Clocking Injustice: Racial Disparities in Specialty Wait Times

OBJECTIVE: Timely access to care is associated with improved morbidity, mortality, and quality of life, making disparate access to specialty care a potential contributor to racial inequities in health outcomes. In this nationwide analysis, we quantified specialty care waits by race and ethnicity and identified potential drivers of observed disparities. STUDY SETTING AND DESIGN: The U.S. Veterans Health Administration (VHA) provides care directly through its network of 170 medical centers and 1,193 associated outpatient clinics. In addition, the VHA pays for millions of appointments with community-based specialists each year. We used multivariate regression models and Kitagawa-Oaxaca-Blinder decomposition to identify drivers of disparities between White and minoritized veterans. DATA SOURCES AND ANALYTIC SAMPLE: We used administrative data to identify patients referred to either VHA or community specialists during 2018-2022 for the 10 highest-volume specialties: cardiology, dermatology, otorhinolaryngology, gastrointestinal endoscopy/gastroenterology, mental health, ophthalmology, orthopedics, podiatry, physical therapy, and urology. PRINCIPAL FINDINGS: Our sample included 6,619,517 referrals to VHA specialists and 3,753,657 referrals to community care. Black patients had the longest mean waits for VHA care (40.0 days, SD = 40.3) followed by American Indian/Alaska Native (38.6 days, SD = 40.0), Hispanic (38.4 days, SD = 38.4), Asian/Pacific Islander (38.1 days, SD = 38.0), and White patients (37.1 days, SD = 39.5). For community care, Black patients had the longest mean waits (52.9 days, SD = 49.3) followed by Asian/Pacific Islander (46.8 days, SD 43.1), American Indian/Alaska Native (46.5 days, SD = 42.1), White (45.1 days, SD = 41.7), and Hispanic patients (42.0 days, SD = 37.6). Disparities were primarily attributable to group-level differences in the distribution of facilities from which patients were referred and specialty mix. CONCLUSIONS: Compared to non-Hispanic Whites, minoritized patients tended to receive referrals from facilities that had longer wait times. Policies designed to increase quality and health care supply in under-resourced areas may be an important strategy in closing racial inequities in timely access to care.