Waiting for Specialists: A Multi-Priority and Multi-Speciality Analysis.

Manageing waiting times for specialist consultations is a critical challenge for healthcare systems worldwide. This study examines how hospitals manage outpatient specialist consultations through multi-priority systems, analysing nearly a million consultations across 29 medical specialities at a major Portuguese hospital (2010-2019). Using fixed-effects models with Driscoll-Kraay standard errors, we investigate how operational factors affect waiting times for first consultations across three priority levels. Each additional day spent in triage adds 0.52 days to urgent consultation waits (p < 0.10) but 1.41 days for routine cases (p < 0.01), demonstrating how delays cascade through the system. Staffing changes primarily benefit routine consultations, reducing waiting times by 1.88 days per additional specialist (p < 0.05). Our analysis reveals sophisticated cross-priority effects: backlogs in higher-priority cases significantly increase waiting times for lower-priority consultations, with each additional high-priority case increasing normal-priority waits by 0.15 days (p < 0.001), showing how hospitals actively protect urgent access while systematically manageing delays for routine appointments. Provider-initiated cancellations disproportionately affect lower-priority cases (0.03 days, p < 0.01), whereas urgent consultations show resilience to scheduling disruptions. A 2017 policy reform reducing maximum waiting times triggered speciality-specific adaptations. Despite increased waiting times across all priority levels (p < 0.05), cardiac units implemented operational adjustments: enhanced triage efficiency (-30.88 days, p < 0.001), improved backlog management (-0.25 days, p < 0.001), and optimised capacity utilization (-0.18 days, p = 0.056). These findings show how hospitals balance clinical prioritisation with system efficiency, as speciality-specific constraints shape access outcomes. We highlight the need for targeted resource allocation and sophisticated triage systems that adapt to changing pressures while maintaining clinical priorities.