From 2014 to 2017, the average time a new patient had to wait for an initial cardiology appointment in major metropolitan areas increased from 16.8 days to 21.1 days, according to a recent survey.

New patients had to wait at least 14 days for an appointment in 13 of the 15 metropolitan areas. Boston (45 days), Portland (32 days) and San Diego (30 days) had the longest wait times. In addition, new patients had to wait an average of 32.3 days to see a cardiologist in 15 mid-sized markets.

Overall, the average wait time for the five specialties that the survey covered increased 30 percent since 2017 to 24.1 days.

Merritt Hawkins, a consulting firm that specializes in recruiting physicians and advanced practice clinical professionals, conducted the survey from Jan. 9, 2017, through Feb. 13, 2017.

Since the company conducted its last survey in 2014, the average wait times increased for all five medical specialties it covered: cardiology, dermatology, obstetrics/gynecology, orthopedic surgery and family practice.

For major metropolitan areas, the average wait time was 32.2 days for dermatology (up from 28.8 days in 2014); 26.4 days for obstetrics/gynecology (up from 17.3 days in 2014); 11.4 days for orthopedic surgery (up from 9.9 days in 2014); and 29.3 days for family medicine (up from 19.5 days in 2014).

For the 2017 study, the company’s research associates called physician offices in 15 major metropolitan areas and 15 mid-sized metropolitan areas. They were asked to contact between 10 and 20 physician offices per specialty in each large metropolitan area and five to 10 physician offices per specialty in each mid-sized metropolitan area.

The research associates attempted to schedule appointments at 1,414 physician offices in 15 metropolitan areas and in 494 physician offices in 15 mid-sized markets

Merritt Hawkins conducted similar surveys in 2004, 2009 and 2014, but it was the first time the company examined 15 mid-sized metropolitan markets of between 88,000 and 143,000 people.

For each call, the research associates asked the offices for their first available time for a new patient appointment for the following: a heart check-up (cardiology), a routine skin exam to detect possible carcinomas/melanomas (dermatology), injury or pain in the knee (orthopedic surgery), a routine “well-woman” gynecological exam (obstetrics/gynecology) and a routine physical (family practice). They also asked each practice if the accepted Medicare or Medicaid.

In 2017, an average of 53 percent of physicians in the 15 metropolitan areas accepted Medicaid patients with the rates varying from a low of 17 percent in Dallas to a high of 97 percent in Minneapolis. The rate increased compared with 2014, decreased relative to 2009 and increased relative to 2004.

Meanwhile, the average rate of Medicare acceptance in the 15 metropolitan areas was 84.5 percent in 2017, up from 77 percent in 2014 when the researchers first asked about Medicare acceptance rates. The rates ranged from a low of 69 percent in Houston to a high of 100 percent in Boston and Minneapolis.

Among the major metropolitan areas, Boston (52.4 days) had the longest average wait time and Dallas (14.8 days) had the shortest. Among the mid-sized markets, Yakima, Washington, (48.8 days) had the longest average wait time and Billings, Montana, (10.8 days) had the shortest.

The survey did not collect the causes for the longer wait times, but the researchers mentioned the longer wait times could be due to more people gaining insurance due to the Affordable Care Act and increases in employment and employer-sponsored insurance. They also noted that the Association of American Medical Colleges has said there is a deficit of 21,800 physicians in the U.S. Further, they speculated that an aging population could contribute to the increased wait times.

The researchers also mentioned that the survey had a few caveats, including that it was difficult to gauge a physician’s availability via one phone call. They also noted some of the telephone systems were difficult to navigate.