More Bad News Physician Survey Reveals Shortages, Workplace Dissatisfaction

For physicians practicing in Massachusetts — and patients trying to access needed services — the news is not good.

The Mass. Medical Society (MMS), in its annual Physician Workforce Study, is reporting “critical and severe” physician shortages in eight specialties — including shortages of primary-care physicians, who are more in demand in the years since the Bay State enacted its landmark health-insurance law — as well as concerns from doctors over a lack of malpractice reform and innovative income models such as global payments and accountable-care organizations.

Overall, the study confirms that the state continues to struggle with recruiting and retaining physicians. Dr. Lynda Young, president of the MMS, said it reveals some new, important findings as well as persistent concerns from prior years.

“We still see severe shortages in primary care and certain specialties, difficult recruitment, a fear of litigation that affects access and availability, and dissatisfaction with a practice environment that continues to deteriorate,” she said. “The good news is that physicians, policymakers, and health officials are working to address critical concerns.”

Among the key findings from the 2011 study from the MMS:

• Eight of 18 specialties studied have been found in short supply, two fewer than last year. Employment in three of them is classified as critical: internal medicine, psychiatry, and urology.
• Internal medicine and family medicine (primary-care specialties) are experiencing severe shortages, respectively, for the sixth consecutive year, approximately mirroring the era of the insurance mandate. The Commonwealth began requiring all residents to purchase health coverage in 2006.
• Substantial percentages of physicians say they are unlikely to participate voluntarily in either global payment programs or accountable-care organizations (more on that later).
• Physician recruiting remains difficult in all five regional labor markets across the state, and as many physicians are as dissatisfied with the current practice environment in Massachusetts as are satisfied.
• The fear of being sued continues to be a substantial negative influence on the practice of medicine, causing physicians to alter or limit their practice and, in turn, affecting the availability of needed services.

Something New

The 2011 study is the society’s 10th annual look at the physician workforce in Massachusetts and includes responses from 1,071 practicing physicians. Among the topics surveyed were the labor supply of physicians by specialties, physician recruitment and retention, satisfaction with the profession and practice environment, opinions of the U.S. health care system, and the impact of professional liability concerns on the practice of medicine.

However, the data on payment-reform initiatives — how doctors feel about concepts like accountable-care organizations (ACOs) and global payments is especially notable, since it’s the first time those topics were included in the survey.

Responses showed many physicians to be hesitant to participate in either global payments or ACOs. Those terms refer to a system by which networks of providers would take on the collective responsibility to care for a certain population of patients, work together to carry out treatment plans, and be paid a flat amount to do. Any cost savings would largely be shared by the providers, but quality measures would be enforced; the system is intended to cut down on redundant or unnecessary care, but still generate the best outcomes (see related story, page 4).

Familiarity with the idea is high, with 57{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of physicians saying they are familiar with global payments. Of that group, 45{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} said they are likely to participate in a voluntary global payment system; 55{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} said they are not likely.

Meanwhile, 58{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of physicians said they are familiar with ACOs. Of this group, 59{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} said they are likely to participate in a voluntary ACO, and 41{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} said they are not likely.

“What is new in this report are the reported concerns of many physicians to participate voluntarily in a system of global payments and accountable-care organizations,” Young said.

Preliminary findings from a separate survey of physicians, conducted recently for the MMS by the Harvard School of Public Health, may provide insight into some reasons for the concerns of physicians. Only 7{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all respondents said their practice has access to computer systems to manage clinical information, and only 29{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} said their group is ready to enter into a global payment contract.

Young said the findings underscore the need for the state to move carefully toward an integrated care system.

“While the medical society believes a shift to global payments and ACOs may help in cost control,” she said, “a one-size payment model does not fit all physician practices. Any shift to a new payment system must be made deliberately and carefully, adjust for risk, be fully transparent, include proper quality measurements and data, provide sufficient resources for proper patient care, meet patient expectations, and avoid unintended consequences.”

Recurring Themes

The primary-care shortage, however, is hardly breaking news on the society’s annual survey. In addition, the MMS’ annual Patient Access to Care Study, which was released in May and surveyed wait times for new patient appointments, showed that more than half of primary-care practices are closed to new patients, and wait times for new patient appointments are long.

State Rep. Michael Finn, D-West Springfield, speaking at a recent seminar in Springfield on health-insurance reform, noted that “we don’t have enough primary-care physicians,” due partly to ongoing trends — other specialty practices simply pay more, for starters — and partly to increased demand for primary care in the wake of the insurance mandate.

In response, he said, the state is exploring options such as loan-forgiveness programs and regional-disparity payments to try to broaden the pool of medical students entering primary care.

In other survey findings:

• While most physicians (81{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) find their careers rewarding, more than half (53{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}) are dissatisfied with the division between patient care and administrative tasks. This is especially pronounced among primary-care physicians, with 63{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} expressing dissatisfaction with the tradeoff between patient care and administrative duties.
• On the liability issue, 46{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of physicians said they have altered or limited the scope of their practice because of the fear of being sued. This percentage tops one-half in nine different specialties: orthopedics (75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}), gastroenterology (71{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}), dermatology (66{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}), neurosurgery (58{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}), emergency medicine (56{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}), obstetrics-gynecology (56{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}), general surgery (52{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}), radiology (50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}), and urology (50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}).
• For the second year, physicians were asked their opinions on the best option for the U.S. health care system. While support for a single-payer system saw a 7{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} jump from last year, 59{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of physicians still prefer other options.