Patient behavioural strategies to improve access to primary care appointments

We conducted a field experiment to measure whether patients' use of different phrases can improve access to primary care appointments and whether patient gender, race, and ethnicity moderate these effects. Simulated patients were randomly assigned to three scripts in seeking an appointment: (1) a control script, (2) an additional prompt to seek an alternate provider, and (3) an additional prompt complimenting the practice for its reputation. Simulated patients were randomly assigned to primary care physicians drawn from a nationally representative sample (N = 1,328). Our results show that the reputation script was not associated with any aggregate differences in access outcomes while the alternate provider script was associated with a 20-percentage point increase [95% CI: 0.11, 0.28; p < 0.01] in appointment offers from alternate providers. However, Black patients realized no access benefits and faced longer wait times. Hispanic patients experienced higher levels of access to alternate providers, but at a cost of lower levels of access with their requested physicians. White patients were the only group to experience more access to alternate providers without facing longer wait times or substitution away from their requested physicians. These equity-decreasing results highlight limitations in individualized efforts of minoritized patients to effectively advocate for improved access.