Having a concierge or direct primary care doctor can help with more than just primary care. Often they have relationships that can help you get seen faster by specialists and have relationships within hospital networks.
Specialist wait times vary widely by specialty and city. AMN Healthcare's 2025 survey of 1,391 physician offices found average new-patient waits ranging from 12 days for orthopedic surgery to 42 days for obstetrics and gynecology across 15 large U.S. metropolitan areas.[1]
The averages only tell part of the story. Individual offices quoted waits of nearly six months for cardiology, more than six months for gastroenterology, and more than nine months for dermatology.[1]
Specialist | Average wait across 15 metros | Longest quoted example |
|---|---|---|
Obstetrics and gynecology | 42 days | 231 days in Boston |
Gastroenterology | 40 days | 208 days in Detroit |
Dermatology | 36.5 days | 291 days in Portland |
Cardiology | 33 days | 175 days in Washington, D.C. |
Orthopedic surgery | 12 days | The AMN summary did not highlight a maximum |
AMN researchers called offices in January and February 2025 and asked for the first available new-patient appointment using a standard hypothetical reason for each specialty. These figures measure scheduling availability for the surveyed scenarios. They do not establish how long every patient will wait, and an office may offer a different date after reviewing the clinical urgency.[1]
A six-month wait is an extreme rather than the norm across every specialty, but it is a documented possibility in several major markets.
A concierge or direct primary care (DPC) doctor may help you get seen sooner by improving the referral, calling the specialist, searching other offices and locations, requesting an electronic consultation, and getting you onto a cancellation list. The practice can also complete appropriate testing and manage your care while you wait.
Here is what to expect and what your doctor can do.
1. Ask the Specialist to Re-Triage the Referral
The first appointment offered is often the next routine opening. It may not reflect how urgently your doctor believes you need to be seen.
A concierge or DPC doctor can send a more specific referral and call the specialist when the facts support an earlier evaluation. The referral should state:
The exact question the specialist needs to answer
How long you have had the symptoms and how they have changed
Important examination findings and test results
Treatments already tried and whether they worked
Why waiting could change the outcome or treatment options
“Joint pain, see rheumatology” gives a scheduling team little basis for triage. A referral that describes new swelling in three joints, morning stiffness lasting 90 minutes, the relevant laboratory results, and the response to anti-inflammatory treatment gives the specialist information to assess urgency.
The Agency for Healthcare Research and Quality (AHRQ) recommends sending the reason for referral, relevant history, medications, and test results. It also advises primary-care practices to build relationships with specialists who provide timely appointments and communicate results.[2]
A doctor-to-doctor call does not guarantee an earlier visit. It gives the specialist a clinical reason to reconsider the date. The specialist may open an urgent slot, direct you to a colleague, request a test first, or confirm that the original date is safe.
This is the long-wait version of a concierge doctor specialist referral: the primary-care doctor stays involved after sending the order.
2. Search More Than One Office
The first specialist may have the longest queue because that doctor works in your usual health system or has the most familiar name. A concierge or DPC practice can search several routes at the same time:
Another qualified physician in the same group
A different office location for the same specialist
An independent specialist outside your usual hospital system
A nearby city with more availability
A telehealth intake followed by local testing
A cancellation list for short-notice openings
Ask the practice to confirm two things before changing the referral: the doctor has the right subspecialty expertise, and the doctor accepts your insurance. Seeing the wrong type of specialist sooner can send you back to the beginning.
Also ask exactly how the cancellation list works. Some offices require patients to call regularly. Others send a text that must be accepted within minutes. Tell the office how far you can travel and how little notice you need.
Concierge and DPC memberships do not remove insurance rules. The specialist may still require a plan referral, and imaging or procedures may require prior authorization. The outside specialist also bills separately unless your membership agreement says otherwise.
3. Request an eConsult or Earlier Telehealth Visit
Some health systems offer an electronic specialist consultation, usually called an eConsult. Your primary-care doctor sends a focused question and the relevant records. The specialist reviews the case and replies without seeing you in person.
An eConsult can recommend a test, suggest interim treatment, clarify whether you need a particular subspecialist, or determine that the in-person visit should happen sooner. It cannot replace every physical examination or procedure.
A systematic review of 43 studies found that eConsults generally improved access and were well accepted by clinicians. Evidence about long-term health outcomes remained limited.[3] An earlier review found response times ranging from 4.6 hours to 3.9 days across the programs studied, although the programs and patients varied widely.[4]
Ask whether the specialist can review your case electronically or see you by video before the in-person appointment. A video visit may handle history review and planning, while some problems still require a hands-on examination. NextMD's guide to telehealth versus in-person primary care explains the difference.
4. Complete Useful Testing Before the Appointment
A referral may stall because the specialist lacks information needed for triage. The first specialist visit may also end with orders for laboratory work or imaging, followed by another wait.
Your concierge or DPC doctor may be able to complete appropriate preliminary work first. Depending on your symptoms and examination, that could include:
Repeating a result that may have been temporary
Ordering focused laboratory tests
Obtaining an electrocardiogram or another office-based test
Arranging imaging when the result will affect urgency or treatment
Reviewing older imaging, pathology, or procedure reports
Checking whether a medication or supplement could explain the change
Testing should answer a defined clinical question. A broad panel can produce unrelated abnormalities, extra expense, and more uncertainty. Ask what each test could show and how the result would change the referral or treatment plan.
