in-class tools that enable managers to thrive in their roles," Berlin says.

Oftentimes, unit staff is too big to allow a nurse manager to develop one-on-one interactions with front-line staff, which denies them consistent feedback and professional-development coaching.

To address this, Berlin says  clinical-care organizations can review unit structures and workloads by tapping assistant nurse managers, whose presence in departments has also been shown to decrease RN turnover rates.

"They can also standardize responsibilities for nurse managers across units (for example, administrative expectations such as budgeting and strategic planning, as well as staff onboarding and hiring expectations) to ensure fair distribution of work, provide consistent and clear expectations, and improve accountability and resource allocation," Berlin says.

Hybrid Work Options

More than half (52%) of nurse managers say that not having work–life balance is a big reason for leaving, and 75% say they could continue their work in some capacity remotely. Berlin notes that "while there will always be critical in-person components to the role, organizations could evaluate what level of flexibility may be appropriate (and potentially highly valued by managers in return)."

Invest in upskilling

Successful nurse managers must have a broad range of knowledge, but they are often hampered by training that is limited to daily tasking, such as working with the HR systems, inventory, chart audits and scheduling.  In addition, nurse managers have varying levels of training and experience. And there is often variability in onboarding and training, with nurse managers learning while on the job.

"Organizations can address this by offering standardized training to establish the skills needed for the role, including the technical skills to handle tasks such as balancing a schedule or managing a budget and the interpersonal skills to deal with activities such as conflict resolution, stakeholder management, and coaching," Berlin says. "Such upskilling can help empower nurse leaders to more effectively manage their departments."

"Moreover, organizations can enhance their overall talent development strategy by implementing mentoring programs," Berlin says. "Given that nurses' interest in management roles tends to wane over time, mentorship initiatives can serve as a vital way to sustain engagement and equip nurses with the necessary leadership skills."

"Additionally, fostering frontline nurses' advancement into leadership positions helps to establish a robust succession plan," Berlin says, "which in turn helps to ensure continuity and stability in leadership."

Tap Tech

Nurse managers tell McKinsey that daily administrative tasks were a top source of frustration. That's where technology comes in. AI-enabled automation, for example, can provide a reprieve for some of these tasks and allow managers to focus on high-level, specialized activities.

"Nearly all nurse managers (98%) say that technology that could simplify staffing, support team recognition, manage audits, and streamline onboarding and hiring would make their jobs easier," Berlin says.

CMS attributes the rapid growth in 2023 to "non-price factors" including the use and intensity of healthcare services.

The nation's healthcare expenditures hit $4.9 trillion in 2023, increasing by 7.5%, up sharply from recent post-COVID annual expenditures and rising to $14,570 per person, federal actuaries reported Wednesday.

The analysis by the Office of the Actuary at the Centers for Medicare and Medicaid Services, published online Wednesday in Health Affairs, showed that growth in 2023 was markedly higher than the post-COVID 4.6% rate of growth in 2022, and 4.6% in 2021, but also well below the 10.6% growth in 2020 when the coronavirus pandemic raged.

Healthcare’s share of the economy was 17.6% in 2023, in line with 17.4% in 2022, but lower than during the pandemic years in 2020 and 2021. 

CMS attributed the accelerated growth in 2023 to "non-price factors," including the use and intensity of healthcare services that were made available owing to strong enrollment in commercial insurance and Medicaid, with 92.5% of the U.S. population covered.

When adjusted for inflation, using the National Health Expenditure deflator, real healthcare spending increased 4.4% in 2023—up from 4.1% in 2022 and higher than the growth rate of 2.9% of the gross domestic product in 2023.

The overall GDP grew 6.6% in 2023, after dramatic volatility during the pandemic that saw the GDP shrink by 0.9% in 2020, followed by increases of 10.9% and 9.8% in 2021 and 2022, respectively. Even with that volatility in both healthcare spending and GDP growth, CMS notes that the growth rates were similar during 2020–23, at 6.6% per year and 6.5% per year, respectively.

