Why healthcare growth stalls between demand and the visit, and a four-quadrant way to find the leak.
There’s a conversation happening in a lot of health system leadership meetings right now. The campaign hit its numbers. Search impressions are up, form fills are up, the call center is busy. And patient volume in the service line barely moved.
The usual next step is to look harder at marketing. Test new creative, shift the channel mix, add budget. Sometimes that’s the right call. More often, the problem sits somewhere marketing doesn’t own: the stretch between a patient raising their hand and a patient walking in the door.
The wait is getting longer
AMN Healthcare’s 2025 Survey of Physician Appointment Wait Times looked at 1,391 physician offices across 15 of the largest U.S. metros. New patients now wait an average of 31 days for an appointment. That’s up 19% from 2022 and 48% from 2004, when the survey began.
The averages hide sharper problems in the specialties that drive revenue. OB-GYN waits averaged 42 days. Gastroenterology, 40. Dermatology, 36.5. Cardiology, 33. In Boston, the average across specialties reached 65 days.
Those are the markets with the highest concentration of physicians. For a health system, every one of those days is exposure. A patient who searched for you, clicked on you and called you can still end up with a competitor, an urgent care or nobody at all.
Two variables, four conditions
We built the Growth Engine Diagnostic around a simple idea: growth depends on two things working together, and most organizations only look at one of them.
The first is consumer demand: search volume for your services, campaign response, referral requests and inbound calls. The second is access capacity: appointment availability, call center performance, referral management and scheduling efficiency. Put demand on one axis and access on the other and every service line lands in one of four conditions.
Peak Performance (high demand, high access). The engine works as designed. Demand turns into referrals, appointments and visits. The job here is to protect capacity in the specialties carrying the load and to copy what’s working into other service lines.
Overheating (high demand, low access). Demand is strong but the system can’t convert it. You see long waits, high call abandonment and referrals that never become visits. This is one of the most common conditions in healthcare growth systems and one of the most expensive, because it looks like success on the marketing dashboard. Adding spend here makes things worse. You pay more to create demand that leaks out.
Idling (low demand, high access). Capacity is sitting open and the market doesn’t know it. Appointment slots go unfilled and referral flow is thin. This is where marketing dollars earn the most, aimed at the specific specialties with room to grow.
Engine Stall (low demand, low access). Both sides need work. No single fix will move it. It calls for a reset across positioning, physician referral development and scheduling operations, planned together.
The point of view
The four quadrants matter less than the decision they force. Before the next budget cycle, every growth leader should be able to answer one question for each priority service line: is our constraint demand, access, or both?
The answer changes where the money goes. An Overheating service line needs capacity and conversion work, not a bigger media plan. An Idling one needs exactly that media plan. Treat them the same and you waste money on one and underfund the other.
It also changes who sits at the table. A CMO who owns only demand is managing half the engine. The systems pulling ahead are the ones where marketing, physician relations and access operations work from the same map and the same numbers. That’s often a harder conversation inside the organization than any campaign. It’s also where the growth is.
The statistician W. Edwards Deming put it plainly: “A bad system will beat a good person every time.” Most healthcare marketing teams are good. The question is whether the system around them lets their work turn into visits.
Find your quadrant
The one-page Growth Engine Diagnostic walks through the indicators for each condition and the focus areas that follow. If you’d rather work through it with us, we run a 30-minute Growth Engine Diagnostic on a single service line. You leave knowing where demand is leaking and what to fix first.
Marketing creates demand. Referrals move patients. Access determines growth.
