Primary care physicians continue to be short supply in the Bay State for the fifth year in a row, according to the 2010 workforce study released today by the Massachusetts Medical Society.
Half of primary care practices are not accepting new patients. Those patients have nearly a month-long wait on average to see a family care doctor and nearly two months for an internist. Doctor shortages are most acute in family and internal medicine but also exist in specialties like urology, dermatology, and neurology.
According to Dr. Alice Coombs, president of the Massachusetts Medical Society, the shortage of primary care doctors means patients who develop symptoms often end up in emergency rooms. “It doesn’t mean the symptoms [are an emergency],” she said. “It just means they cannot get into see their doctor in a reasonable [amount of time].”
The 2006 health care law required that all Massachusetts residents have insurance, in part to cut down on trips to emergency rooms. But Coombs said that, despite the mandate, the rate of emergency department visits has steadily increased to the tune of 2.5 to 3 percent per year.
“Nothing that’s been proposed or that’s attempted in the country for decades has done anything serious to address the primary care shortage,” said Alan Sager, professor of health policy and management at Boston University’s School of Public Health. Only one-third of American doctors are in primary care; the average in other wealthy countries is closer to half, according to Sager. “Very likely, if we had more physicians in primary care, we would be able to serve more people more adequately at lower cost,” he said.
According to Dr. Richard Dupee, governor of the Massachusetts chapter of American College of Physicians, most residents entering Boston-based training programs have already decided to go into popular specialties like cardiology or oncology because of lifestyle and income considerations. They also believe they will face fewer administrative hassles with insurers, he said. “That’s a significant change from the way things have been over the last 40 or 50 years.” the internist and geriatrician said.
Dupee, who is also the chief of geriatrics at Tufts Medical Center, sees what happens first-hand. He rotates second-year medical residents through his own primary care practice, Wellesley Medical Associates. Students love the patients and the ability to process medical records electronically, he said. But even with those pluses, he said, the residents prefer to work at General Medical Associates, the primary care clinic at Tufts, or at another Boston hospital where paychecks and hours are more predictable, especially on nights and weekends.
The Medical Society study also found significant regional disparities outside Boston. The Pittsfield/western Massachusetts, New Bedford/Barnstable, and Worcester labor markets all had critical shortages of doctors, including significant issues with recruiting and retention. As a result, community hospitals in those areas are suffering. Over the past three years, 82 percent of the heads of community facilities surveyed reported that recruitment was more difficult in 2010.
“I never would have considered that Cape Cod…would be underserved,” said Dupee. “But I have a ton of patients coming up from Cape Cod because they can’t find a doctor.” (Teaching hospitals fare better. Only about 25 percent of teaching hospital department chiefs reported problems.)
Although 43 percent of physicians surveyed said they were satisfied overall with their practices, 41 percent were not. A major reason for dissatisfaction is frustration with Medicare and private health insurance bureaucracies. About half of the doctors surveyed believe that they spend too much time on administrative tasks, up from 44 percent last year.
Lawsuits also worry doctors. Another 46 percent said they had changed or cut back in their practices because of fears about malpractice lawsuits. More than 80 percent of neurosurgeons, 74 percent of urologists, and 60 percent of gynecologists were among those who said they cut back or altered their practice because of those concerns. Sager called the malpractice system “completely broken,” comparing it to someone who’s had too much to drink at a party and falls between two chairs. He said the system “does a terrible job of identifying and weeding out dangerous doctors and it does a terrible job of fairly compensating victims of harm.”
