> I don't remember it being this bad in the past. Perhaps things have changed in the several years since those publications were published.

There's an analogous pattern happening in clinical trials that I suspect is related: there has been a consolidation by private equity[0].

There are several reasons for this, but the gist of it is that pharmas have moved much of the actual work of running large clinical trials to contract research orgs (CROs) and the cost of recruiting patients for trials, training staff, records keeping, and administering the trial becomes out of reach for small independent sites where clinical trials are executed. It's also more efficient on the sponsor side to interface with one large entity rather than several small entities.

I suspect that the increasing demands of technology and burden of records keeping in both clinical trials and health insurance makes it difficult for small independent sites to operate profitably. So what happens is that many small, independent offices end up joining a larger entity that can consolidate some of the "system level complexity" more efficiently. The tradeoff is that it's no longer about the doctor-patient relationship; it's about efficiency and profits.

I also suspect that part of it is that PE realizes that consolidation lets them control prices. If they can control a network of trial sites, then they have more power to negotiate rates with sponsors and CROs for each patient they sign up to the trial. The bigger the network, the greater their leverage. I think this probably also holds true for healthcare and insurance providers in general.

[0] https://www.fiercebiotech.com/cro/private-equity-invests-tri...

I live just outside a large urban area, and my wait time for a PCP is weeks if I agree to see their PA (the PCP will review all findings anyway), or days if I put myself on their cancellation list. Maybe try calling around just outside of your urban area.