Editorial It’s Time To Address The Commonwealth’s Physician Shortage

The Mass. Medical Society (MMS) commissioned a study recently that revealed what those involved in health care knew already — or should have known; that the state has a physician shortage, and that this situation is now having a direct impact on patient care.

The study, released earlier this month, revealed that there are acute shortages of physicians in six medical specialties: neurosurgery, anesthesiology, radiology, gastroenterology, cardiology, and orthopedics. What’s more, the study, which involved surveys of physicians and patients, found that these shortages resulted in waits for medical services that far exceed national averages.

Indeed, the study revealed that there is a six-week wait for primary care in the Commonwealth, and average waits of 32 days for cardiology care, 44 days for gastrointestinal care, 39 days for obstetrics and gynecological care, and 18 days for orthopedic surgery. (Most physicians consider waits of more than 14 days to be a sign of a busy and burdened practice.)

Behind all these numbers is the indisputable fact that the physician shortage, which has been noted and acknowledged as a time bomb waiting to go off, is already having some dire consequences. We suggest that the MMS, the state Legislature, the Mass. Hospital Assoc., and whoever else might want to get involved, commission the proverbial blue-ribbon panel to find a way to stem this tide.

Such a body should start work soon, because there are a number of problems contributing to the shortage of physicians, and none of them come with easy answers.

At the root of the problem is the cost of doing business in the Commonwealth, and this is a matter that includes everything from the price of malpractice insurance to the price of real estate, especially in the Boston area. Other factors include reimbursement rates — this time, below national averages — paid by both public and private payers.

Bay State physicians are not alone in facing these problems. Malpractice rate have skyrocketed in many states, and reimbursement rates are inadequate in several regions. But the conditions here are trending in the wrong direction, to the point where many recent medical school graduates do not consider Massachusetts, while some with established practices are actively searching for greener pastures.

The MMS study adds some teeth, quantitatively and qualitatively, to the argument that the shortages are leading to physician burnout and those aforementioned long waits for medical care. In fact, the patient poll, conducted by Opinion Dynamics, found that 15{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the 400 Massachusetts patients surveyed found it “extremely difficult” to obtain medical care, more than double the figure from a similar poll taken only two years ago. Cost and difficulty getting an appointment were the two most commonly cited factors that led to that assessment.

The problem seems to be even more acute in suburban and rural areas. In Hampshire County, for example, which includes Amherst and Northampton, the average wait for gastroenterology service was 92 days, according to the survey, or more than six times the preferred wait time.

Even more troubling that those statistics are comments from physicians, which indicate that the shortage is having a direct impact on quality of care administered when people can receive services. One Lowell-based radiologist told the poll takers that the shortage of physicians in that specialty puts additional pressure on those providing care, in this case, the scrutinizing of MRIs and CAT scans for signs of disease.

“The push is to read them faster and get them done quicker,” he said, “and that may lead to more misses of disease markers.”

What the MMS study ultimately reveals is the Commonwealth is experiencing a very dangerous cycle. As shortages of physicians become more acute, those left to handle the workload are put under more stress and strain. Couple this phenomenon with the high cost of doing business in the Bay State, and it’s easy to see why more physicians are looking elsewhere. And as they leave for other parts of the country, those who remain are placed under even more stress.

The challenge for the Commonwealth is to somehow break this cycle before it spins out of control. As we said, the problems don’t come with quick or easy solutions — starting with the price of real estate. But a focused effort to address all the factors leading to the current crisis (yes, we can call it that) needs to be launched.

That’s because this situation won’t fix itself, and the many costs associated with a physician shortage can now be clearly seen.