Long wait times to see a specialist are a familiar frustration in many health systems, and the standard response has been intuitive: hire more physicians. If there are too many patients and too few doctors, surely adding doctors should help. But a new analysis published in NEJM Catalyst suggests that this obvious solution is unlikely to work on its own — and may, in some circumstances, make the problem worse.
The reason lies in how demand behaves. When access to specialists improves, more patients are referred, including those who might have managed without specialist care, and the additional capacity is quickly consumed. Meanwhile, the underlying flow of patients through the system may remain unchanged. Simply adding supply without addressing how patients enter and move through the pipeline can leave waits as long as before. The analysis argues for a more systemic approach: reforming referral pathways, strengthening primary care and ensuring that specialist time is reserved for those who genuinely need it. The finding is a reminder that in complex systems, the intuitive fix is not always the effective one.