The results may also route you to the correct subspecialist. A cardiology referral could lead to a general cardiologist, an electrophysiologist for a heart-rhythm problem, or a heart-failure specialist. A precise referral can prevent a long wait for the wrong office.
5. Treat What Primary Care Can Manage Safely
A referral does not end primary care's role. Your doctor may be able to treat symptoms, adjust an existing medication, begin standard initial treatment, or manage a related condition while you wait.
What is safe depends on the possible diagnosis. Starting treatment too early could obscure an important finding or interact with another medication. In other cases, primary care can relieve symptoms or begin treatment safely.
Ask:
What are we treating while the diagnosis remains uncertain?
What improvement should I expect, and by when?
Which side effects or changes require a call?
Could this treatment affect the specialist's examination or testing?
Your doctor can also manage conditions that affect the specialist's eventual plan. Someone waiting for orthopedic evaluation may still need blood-pressure control, medication review, or diabetes management before surgery becomes an option. Patients managing several diagnoses can read NextMD's guide to concierge medicine for chronic conditions.
6. Send a Record the Specialist Can Use
A complete referral package can improve triage and prevent the first appointment from becoming a search for missing information. It should include:
A one-paragraph summary and referral question
A dated symptom timeline
Current medications, exact doses, allergies, and prior reactions
Relevant laboratory results with collection dates
Imaging reports and image files when requested
Pathology, procedure, or operative reports
Treatments tried, including dose, duration, and result
The decisions you need help making
The U.S. Food and Drug Administration recommends keeping a current list of prescription medicines, over-the-counter drugs, vitamins, and supplements, including the strength and instructions for each item.[5]
With limited exceptions, the Health Insurance Portability and Accountability Act (HIPAA) gives you the right to inspect and receive copies of medical and billing records held by covered providers and health plans.[6] Request important records early. Confirm that the specialist received them and attached them to the correct chart.
7. Set a Monitoring and Escalation Plan
A six-month wait needs scheduled follow-up. Before leaving primary care, agree on:
Which symptoms, measurements, or test results you will track
When your doctor will review them
What change should trigger another examination or referral call
Which symptoms require urgent or emergency care
Who reviews each result and contacts you
New or worsening symptoms may change the referral's urgency. Tell your doctor rather than assuming the original appointment date still applies.
Some symptoms require emergency care. The Centers for Disease Control and Prevention advises calling 911 for possible heart-attack symptoms such as chest discomfort, shortness of breath, faintness, or pain in the jaw, neck, back, arms, or shoulders.[7] Sudden one-sided weakness, trouble speaking, vision loss, loss of balance, or a sudden severe headache can indicate stroke and also require an immediate 911 call.[8] Do not wait for a routine message response in an emergency.
Nine Questions to Ask This Week
Is this appointment date medically appropriate?
Can you ask the specialist to re-triage my referral?
Can your office check other doctors and locations?
Am I on the cancellation list, and how does it work?
Can you request an eConsult or earlier telehealth visit?
Which tests would change the urgency or referral destination?
What can you treat safely while I wait?
When will you see me again?
Which changes require a same-day call, urgent care, or 911?
Primary Care Should Stay Involved
A specialist referral adds expertise to your care. It does not remove your primary-care doctor from the plan.
A concierge or DPC practice may have more time to call several offices, assemble records, review new results, and reassess the referral. The services vary, so ask how the office handles long specialist waits when choosing a concierge or DPC doctor.
These steps can produce an earlier appointment. When the date does not change, they still create a defined care plan for the months before the specialist visit.
Search NextMD to find physician-led concierge and direct primary-care practices. When you call, ask what the practice does when the specialist you need is booked for months.
A Note From the Author
This article provides general education and is not medical advice. A clinician who knows your history must decide which tests, treatments, and referral timing are appropriate. Call 911 for symptoms of a medical emergency.
Sources
AMN Healthcare. (2025). 2025 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates. Read the appointment wait-time survey
Agency for Healthcare Research and Quality. (2024). Make Referrals Easy: Tool 21. Health Literacy Universal Precautions Toolkit, 3rd Edition. Read AHRQ's referral-management guidance
Liddy, C., Moroz, I., Mihan, A., Nawar, N., and Keely, E. (2019). A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide. Telemedicine and e-Health, 25(3), 184–198. Find the systematic review on PubMed
Liddy, C., Drosinis, P., and Keely, E. (2016). Electronic Consultation Systems: Worldwide Prevalence and Their Impact on Patient Care, a Systematic Review. Family Practice, 33(3), 274–285. Find the systematic review on PubMed
U.S. Food and Drug Administration. (2025). Create and Keep a Medication List for Your Health. Read the FDA medication-list guidance
U.S. Department of Health and Human Services. (2025). Your Medical Records. Review patient access rights under HIPAA
Centers for Disease Control and Prevention. (2024). About Heart Attack Symptoms, Risk, and Recovery. Review heart-attack symptoms and emergency guidance
Centers for Disease Control and Prevention. (2024). Signs and Symptoms of Stroke. Review stroke symptoms and emergency guidance
Source Attribution
Wait-time benchmark: AMN Healthcare 2025 survey
Referral workflow: AHRQ referral-management guidance
Electronic specialist consultation evidence: two peer-reviewed systematic reviews indexed by PubMed
Patient safety and records: FDA, HHS, and CDC