The design of this study was cross-sectional, and the study was limited to a descriptive analysis.

The offices of three different kinds of specialists—cardiologists, endocrinologists, and ophthalmologists—in NYC were contacted by telephone to determine the number of days required to schedule an appointment for a new patient with diabetes.

The sample frame was cardiologists, endocrinologists, and ophthalmologists, listed on the websites of all accredited private or public hospitals in NYC in the fall of 2022.

Each website was reviewed, and contact information for each provider was excerpted into a separate file. Each office telephone number listed on the website was called to determine the following information: whether the physician was accepting new patients, type of insurance accepted (private, public, and none), and number of days for a person with newly diagnosed diabetes to obtain an appointment.

Exclusion criteria included physicians who were not accepting new patients, no longer worked at the hospital, those who only saw specific types of patients (eg, pediatrics), and those who did not have a working phone number. Furthermore, when a doctor was listed at multiple locations, a random number generator was used to randomly select only one office to include. Time on hold while scheduling appointments and availability of web-based booking (“ZocDoc” or the hospital website) were noted, as well as the type of insurance accepted by providers (Medicaid, commercial, or none).

Of the 1639 unique physicians affiliated with (private and public) hospitals in the three subspecialties, a total of 1032 (341 of 670 cardiologists, 228 of 315 endocrinologists, and 463 of 654 ophthalmologists) were in active practice and did not require a referral (Figure 1). For each subspecialty, we determined the mean (SD), IQR, and total range for the continuous variables: the number of days until the first available appointment and the time to reach someone at the office on the telephone to make an appointment. Categorical variables included types of insurance accepted and whether it was possible to schedule an appointment through ZocDoc (a NYC-based web-based appointment booking service) or on the web at the hospital website. All analyses were performed using SPSS (version 28; IBM Corp) [21].

This study was approved by the institutional review board at Teachers College, Columbia University (protocol #23-029). This study did not meet the definition of human participant research for the institutional review board at William Paterson University.

The importance of early detection and treatment of macrovascular and microvascular complications caused by diabetes results in considerable personal and societal costs [22,23]. Living with diabetes requires considerable self-management on a daily basis, as well as scheduling multiple clinical appointments for screening and checkups. Because of the increased risks of macrovascular and microvascular complications, diabetes is the most costly chronic condition in the United States [24], with some estimates stating that 25% of all US health care costs are attributed to the disease [25]. Timely access to health care and education at an early stage in the natural history of the disease can help people with diabetes learn self-management knowledge and skills and delay the incidence of complications [5,26]. Surprisingly, we did not identify any published studies in peer-reviewed biomedical journals that documented the time required for a new patient to obtain an appointment with each of the 3 main clinical specialists who care for people with diabetes: cardiologists, endocrinologists, and ophthalmologists.

The results from this study provide an initial estimate of the wait times required for a new patient to see each of the 3 specialists in NYC. The results indicate considerable variation in wait times both between and within the 3 specialties examined. For example, compared with the mean wait time for a new patient to see a cardiologist, the mean wait time to see an endocrinologist was more than twice as long (36 days vs 82 days), with the mean wait time for seeing an ophthalmologist falling in between (approximately 50 days). The 25% of cardiologists with the shortest wait times were 12 or fewer days, while the 25% with the longest wait times were 51.5 days or longer. For endocrinologists, the 25% with the shortest wait times were 56 or fewer days, while the 25% with the longest wait times were 101 days or longer. The largest IQR in wait times was observed for ophthalmologists; the 25% with the shortest wait times was 10 or fewer days, while the 25% with the longest wait times was 72 days or longer.

While the concept of surveillance may have a negative connotation from socio-political perspectives, surveillance is one of the main public health strategies used for disease prevention and control. By identifying subgroups within the population at high risk, scarce resources can be directed in an appropriate and efficient way. Disease surveillance, therefore, plays a prominent role in national disease prevention and health promotion efforts, including documentation of causes of death, comorbidity, disability, the use and cost of health care, and a wide range of preventive health behaviors [27,28]. Nevertheless, we did not identify any published studies in peer-reviewed biomedical literature regarding wait times for medical appointments, a gap in current knowledge this study aimed to address.

As this was a cross-sectional study, the findings cannot be generalized over time. There were some inaccuracies on the web pages used to construct the sampling frame (including physicians listed who did not provide clinical care or were no longer employed at the respective clinical setting). This in itself is an important finding because it shows the frustration a person with diabetes may face in attempting to schedule an appointment with a provider who is not available. Another limitation is that the data were based on reports from office staff, which may not have been accurate. Nevertheless, this simulates the kinds of information that would have been available to prospective patients calling the respective offices. The doctors included in this study were all affiliated with a hospital in NYC, which provides an incomplete sampling frame of all practices.

This study was focused on health care providers addressing cardiology (macrovascular complications), endocrinology (metabolic control), and ophthalmology (microvascular complications causing diabetic retinopathy) [29]. These 3 aspects of care influence the natural history of diabetes and its major complications. Endocrine-level control of metabolism is paramount for those with diabetes, as it mediates the progression of disease [29]. Poor metabolic control over time causes a wide range of negative clinical consequences [29], including increased risk for heart disease and heart failure [30], which is the leading cause of death in the United States, as well as increased risk, progression, and severity of diabetic retinopathy, the leading cause of nontraumatic blindness among working age adults [30,31]. Both cardiovascular disease and diabetic retinopathy can be treated effectively in the early stages; however, once clinical signs and symptoms are apparent, treatment is less effective [29,30].

Given the paucity of research on wait times for newly diagnosed people with diabetes to obtain an appointment with different specialists, this study provides preliminary estimates that can serve as an initial reference. The geographic scope of this study was limited to NYC, which has a far greater concentration of clinical specialists than many other geographic areas [32]. It is reasonable to expect that wait times may be considerably longer in areas with fewer providers. However, this requires confirmation since providers in some areas may offer remote accessibility. Those with the greatest needs and at the highest risk of experiencing complications from diabetes tend to have the least access to timely health care services [33-35]. While time spent waiting for an appointment is relevant for everyone in the population, it is especially important for people who require multiple annual appointments [36,37]. Additional research is needed to document the extent to which wait times are associated with complications and the demographic and socio-economic characteristics of people served by different providers.