The Doctor Is Not In

Medical Society Study Shows Continued Primary Care Shortages

The Mass. Medical Society recently released its annual Physician Workforce Study, showing a fifth consecutive year of shortages of primary care physicians, half of primary care practices closed to new patients, shortages in 10 of 18 physician specialties across the state, and community hospitals continuing to be the most affected by persistent physician shortages.
The 2010 study is the society’s ninth annual look at multiple aspects of the physician workforce, and builds on the previous eight years of data. The study surveys teaching hospitals, community hospitals, practicing physicians, medical directors of medical groups, and resident and fellow programs throughout the state. It is the most comprehensive examination of the physician workforce in the state done on an annual basis.
The report’s key findings include:   
• The primary care specialties of family medicine and internal medicine are in critically short supply, the fifth consecutive year of shortages for these specialties;
• Ten of 18 specialties studied have been found in short supply, three more than last year;
• High percentages of primary care practices are closed to new patients: 54% of family medicine physicians and 49% of internal medicine physicians are not accepting new patients;
• Wait times for new patients for primary care continue to be long, with an average wait time of 29 days for family physicians and 53 days for internists;
• With the exception of Boston, physician shortages exist in all regional labor markets across the state;
• Community hospitals continue to be the most seriously affected by the physician shortages, with difficulty filling vacancies and retaining physicians, resulting in the need to alter services and change staffing patterns; and
• The fear of being sued remains a substantial negative influence on the practice of medicine, affecting access to and availability of physician services.
“The findings from this latest analysis,” said Dr. Alice Coombs, president of the Mass. Medical Society, “clearly show how fragile access to care for patients is across the entire Commonwealth.
“The state’s universal health care plan has improved access to care,” she continued, “but universal coverage and access can only be sustained with a strong physician workforce. As we continue to look at reforming the health care system, we must do so carefully and deliberately in all aspects, and that includes the next steps for cost control, particularly with respect to establishing a fair system of payment reform.
“A strong physician workforce is critical to delivering top-quality and cost-effective care,” Coombs went on. “If physicians think that the viability of their practices is threatened or unsustainable under a new payment system, Massachusetts may encounter further problems with recruitment and retention. And that, certainly, will affect patient care.”
Coombs said the physician workforce in Massachusetts continues to be affected by a lingering poor practice environment in the state. The Society’s Physician Practice Environment Index, a statistical indicator of nine factors that shape the environment in which physicians provide patient care, dropped 0.8% in 2009, and has fallen in 16 of the past 18 years. Since 1992, the Massachusetts Index has declined by 26.4%, significantly more than the 21.3% decline in the comparable national index. The index takes into account such factors as the cost of maintaining a practice, median physician income, liability insurance rates, and hours spent on patient care.
Here are some details on the report’s key findings: 
 
Specialties Classified in Short Supply
The medical society’s 2010 analysis found 10 of 18 specialties studied in short supply: dermatology, emergency medicine, family medicine, general surgery, internal medicine, neurology, orthopedics, psychiatry, urology, and vascular surgery.
Over the last three years (2008-10), six specialties have been operating within tight labor market conditions in each of those years: family medicine, internal medicine, vascular surgery, urology, dermatology, and neurology.
A trend analysis over a five-year period (2006-10) shows that 11 specialties have been in short supply in at least three of those five years: family medicine, internal medicine, vascular surgery, urology, dermatology, neurology, psychiatry, general surgery, orthopedics, emergency medicine, and neurosurgery.
  

Primary Care Practices Closed to New Patients; Long Waits
The primary care specialties of internal medicine and family medicine continue to be under intense pressure following the establishment in 2006 of the state’s health care reform law, which resulted in some 440,000 residents being added to the insurance rolls.
A survey of physician practices showed that approximately half of primary care physicians are not accepting new patients. The percentage of family medicine physicians who are not accepting new patients has increased from 30% in 2007 to 54% in 2010 — the highest it has been in four years. The percentage of internal medicine physicians no longer accepting new patients decreased slightly from the previous year to 49% in 2010 — the same level it was in 2007.
Meanwhile, long wait times for appointments for new patients continue. For internal medicine, the average wait time increased to 53 days, nine days longer than last year’s figure of 44 days and the highest it has been in six years. For family medicine, the average wait time is 29 days, 15 days shorter than last year’s figure of 44 days.

Shortages Across the State
A regional analysis of the 18 specialties for the five metropolitan statistical areas in the state (Boston, Worcester, Springfield, New Bedford/Barnstable, and Pittsfield/Western Mass.) found that, with the exception of Boston, all regional labor markets were experiencing shortages of physicians. Critical shortages exist in Pittsfield/Western Mass. and Worcester.
In an analysis of the 18 specialties examined by the study, the percentage of practicing physicians in the four labor markets of New Bedford/Barnstable, Pittsfield/Western Mass., Springfield, and Worcester who responded that they were dealing with an inadequate pool of physicians, had difficulty in filling vacancies, needed to alter services, and needed to adjust staffing exceeded the percentage of physicians in the Boston market by at least nine percentage points.
In the four labor markets outside of Boston, more than two-thirds of the practicing physicians said there was an inadequate pool of physicians for recruiting. This characteristic was especially acute in New Bedford/Barnstable and Pittsfield/ Western Mass., where more than eight out of 10 said the pool was inadequate.

Community Hospitals Are Most Affected By Shortages
Community hospitals continue to be the most affected by the consequences of physician shortages. All (100%) of the medical-staff presidents of community hospitals reported they are experiencing difficulty filling vacancies, and 82% reported that the amount of time to recruit a physician has risen, an increase of 5% over the average of the previous eight years of the studies.
Community hospitals are also reporting the most difficulty with retaining physicians, with 64% saying retention has become harder over the past three years. However, this is an improvement from the average of the previous seven-year period, when 79% reported difficulty in retaining physicians.
Additionally, 64% of community hospitals reported that physician shortages required them to alter the services they provide, a substantial increase from 43% in last year’s study. Meanwhile, 82% of medical-staff presidents responded that physician-supply problems required adjustments in their staffing patterns, a large increase from 64% last year and the average ratio of 56% for the years 2003-09.

Professional Liability Hinders Practice of Medicine
The 2010 study once again found that medical malpractice concerns and the fear of being sued continue to have a substantial negative influence on physicians and the practice of medicine. This finding is consistent with the society’s previous workforce studies and its first-of-a-kind Investigation of Defensive Medicine in Massachusetts, released in November 2008, which showed that the fear of being sued is a serious burden on health care. Findings from the 2010 Workforce Study:
• A full 46% of practicing physicians surveyed said their practice has been altered or limited because of the fear of being sued, the same percentage as last year; and
• More than half of physicians in five specialties said they have altered or limited their practice because of the fear of being sued: neurosurgery (82%); urology (74%); emergency medicine (70%); orthopedics (70%); and obstetrics/gynecology (60%). Also, 40% or more of physicians in nine other specialties have changed their practice for the same reason: cardiology, neurology, gastroenterology, general surgery, dermatology, psychiatry, radiology, internal medicine, and family medicine.

Additional Findings
For the first time, more physicians (43%) expressed satisfaction with the practice environment than not (41%).
However, more physicians expressed displeasure with the tradeoff between patient care and administrative tasks. More than half (51%, up from 44% last year) of all practicing physicians regardless of specialty expressed displeasure with the abundance of administrative measures. Among primary care physicians, 59% expressed displeasure.