Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor?

Dear Editor,

We read with sincere interest the article by Shumer et al. entitled “Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor?” (1), which explores how patients navigate the trade-off between prompt access and maintaining an ongoing relationship with their primary care physician. We are family physician researchers from Spain, and we wish to offer several reflections arising from the data presented, as well as from our context in Spanish primary care. Our comments also connect with the perspectives recently expressed by Tenajas and Miraut regarding how collaborative practice shapes continuity in chronic disease management (2).

In our clinical setting, continuity of care has traditionally been recognized as a foundational element of family medicine. Numerous studies have demonstrated how interpersonal continuity can help sustain trust, improve medication adherence, and potentially reduce hospital admissions for ambulatory care–sensitive conditions (3). Shumer et al. show that many patients are willing to wait for an appointment with their established doctor rather than obtain immediate care from a different provider, especially in situations involving mental health issues, new concerns about chronic conditions, or sensitive examinations (1). We believe these findings reinforce the notion—rooted in well-known reviews on continuity—that a stable, ongoing relationship with a primary care physician fosters a deeper level of patient-physician understanding, which in turn may contribute to better care outcomes (4). In Spain, the family physician typically cares for a defined, geographically-based patient list. This structure is designed to prioritize stability and continuity, yet organizational strains—such as rising demand, more fragmented contracts for providers, and disruptions in scheduling—can impede the very continuity our patients value. When patients experience frequent changes in their assigned physician or must resort to walk-in services within the public system, the perceived benefits of continuity described in Shumer et al. become harder to achieve.

Organizational challenges also hamper efforts to guarantee continuity of care in Spanish centers of health. While our national system aspires to preserve the continuous relationship between doctor and patient, practical difficulties remain. Complex scheduling pressures, mandatory emergency or “rapid access” slots, and significant administrative loads can prevent physicians from providing the relational and longitudinal care patients desire. In light of Shumer et al.’s results, it is worth re-examining how clinics manage demand for urgent visits. Although providing immediate attention may be necessary for certain acute presentations, it often fragments the care experience for chronic or sensitive conditions. The present study’s data, illustrating that over half of participants would rather wait three to four weeks to see their own physician for issues involving mental health or sensitive examinations, invites us to consider reorganizing timetables and triage protocols. This resonates with the point raised by Tenajas and Miraut (2), who underscore that collaborative, carefully coordinated practice is essential to reduce the fragmentation of chronic disease management. The Spanish family medicine model might incorporate more flexible yet protected appointment slots to ensure that long-term continuity is not sacrificed for the sake of same-day access.

Training new practitioners in the importance of continuity is essential for ensuring that its benefits continue to thrive in changing health systems. Shumer et al. discuss situations in which patients exhibit strong preferences for their own doctor, particularly older adults and those with chronic conditions (1). These findings mirror prior research suggesting that patients with more complex health needs often place a higher premium on an ongoing doctor-patient bond (4). In Spain, family and community medicine residency programs have begun incorporating specific modules on patient-centered care, communication skills, and continuity as part of their competencies. Nonetheless, the high turnover in certain primary care positions can undercut the training experiences of residents, who often observe the frustration of having little time to foster relationships with patients. Ensuring stable contracts and maintaining realistic patient quotas would help align day-to-day practice with the continuity ideals that Shumer et al. emphasize. Furthermore, those undertaking independent research roles in primary care—often the same physicians working part-time in health centers—should be supported in documenting how continuity affects patient outcomes so that the kind of robust data presented by Shumer et al. can be expanded within diverse populations and systems.

It is also instructive to consider the ethical and emotional implications that arise when continuity is lacking. Shumer et al. highlight patient willingness to wait for their usual physician specifically in circumstances related to mental health or personal examinations (1). We interpret this as evidence that some patients see continuity not as a dispensable convenience, but rather as an integral part of a safe, trusting environment. The importance of trust cannot be overstated: it extends beyond clinical accuracy and penetrates into a patient’s sense of autonomy, dignity, and security when discussing intimate issues. In Spain, recent research has pointed to continuity as a factor that can deepen the therapeutic alliance, enabling better detection of psychosocial problems (5). When physicians rotate frequently or are unable to ensure follow-up, patients may lose the sense of confidence that Shumer et al.’s participants associated with seeing their own doctor. Ethical guidelines in Spanish primary care often cite the patient-doctor relationship as a core principle, yet the strains on the public health system sometimes place that principle at risk. We believe the data from Shumer et al. should prompt renewed attention to organizational models that reinforce continuity for vulnerable patient groups, especially those requiring extensive psychosocial support.

