Previous research suggests that access to health care may influence the diagnosis and treatment of obstetric and gynecologic pathologies. Audit studies, a single-blinded and patient-centered design, have been employed to measure access to care for health services. To date, no studies have assessed dimensions of access to obstetrics and gynecologic subspeciality care based on insurance type: Medicaid versus commercial.
To evaluate the mean appointment wait time for a new patient visit to female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, and reproductive endocrinology and infertility when presenting with Medicaid versus commercial insurance.
Each subspecialty medical society has a patient-facing physician directory of physicians across the United States. Eight hundred unique physicians were randomly selected from the directories (200 per subspecialty). Each of the 800 individual physicians was called twice. The caller presented with Medicaid or, in a separate call, with Blue Cross/Blue Shield. The order in which the calls were placed was randomized. The caller asked for the soonest appointment available for respective medical conditions based on subspecialty: stress urinary incontinence, new-onset pelvic mass, preconceptual counseling after an autologous kidney transplant, and primary infertility.
From eight hundred physicians initially contacted, 477 responded to at least one call in 49 states plus the District of Columbia. The mean appointment wait time was 20.3 (SD +/- 18.6) business days. A significant difference was found in new patient appointment wait times by type of insurance, with 44% longer wait time for Medicaid (ratio = 1.44, 95% CI = 1.34 to 1.54, p <0.001). When the interaction between insurance type and subspecialty was added to the model, it was also highly significant (p<0.01). More specifically, Medicaid patients in female pelvic medicine and reconstructive surgery had a longer wait time compared to commercially insured patients. Patients seeking care in maternal-fetal medicine had the least difference, but Medicaid wait times were still longer than commercial insurance wait times.
Typically, a patient can expect to wait 20.3 days for a new patient appointment with a board-certified obstetrics and gynecology subspecialist. Callers presenting with Medicaid insurance experienced significantly longer new patient appointment wait times than callers with commercial insurance.

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