VA Patient Appointment Wait Times Vary Across the United States

Veterans seeking medical care through the Department of Veterans Affairs (VA) have experienced long and disparate patient appointment wait times across various healthcare settings, even after attempts to improve care access, according to a JAMA Network study.

The Veterans Health Administration (VHA)—the branch of the VA that facilitates healthcare delivery for veterans— depends on community-based clinics to meet millions of appointment requests for hundreds of thousands of veterans each year, the researchers said.

The study, which included 4,846,892 veterans who sought medical care from January 1, 2018, to June 30, 2021, measured geographic variation in appointment wait times from VHA and community-based clinicians. The researchers looked at wait times for primary care, mental health, and other specialties.

By leveraging VHA’s Corporate Data Warehouse, researchers gathered data on appointment specialty, patients’ residence, when the referral was initially made, and when the appointment was completed.

VHA medical centers are split into Veterans Integrated Services Networks (VISNs) regions.

The United States is split into 18 VISNs, which consist of catchment areas of their constituent medical centers.

Among VHA facilities, veterans waited an average of 29.0 days for a primary care appointment. In community-based clinics, veterans waited nearly 38.9 days for a primary care appointment.

There was substantial geographic variation in appointment wait times. 

In VISN 10, which covers Ohio, Indiana, and Michigan, primary care appointment wait times were at their lowest for VHA clinicians, averaging 22.4 days. In contrast VISN 15, which covers Kansas and Missouri, appointment wait times were at their highest of 43.4 days.

Less than 53 percent of these appointments met the VHA wait time access standard of 20 days or less, researchers found.

Among community-based appointments, the range was between 25.4 days in VISN 23, which consists of North and South Dakota, Minnesota, Nebraska, and Iowa, and 52.4 days in VISN 12, which includes Wisconsin and Illinois.

On average, 15 of the 18 VISNs had shorter wait times for VHA than community care. 

Appointment wait time for VHA clinicians was an average of 33.6 days for mental health and 35.4 days for all other specialties.

Researchers found that VISN 6, which covers Virginia and North Carolina, had the highest mental health appointment wait time of 42.0 days. The lowest mental health appointment wait time was found in VISN 12.

For all other specialties that the study examined, VHA appointment wait times ranged from 30.3 to 41.9. The lowest was seen in VISN 2, and the highest in VISN 6.

For community-based clinicians, appointment wait times average around 43.9 days for mental health and 41.9 days for all other specialties.

Within the community clinic sector, VISN-level appointment wait times ranged from 29.3 to 65.7 days for mental health, with the lowest times in VISN 2, which covers New York and New Jersey, and the highest in VISN 5, which covers Maryland, Washington DC, and West Virginia.

Nearly 88 percent of the total appointment volume had shorter wait times for VHA clinicians than in community-based care clinics.

Among community-based appointments, VISN-level appointment wait times ranged from 34.7 to 54.8 days for all other specialties. The lowest was found in VISN 15, and the highest wait time was in VISN 7, covering Alabama, Georgia, and South Carolina.

Overall, 44.2 percent of appointments with VHA clinicians exceeded wait time standards, and 49.9 percent of appointments with community care clinicians exceeded wait time standards.

The results imply that policies to expand veterans’ access to private-sector clinicians, such as the Veterans Access, Choice and Accountability Act in 2014 and the VA MISSION, may not lead to lower wait times in certain regions, the researchers mentioned.

VA should focus on interventions that increase the number of ways patients in underserved areas can interact with the healthcare system, researchers recommended.

“The VA Office of Rural Health supports programs that address the healthcare needs of rural veterans through telemedicine, social workers, and transportation services,” the researchers wrote. “For instance, VA Clinical Resource Hubs provide primary, mental health, and specialty care to rural areas through a variety of modalities intended to improve access to care.”

Alternative methods such as online appointment scheduling have been used to address long appointment wait times.  Two researchers from Kaiser Permanente found that open access scheduling reduced their appointment wait times from 55 days to one day.

Generally, timely access to care can reduce the risk of poor health outcomes. Yet, VHA has notoriously had extensive appointment wait times for patients.

To improve access to care for veterans, Congress passed the Veterans Access, Choice, and Accountability Act in 2014 and the VA MISSION (Maintaining Systems and Strengthening Integrated Outside Networks) Act in 2018. 

These acts, created in response to the VA wait time scandal in 2014, allowed enrolled veterans to access primary, emergency, mental health, and other specialty care in their communities at non-VA health facilities.

The study’s results suggest that policymakers must take additional steps to secure veterans’ access to care.