Of the $14,570 in per person health spending in 2023, CMS says the federal government accounted for 32% ($4,689 per person). Households paid for 27% ($3,942 per person), private businesses accounted for 18% ($2,677 per person), state and local governments another 16% ($2,279 per person), and other private revenues the remaining 7% ($983 per person)

Spending by Source of Funds

• Private Health Insurance (30% share): Spending for private health insurance reached $1.5 trillion in 2023 and increased 11.5%. The robust growth in 2023 was driven by increased enrollment in Marketplace and employer-sponsored private health insurance plans, strong growth in spending for goods and services, and strong growth in the net cost of insurance. In 2023, enrollment in private health insurance increased 1.6%, or by 3.3 million individuals. 

• Medicare (21% share): Medicare spending reached $1 trillion in 2023, increasing 8.1% following 6.4% growth in 2022. This faster growth was driven by a turnaround in traditional fee-for-service spending growth (from a decline of 1.4% in 2022 to an increase of 1.7% in 2023). Medicare Advantage private plan spending continued to experience rapid growth (increasing 14.7% in 2023 following 15.7% growth in 2022) and accounted for 52% of total Medicare expenditures in 2023 (from a 39% share in 2019). Total Medicare enrollment grew 2.1% in 2023, a slight acceleration from 2022 when enrollment increased 1.9%. 

• Medicaid (18% share): Medicaid spending increased 7.9% to $871.7 billion in 2023, a slower growth rate than in 2022 (9.7%) and 2021 (9.5%). In 2023, Medicaid enrollment increased 0.8%, following growth of 7.5% in 2022, and reached 91.7 million, even as states resumed the re-determination of Medicaid eligibility (also referred to as “unwinding”) following the end of pandemic-era coverage protections. 

• Out-of-Pocket (10% share): Total out-of-pocket spending increased by 7.2% in 2023 to $505.7 billion, a slight acceleration from growth of 6.9% in 2022. Hospital care, physician and clinical services, and nursing care facilities and continuing care retirement communities, which collectively accounted for 33% of all out-of-pocket spending in 2023, were the main contributors to the faster growth in 2023. 

Spending by Service or Product

• Hospital Care (31% share): Spending for hospital care services increased 10.4% in 2023 to reach $1.5 trillion. This rate of growth was the fastest since 1990, when hospital spending increased 10.8%. Faster growth in 2023 was driven by non-price factors (which include the use and intensity of services), with an increased number of hospital discharges and increased Medicare outpatient hospital utilization.  

• Physician and Clinical Services (20% share): Spending for physician and clinical services increased 7.4% to $978 billion in 2023, which was faster than the growth rate of 4.6% in 2022. Faster growth in 2023 was driven by non-price factors (which includes use and intensity of services), while price growth remained low at 0.6%.  

• Retail Prescription Drugs (9% share): Retail prescription drug spending increased 11.4% to $449.7 billion in 2023, accelerating from a rate of 7.8% in 2022. The rapid growth in spending for drugs used to treat diabetes and obesity contributed to faster overall growth in retail prescription drug expenditures.  

Eight-in-10 surveyed provider execs say the rise in payer denials is 'brazen' and 'intentional.'

Friction between health systems and payers has worsened over the past three years, a new survey finds, with 80% of provider CFOs accusing the plans of "intentional or systematic efforts to increase denials."

The report from the Healthcare Financial Management Association found that nearly six-in-10 CFOs surveyed for "Bridging the Payer-Provider Divide" say their relations with payers are deteriorating.

The CFOs didn't hold back, describing the high rates of payer denials and claim adjudication errors as "dirty tactics," "brazen" and "shocking." Surging denials have led 75% of respondents to add financial services staff in the past three years to manage the process.

In sharp contrast, health plan executives reviewing the findings claim payer-provider relations are strong, and they point to value-based care initiatives as evidence.

So, where's the disconnect?

"Hospitals and health plans engaged in value-based payment initiatives have had some success in developing collaborative working relationships," says Richard L. Gundling, who leads HFMA's content and professional practice.

"But on the fee-for-service side, the tenor of these relationships has deteriorated as providers' frustration levels with payers' administrative requirements and expectations have increased."

About 64% of CFOs say it's too early to tell what effect AI will have on dealings with payers, and another 29% expect AI to make matters worse. Increased payer transparency around payment rules and behaviors was cited by 75% of respondents as the primary change that could strengthen their organization's payer relationships.

About 87% of CFOs say strained relations with health plans hurts care delivery and that patients often blame them instead of payers for delays and coverage denials.

The report offers ideas for building stronger payer-provider connections.