I think it is because setting up and getting to them are so much more difficult than local clinic appointments, even here where we have so few local doctors available that it can take up to 12 weeks to get an appointment.
Setting up out of town or out of province appointments sometimes has to begin months in advance and it is up to you to do your own legwork so that you know what questions to ask, what pre-appointment lab tests to set up and how to prepare for them and how far in advance before the specialist appointment they have to be done and is your province medical system going to pay for any of this....how to connect the various doctors at the various clinics through fax numbers.....getting all the necessary paper work for labs and for specialists and on and on and on it goes. Then once everything is set up for the appointment you struggle for the next however long with a niggling concern that at the last minute you will get a phone call from the office of the doctor you are seeing to tell you your appointment has been changed.
Assuming that all is well for the expected appointment date, you also have to make sure that work issues, lawn mowing and maybe bird feeing are covered at home while you are gone. Depending on the distances involved you may need to also book accommodation well in advance, decide how much you can afford to spend on meals for an overnight, or 2 night stay away, as well as figure out how you are going to afford the gasoline or the bus ticket to get there and back. Often friends and relatives have to be told that, while you will be in their area and it has been X number of months or years since you have seen them, sadly there will be no time to get together with them due to the nature of your visit in their town or city. (I have learned the hard way that no matter how small or large the geographic location you are going to for medical appointments is, if you don't tell everyone you know there that you will be there but have no time to visit anyone, you WILL be spotted while you are there and then the fur will fly. Trying to explain to people after the fact that you were in their town, yes you were, but had no time to visit them or anyone else, no you really didn't, means that now you are a hateful, friendship betraying liar who is reneging on your relationship with them.....o yes you are!!)
At the appointment you have to be sure you have a written list of questions, possible questions, impossible questions in order to cover all the bases before you leave. Once you have headed out on the highway back home it is too late to ask any more questions or get any more assistance without beginning the entire "out of town/province" medical appointment cycle all over again.
All of the above for an appointment with some kind of specialist or lab technicion that lasts on average between 3 and 20 minutes.
Yup, I just went through the entire out of province medical appointment joy again. It is going to take me a couple of days to recover from the past 6 months of preparation for it.
At least my appointment lasted the full 20 minutes! Hallelujah!