Searching for a new physician only to find their patient panel is closed is a common frustration for many people seeking healthcare access. This situation, often referred to as a “closed panel,” means the physician or practice is temporarily not accepting new patients. The reasons are tied to complex pressures within the healthcare system that limit a doctor’s capacity to provide quality care to a growing population. Understanding these factors reveals the systemic challenges affecting the entire healthcare environment.
Practice Capacity and Patient Load Limits
A doctor’s ability to accept new patients is governed by their existing “panel size,” the total number of patients for whom they are professionally responsible. While an older standard suggested primary care physicians could manage 2,500 patients, studies indicate a realistic panel size ranges from 1,200 to 1,900 people to maintain high-quality care. Research suggests delivering all recommended acute, chronic, and preventive care for a 2,500-patient panel would require a physician to work over 21 hours per day, an unsustainable workload. Practices must cap enrollment to prevent patient load from compromising medical outcomes, as larger panels decrease continuity and preventive screenings.
A new patient appointment demands significantly more time than a routine follow-up visit. A comprehensive new patient evaluation requires 45 to 60 minutes to review history, perform an exam, and establish a care plan. An established patient visit may only require 30 to 40 minutes, meaning the intake process for one new patient consumes the time dedicated to two established patients. This time disparity forces practices to limit new patient slots to ensure existing patients receive timely follow-up and acute care appointments.
The administrative burden of modern medicine further constrains a physician’s time for clinical work and new patient intake. For every hour a physician spends interacting with a patient, they typically spend an additional two hours on clerical tasks, primarily managing the electronic health record (EHR). This extensive documentation and charting often contributes to burnout and reduces the total number of hours a physician can dedicate to seeing new people. Practices must account for this non-clinical workload when setting panel capacity, which restricts the rate at which they can safely onboard new individuals.
The Role of Insurance and Reimbursement Models
A doctor’s participation in health plans, known as credentialing, is a major administrative barrier that limits network acceptance. Becoming an approved provider for a single insurance company is a complex, time-intensive process that can take 90 to 180 days to complete. Since each payer has unique requirements, many practices limit the number of insurance networks they join to reduce this ongoing administrative workload. The financial cost of delayed credentialing can be substantial, with estimates suggesting revenue losses of up to $7,500 per day per physician.
Varying payment rates create a strong financial incentive for practices to limit the number of patients they accept from certain plans. Commercial health insurance plans pay physicians significantly higher rates, often averaging around 143% of what Medicare pays for the same service. Government-sponsored programs like Medicaid often have the lowest reimbursement rates, sometimes paying less than half of the Medicare rate. To remain financially viable, practices often use higher commercial rates to subsidize the lower reimbursement from government plans, leading them to limit intake from the lowest-paying networks.
The gradual shift toward “value-based care” models also contributes to the necessity of smaller patient panels. These models compensate physicians based on the quality of patient outcomes and comprehensive management, rather than simply the volume of services performed. Under this new structure, doctors are incentivized to spend more time with individuals, especially those with complex or chronic conditions, necessitating a reduction in total patient volume to meet quality metrics. A value-based model may determine that a physician caring for high-need patients must have a significantly smaller panel to achieve the same level of compensation as a colleague with a panel of healthier patients.
Underlying Physician Supply Gaps
The primary barrier to finding an available doctor is the systemic shortage of physicians across the country, which exacerbates local capacity problems. The Association of American Medical Colleges (AAMC) projects a national shortfall of up to 86,000 physicians by 2036, with primary care facing a deficit of between 20,200 and 40,400 providers. This long-term supply problem means there are simply not enough doctors to meet the nation’s increasing healthcare demand, driven by population growth and an aging demographic.
The lengthy training pipeline required to produce a fully licensed physician ensures that supply cannot quickly adapt to sudden shifts in demand. Becoming an independent physician requires four years of undergraduate study, four years of medical school, and a minimum of three to seven years of residency training, totaling a minimum commitment of 11 to 15 years. Because of this significant lag time, policy changes aimed at increasing the physician workforce today will not yield a fully practicing doctor for over a decade, preventing a rapid solution to the immediate access crisis.
The distribution of the existing physician workforce also creates significant geographic gaps, leaving many areas underserved. On average, rural areas have a 39% higher patient burden per primary care physician than urban areas, meaning rural residents struggle significantly more to find a doctor. The concentration of physicians in metropolitan areas leaves many rural communities in Health Professional Shortage Areas, further limiting options for those outside of major cities.
The increasing rate of physician burnout is actively shrinking the available workforce, as established doctors choose to retire early or reduce their clinical hours. Surveys indicate that a significant number of medical groups have had physicians retire or leave unexpectedly due to burnout. High rates of administrative burden, long hours, and emotional stress contribute to many physicians, particularly those nearing retirement age, choosing to step away from full-time clinical practice, further reducing the overall capacity of the healthcare system.