A Shallow Pool Physician Recruitment Poses Challenges In Greater Springfield And Across State
Medical schools across Massachusetts produce thousands of physicians each year. The challenge is persuading them to work in the state — and in Western Mass. in particular.
For the second straight year, the physician labor market in the Greater Springfield area is significantly tighter than in most other urban regions in Massachusetts, according to the 2004 Physician Workforce Study conducted by the Mass. Medical Society (MMS).
That reality poses significant challenges to the recruitment efforts of hospitals, physician groups, and other health care institutions.
The disparity is not insignificant. “In both the 2003 and 2004 surveys, the inadequacy of the labor pool and the degree of difficulty in recruiting in the Springfield metro area was 7{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} more severe than for the sample as a whole,” the recently released MMS report states.
The responses to survey questions concerning recruitment time and the ability to retain physicians followed an inconsistent pattern across the five urban areas — which also include the regions around Boston, Worcester, Pittsfield, and New Bedford — but the study uncovered nearly unanimous agreement across all five urban areas that physician retention has become more difficult in the past year.
“We continue to get solid confirmation of what is one of the most striking characteristics of our physician labor force — that, despite our world-renowned reputation for medical care, Massachusetts remains a difficult place for physicians,” said Thomas E. Sullivan, M.D., president of MMS, which represents some 18,000 physicians, medical residents, and students across the Commonwealth.
And in Greater Springfield, home of several hospitals — including Baystate Medical Center, Mercy Medical Center, Holyoke Medical Center, and Noble Hospital the situation is especially dire.
Lagging Behind
When asked whether the current pool of physician applicants is sufficient to fill vacant positions or expand practices, 24{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of respondents in Greater Springfield said the pool is adequate, while 76{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} said it is not — the same numbers as last year, and continuing to trail the rest of the state.
In Greater Pittsfield, however — home to Berkshire Medical Center and North Adams Regional Hospital — 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} percent said the pool is adequate, a 4{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} increase from 2003, and just 1{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} below the state average. In Greater Worcester, 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} reported an adequate recruiting pool, and the number was a healthy 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in the Boston metropolitan area. But in the region encompassing New Bedford and Fall River, the numbers plunged from 32{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2003 to 19{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} today.
When asked whether their facility or practice is having trouble filling vacancies, 75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of Greater Springfield respondents said they are, a 2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} drop from 2003. In Pittsfield, 65{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} said they are having such difficulties, a 3{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} decrease from last year.
Those numbers closely follow the pattern of the first question, but not all regions reflected such correspondence between the two questions. In Boston, for instance, only 52{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of respondents said they are having trouble filling positions, a 14{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} decrease from 2003 and a full eight points lower than the percentage of respondents who called the applicant pool “insufficient.”
Dr. James Fanale, chief medical officer and chief operating officer at Mercy Medical Center, said the Springfield area faces a uniquely competitive situation in that doctors choose the region for its quality of life, but they have the option of finding employment around Hartford or Albany as well, realizing similar quality of life and higher reimbursement rates from public and private payers. Massachusetts’ low rates, on the other hand, have become a barrier to recruitment.
“The difference in jobs might not be that great, so why wouldn’t you go to Hartford?” Fanale said. “The math isn’t always that simple, but it’s getting simpler.”
Clearly, recruitment problems affect the entire state, not only Western Mass. Among all respondents, 93{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of community hospitals, 65{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of practicing physicians, and 59{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of teaching hospitals say they have difficulty filling physician vacancies.
And recruiting times have increased to an average of 13 months, with four specialties experiencing much longer periods: neurosurgery (30 months), vascular surgery (20 months), gastroenterology (20 months), and orthopedics (19 months). Across the state, 72{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of survey respondents say the time needed to recruit for all positions has increased over the past three years, but that figure is 83{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in Greater Springfield and 86{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in the Pittsfield region.
Using the survey results and other statistics, the MMS has declared five specialties — anesthesiology, cardiology, general surgery, orthopedics, and radiology — to be in “severe shortage,” and one, neurosurgery, has been designated to be in “critical shortage” for the second straight year.
In addition, all 14 specialties studied are deemed to be experiencing “very tight” labor markets, including radiology, anesthesiology, neurosurgery, cardiology, gastroenterology, orthopedics, general surgery, internal medicine, emergency medicine, psychiatry, vascular surgery, obstetrics/gynecology, family practice, and pediatrics.
Feeling the Strain
According to Sullivan, the stresses that physicians face in the Bay State directly affect the recruiting situation. He noted administrative hassles and inefficiencies, low reimbursements for services, the high cost of maintaining a practice, and medical liability insurance as some primary concerns — with liability costs in particular being viewed as a growing threat to the viability of some practices.
“That we can maintain this quality care and medical leadership in such an unfriendly environment is remarkable,” Sullivan said. “It speaks volumes about the strength of our physicians. But it’s also clear that our physicians are under extreme stress, and we are beginning to see its impact — on doctors, patients, and the health care system overall.”
In the MMS study, 49{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of physician respondents said that the fear of being sued has caused them to alter or limit their scope of practice, and for four specialties, the rate exceeded 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}: emergency medicine (68{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}), obstetrics/gynecology (64{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}), neurosurgery (64{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}), and orthopedics (60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}).
The percent of physicians whose liability insurance expense exceeds 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of their total operating costs jumped to 47{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} — 12 points higher than last year. In addition, Massachusetts physicians have seen three straight years of double-digit percentage increases in their average professional liability premiums.
The 2004 analysis follows the release of the annual MMS Physician Practice Environment Index, a statistical indicator of selected factors that shape the environment in which physicians provide patient care in the state. The latest index, for 2003, fell for the 10th consecutive year, to an all-time low.
Economist James Howell, Ph.D., of The Howell Group, the lead consultant for the workforce study and the environment index, sees a clear connection between both reports.
“The research is clear, solid, and continues to speak to us in no uncertain terms,” Howell said. “The physician in Massachusetts has been, is, and will be facing more challenges. Unless relief comes, such conditions create a double-edge sword. They provide the impetus for those now here to leave, and they establish obstacles that prevent others from coming here to practice.”
The MMS worries about a phenomenon dubbed “learn then leave,” as evidenced by surveys showing that only 35{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of medical residents and 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of fellows in the Commonwealth plan to pursue their medical careers here.
“We emphasize the region and lifestyle and ease of practice,” Fanale said. “That won’t always overcome the financial obstacles, but you’ve got to try — and, hopefully, the supply-and-demand equation will eventually solve itself.”