MMS Study Confirms Continuing Physician Shortages in Primary Care, Psychiatry, Six Other Specialties

WALTHAM, Mass. — Massachusetts continues to experience physician shortages in primary care, psychiatry, and six other specialties that are adversely affecting patient access to care, according to the latest physician workforce study released today by the Massachusetts Medical Society, the statewide organization of physicians.

The society’s 2007 Physician Workforce Study found physician shortages in primary care (family practice and internal medicine), psychiatry, and vascular surgery for the second consecutive year. Anesthesiology, cardiology, gastroenterology, and neurosurgery remain in short supply, while urology appears on the list for the first time.

In public opinion surveys conducted as part of the workforce study, the MMS also found that access to primary care physicians, as well as some specialists, remains strained and waiting times for appointments are increasing. Study results also showed a steep drop in the percentage of internists who are accepting Medicaid.

“Massachusetts may be leading the nation in health care reform,” said Dr. B. Dale Magee, president of the MMS, “but we’re falling behind in a critical aspect of patient care, and that’s the supply of physicians. With an aging population, health care reform, and soaring rates of obesity and chronic diseases such as diabetes, hypertension, and arthritis, real questions are surfacing about whether enough physicians will be available in Massachusetts to handle the increased demand for health care services. Adequate physician supply is essential to the success of health care reform, and our latest analysis raises a host of concerns.”

The study also pointed out that the state faces a problem of “disproportionate supply” of physicians in urban versus rural areas.

Shortages in internal medicine, family practice, and psychiatry are consistent with growing shortages in those specialties nationwide. The medical society’s study found that the most critical scarcity facing community hospitals is primary care physicians: 54{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of community hospitals report shortages in internal medicine, and 43{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} report shortages in family practice.

MMS officials say the findings on primary care physicians are disturbing and should be a cause for concern as the state implements universal coverage and thousands more citizens seek primary care doctors. The findings also support consistent warnings about a primary care crisis from the American College of Physicians and the American Academy of Family Physicians.

The shortage of psychiatrists also mirrors a nationwide condition, especially acute with child psychiatrists, and also raises concerns as more patients — children, families, and returning veterans — seek mental health services.

According to MMS officials, the continuing stress on the physician workforce results in part from a deteriorating practice environment in the Commonwealth. The society’s Physician Practice Environment Index, a statistical indicator of nine selected factors that shape the overall environment in which physicians provide patient care in Massachusetts, has fallen for 13 consecutive years. The index takes into account such factors as physicians’ cost of doing business, median physician income, and professional liability costs.

Seven of 14 physician specialties studied by the society have been listed as in severe or critical shortage for at least four of the six years of studies: anesthesiology, cardiology, gastroenterology, general surgery, neurosurgery, orthopedics, and radiology. Urology was examined for the first time in the 2007 study.

A recurring theme throughout the six years of the society’s studies is increasing difficulty in recruitment and retention of physicians. Both continue to be major obstacles in overcoming physician shortages in the Commonwealth.

Data from the 2007 study show that recruitment has become more difficult for 68{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of teaching hospitals, 83{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of community hospitals, and 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of practicing physicians. Such difficulties are reflected in the long times to recruit physicians. The average time to recruit a physician is more than 13 months, but extends even longer for selected specialties. Physician recruitment times are consistently the longest for neurosurgeons (26.3 months), orthopedists (22), urologists (21.7), vascular surgeons (19.3), gastroenterologists (17.9), and general surgeons (17.4).

The specialty of neurosurgery, critical to emergency and trauma departments, continues to be under extraordinary stress in the physician labor market. Not only is the time to recruit by far the longest of any specialty, but neurosurgeons are increasingly affected by other factors: 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of neurosurgeons responding to the survey said that their professional liability (medical malpractice) costs are greater than 15{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of their total operating costs, and 63{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} said they have altered or limited their scope of practice because of the fear of being sued. It is also one of only two specialties (along with anesthesiology) that has been categorized as in critical or severe shortage in all six years of the society’s workforce studies.

The 2007 study again found that professional liability continues to have a large impact and influence on the practice of medicine. High costs for medical malpractice insurance negatively affect the state’s competitive position to recruit and retain physicians. Since 1992, liability insurance rates have increased 127{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in Massachusetts, slightly less than the 138{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} for the nation. The fear of being sued is also affecting patient access to care: 48{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of practicing physicians responded that they have altered or limited their services because of such fears.

The 2007 study also looked at physician workforce issues across five regions in Massachusetts: Boston metropolitan area; New Bedford/Fall River/Barnstable County (Cape Cod); Pittsfield (Berkshire County); Springfield; and Worcester.

Two major findings from the regional data indicate that a large percentage of physicians (37{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 54{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) expressed dissatisfaction with the current practice environment in the state, and that physician shortages have seriously impacted patient care. Close to one-third of physicians have altered services or adjusted staff to address patient demands.

In other regional findings of note, no less than 61{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of physicians surveyed in any of the five regions said they are experiencing difficulties filling physician vacancies, and in the four regions outside of Boston, 66{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 87{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of physicians surveyed said the pool of applicants is inadequate to fill vacancies. In the Pittsfield region, 87{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of physician respondents report that the pool of applicants is inadequate to fill vacancies — a finding that has appeared in all previous workforce studies, and one that underscores the disparity in supply between urban and rural areas.

The study’s two public opinion polls (one of physicians’ offices and one of Massachusetts residents) revealed that access to primary care physicians remains difficult, as are referrals to specialists, and people with lower incomes and without insurance experience more difficulty accessing care.

While survey results indicated that 65{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of residents are ‘very satisfied’ with their care (a jump of 9{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} from the previous year) and 26{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} are ‘somewhat satisfied,’ problems with access to care increased. Less than half (42{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) of respondents who made an appointment to see a primary care physician could be seen within a week, a drop of 11{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} from the previous two years. The same trend was reported with appointments to specialists. The most commonly cited reason (23{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of respondents, a rise of 13{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} from the previous year) for delays in appointments was ‘overcrowded doctors’ offices.’

Also, the study showed a steep drop in the percentage of internists who report accepting Medicaid: only 59{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} now report accepting Medicaid, down from 73{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2006 and 79{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2005.