Balancing continuity with accessibility remains a key challenge for health planners. The results from Shumer et al. show that a large subset of patients readily accept an alternative professional if the situation is genuinely urgent or presents simpler complaints (1). For instance, only a small percentage would wait weeks to be seen for a sore throat. This is consistent with earlier conceptual frameworks on primary care, which recognize that both accessibility and longitudinality serve important, albeit distinct, functions (6). Policies in Spain have increasingly sought to provide rapid access points—for example, urgent care centers or advanced practice nurse consultations—for minor ailments. The findings by Shumer et al. highlight the need for clearer communication around when a “quick fix” alternative is beneficial and when waiting for the usual physician is preferable. As Tenajas and Miraut note in their eLetter, establishing collaborative practice models can also help distribute responsibilities among multidisciplinary teams while safeguarding the physician-patient bond in situations requiring a higher degree of continuity (2). Nurse practitioners, social workers, and administrative staff can handle certain tasks independently, freeing up time for physicians to focus on intricate and long-term concerns. This approach could be particularly beneficial in our Spanish centers, many of which are already oriented toward teamwork and population-based care.

We also believe the arguments advanced by Shumer et al. find a natural counterpart in the perspectives offered by Spanish primary care research on patient satisfaction and care quality. Studies have shown that strong primary care systems, characterized by stable relationships and comprehensive scope of services, correlate with better health outcomes (6). Within this framework, the question of whether patients would accept convenience over continuity is not merely academic. It has practical significance for policy decisions—especially those regarding resource allocation, staffing levels, and the time physicians can devote to continuity-building activities. As reported by Barker et al., robust continuity of care is often associated with reduced hospitalizations for preventable conditions (3). This is a particularly salient consideration for national health systems facing rising costs and growing populations with complex chronic diseases. Therefore, the insights provided by Shumer et al. should be included in broader debates on sustaining efficient yet personalized care in contexts like ours.

Finally, it is valuable to tie these considerations to the recent letter from Tenajas and Miraut (2), which interprets continuity through a collaborative lens. Their discussion of teamwork in chronic disease management aligns with our daily reality in Spain, where family physicians, nurses, and administrative colleagues attempt to foster cohesion. We find that Shumer et al.’s results confirming a strong patient preference for an ongoing relationship—especially with older and sicker patients—reaffirm the principles that Tenajas and Miraut articulate regarding the shared responsibility of teams. The new data from Shumer et al. helps underscore how continuity, a hallmark of general practice in many European settings, can be maintained even in the face of surging patient volumes and a heightened demand for immediate appointments, as long as teams coordinate effectively and system leaders value interpersonal bonds as much as short wait times.

In our opinion, the study by Shumer et al. offers a detailed and methodologically sound investigation into an issue that resonates globally, including in our Spanish context. As a family physician and an independent researcher, we see the article’s findings on continuity preferences as consistent with our own experiences, where patients commonly prioritize personal connections with their physician for more sensitive or ongoing concerns. Still, the challenge remains to develop flexible systems that accommodate urgent care while preserving the core advantages of longitudinal relationships. The reflections presented here, emphasize that teamwork, careful scheduling strategies, support for continuity in residency training, and a measured approach to balancing accessibility are central to improving patient satisfaction and health outcomes in Spain, and likely beyond. We appreciate the authors’ contribution to this important conversation and hope that further comparative studies will continue to shed light on the best ways to integrate convenience and continuity within primary care.

REFERENCES

1. Shumer G, Chen D, Holkeboer J, Marshall L, Kinney D, Sen A, et al. Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor? Ann Fam Med. 2025 Mar 1;23(2):151–7.

2. Tenajas R, Miraut D. Collaborative Practice Shapes Continuity in Chronic Disease Management. Ann Fam Med. 2025 Apr;23(2):eLetter.

3. Barker I, Steventon A, Deeny SR. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. BMJ. 2017 Feb 1;356:j84.

4. Saultz JW, Lochner J. Interpersonal Continuity of Care and Care Outcomes: A Critical Review. Ann Fam Med. 2005 Mar 1;3(2):159–66.

5. Aller MB, Vargas I, Waibel S, Coderch-Lassaletta J, Sánchez-Pérez I, Llopart JR, et al. Factors associated to experienced continuity of care between primary and outpatient secondary care in the Catalan public healthcare system. Gac Sanit. 2013;27:207–13.

6. Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. Oxford University Press; 1998. 454 p.