Norma Crenshaw was running a fever and feeling sick to her stomach. She called her doctor but was told she'd have to wait a few days to be seen.

Crenshaw had little patience – and told her doctor's office that, appointment or not, she was on her way.

It wasn't the first time the south Sacramento woman muscled her way in for a doctor's visit. "A few days is too late if you're sick," Crenshaw said.

Who could blame her?

The average waiting time to see a general practitioner is 20 days in some of the country's largest cities, according to a recent national survey. The study suggests that long wait times reflect symptoms of the country's ailing health care system.

California is about to become the first state in the nation to impose so-called timely access rules on health maintenance organizations, or HMOs, and other care providers. The new rules also could force a culture change in customer service for an industry critics say is in sore need of an overhaul.

The regulations themselves – which dictate the maximum time a person must wait to see a doctor, depending on the illness and the doctor's specialty – will hardly be enacted in a timely manner. They arrive after seven years of debates among quarreling factions.

As the California Department of Managed Health Care sprints toward enacting the rules by year's end, some in the health care industry fret over the approaching deadline.

Consumer advocates, however, want no further delays, using an oft-heard mantra: Treatment delayed is treatment denied.

"We should no longer be debating the wisdom of timely access," said Anthony Wright, executive director of Health Access California, a Sacramento-based advocacy group.

Wright's group won passage of legislation in 2002 requiring state regulators to draft timely access rules for HMOs, which provide coverage for 21 million Californians. The standards were to be implemented by 2004 but were bogged down by delays and intense scrutiny from doctors, health plans and consumer groups.

Last year, draft regulations were thrown out by the Office of Administrative Law. It said the public hearings didn't comply with state guidelines.

"It's been long enough, and consumers deserve to have these rules out," said Lynn Randolph, the spokeswoman for the managed health care department.

Merritt Hawkins and Associates, a Texas-based market research firm, surveyed family practice physicians and specialists in 15 metropolitan areas from September to March – 1,162 medical offices in all.

On average, the survey found it took 20 days for a family physician to see a patient requesting a physical. Among cardiologists, the average wait time nationally was about 16 days; for a dermatologist, 22; and for an obstetrician-gynecologist, 28. An orthopedic surgeon was available in 17 days.

The wait can sometimes be unbearable. Ernest Hesseltine, 35, of Dixon says he nearly lost his job because of the months of delays to repair his arthritic knee.

"I kept calling and calling, and I was told that I just had to wait until the doctor had an appointment," said Hesseltine, who complained to state regulators about delays at Kaiser Permanente in Vallejo.

His complaint was among the 625 received in the past three years by the Department of Managed Health Care.

"Because of my knee, I couldn't drive my truck. It was too painful to push the clutch," said Hesseltine. He finally had surgery last June, six months after being told he needed an operation, and is back at work after a six-month recovery.

Kaiser would not comment specifically about Hesseltine because of privacy rules. But a spokeswoman said the company has measures in place to improve timely access, including same-day appointments for urgent cases and a host of electronic services giving patients quick access to doctors.

On the surface, the issue could be diagnosed as a problem of supply and demand: There are not enough doctors to treat the sick and injured. But most acknowledge the matter is more complicated.

Call The Bee's Bobby Caina Calvan, (916) 321-1067.